The Ethical Dilemma of Truth-Telling in Healthcare in China

"I feel like I'm walking on eggshells": a qualitative study of moral distress among Chinese emergency doctors

BACKGROUND

While the number of emergency patients worldwide continues to increase, emergency doctors often face moral distress. It hampers the overall efficiency of the emergency department, even leading to a reduction in human resources.

AIM

This study explored the experience of moral distress among emergency department doctors and analyzed the causes of its occurrence and the strategies for addressing it.

METHOD

Purposive and snowball sampling strategies were used in this study. Data were collected through in-depth, semi-structured interviews with 10 doctors working in the emergency department of a tertiary general hospital in southwest China. The interview data underwent processing using the Nvivo 14 software. The data analysis was guided by Colaizzi's phenomenological analysis method.

STUDY FINDINGS

This study yielded five themes: (1) imbalance between Limited Medical Resources and High-Quality Treatment Needs; (2) Ineffective Communication with Patients; (3) Rescuing Patients With no prospect of treatment; (4) Challenges in Sustaining Optimal Treatment Measures; and (5) Strategies for Addressing Moral Distress.

CONCLUSION

The moral distress faced by emergency doctors stems from various aspects. Clinical management and policymakers can alleviate this distress by enhancing the dissemination of emergency medical knowledge to the general public, improving the social and economic support systems, and strengthening multidisciplinary collaboration and doctors' communication skills.

Chinese and Belgian pediatricians' perspectives toward pediatric palliative care: an online survey

BACKGROUND

As pediatricians play a vital role in pediatric palliative care (PPC), understanding their perspectives toward PPC is important. PPC is established for a long time in Belgium, but has a shorter tradition in China, although it is growing in the last decade. Sampling and comparing the perspectives of these pediatricians could be insightful for both countries. Therefore, we sampled and compared perspectives of pediatricians in China and Belgium toward PPC, and explored factors influencing their perspectives.

METHODS

We conducted a cross-sectional online survey using the validated Pediatric Palliative Care Attitude Scale (PPCAS). Over a five-month period, we recruited pediatricians practicing in China (C) and Flanders (F), Belgium. Convenience sampling and snowballing were used. We analyzed data with descriptive statistics, and evaluated group differences with univariate, multivariate and correlation tests.

RESULTS

440 complete surveys were analyzed (F: 115; C: 325). Pediatricians in both regions had limited PPC experience (F: 2.92 ± 0.94; C: 2.76 ± 0.92). Compared to Flemish pediatricians, Chinese pediatricians perceived receiving less unit support (F: 3.42 ± 0.86; C: 2.80 ± 0.89); perceived PPC less important (F: 4.70 ± 0.79; C: 4.18 ± 0.94); and faced more personal obstacles while practicing PPC (F: 3.50 ± 0.76; C: 2.25 ± 0.58). Also, select socio-demographic characteristics (e.g., experiences caring for children with life-threatening condition and providing PPC) influenced pediatricians' perspectives. Correlational analyses revealed that pediatricians' PPC experiences significantly correlated with perceived unit support (ρF = 0.454; ρC=0.661).

CONCLUSIONS

Chinese pediatricians faced more barriers in practicing PPC. Expanding PPC experiences can influence pediatricians' perspectives positively, which may be beneficial for the child and their family.

Family roles in informed consent from the perspective of young Chinese doctors: a questionnaire study

BACKGROUND

Based on the principle of informed consent, doctors are required to fully inform patients and respect their medical decisions. In China, however, family members usually play a special role in the patient's informed consent, which creates a unique "doctor-family-patient" model of the physician-patient relationship. Our study targets young doctors to investigate the ethical dilemmas they may encounter in such a model, as well as their attitudes to the family roles in informed consent.

METHODS

A questionnaire was developed including general demographic characteristics, the fulfillment of the obligation to fully inform, who will be informed, and the ethical dilemmas in decision-making. We recruited a total of 421 doctors to complete this questionnaire, of which 368 met the age requirements for this study. Cross tabulation and Pearson's chi-squared test were used to analyze the differences between types of patients for categorical variables, and a p-value < 0.05 was considered statistically significant.

RESULTS

Our data shows that only 20 doctors (5.40%) stated "informing the patient alone is sufficient" when it comes to informing patients of their serious conditions. The rest of the participants would ensure that the family was informed. When facing elderly patients with decision-making capacity, the data was statistically different (3.8%; P < 0.001) The primary reason for ensuring that family members be informed differs among the participants. In addition, when family members asked doctors to conceal the patient's medical condition for the best interests of patients, 270 doctors (73.4%) would agree and cooperate with the family. A similar proportion (79.6%) would do so when it comes to elderly patients.

CONCLUSIONS

(1) Chinese doctors pay extra attention to informing the patient's family, which may not be in the patient's best interests. (2) Chinese doctors treat adult (but not elderly) patients and elderly patients differently when it comes to informing family members. (3) When family members request that doctors withhold information from patients "in the best interest of the patient," the majority choose to comply with the request, although this may cause them distress.

Good death from cancer-the patient view: systematic review of qualitative studies

BACKGROUND AND OBJECTIVE

An in-depth understanding of what constitutes a good death among patients with cancer is vital to providing patient-centred palliative care. This review aimed to synthesise evidence on the perceptions of a good death among patients with cancer.

METHODS

This systematic review involved a synthesis of qualitative data. A three-step process suggested by the Joanna Briggs Institute was used to synthesise the data.

RESULTS

A total of 1432 records were identified, and five articles met the inclusion criteria. Seven synthesised findings emerged: (1) being aware of cancer, (2) pain and symptom management, (3) dying well, (4) being remembered after death, (5) individual perspectives of a good death, (6) individual behaviours leading to a good death, and (7) culture and religions. A structural framework was developed to elicit two layers that could be regarded as determinants of a good death. One layer suggested how multiple external issues impact a good death, whereas the other layer involves patients' internal attributes that shape their experiences of a good death. The elements in the two layers were inter-related to exert a crossover effect on good death in specific cultural and religious contexts.

CONCLUSION

A good death is a process initiated from the time of awareness of cancer and extends beyond demise. Holistic approaches encompassing the management of physical and psychological distress along with psychosocial behavioural interventions to enhance patients' positive perspectives and behaviours are recommended to improve their quality of life and death.

Awareness and Perceptions of Palliative Care Among the Elderly: A Qualitative Study

Objectives: With the rapidly aging population worldwide, the demand for palliative care is increasing. Palliative care publicity and education must be further developed globally, especially for the elderly. It is essential to perform targeted promotion by understanding the awareness and needs of palliative care of the elderly. This study aimed to investigate elderly people's awareness of palliative care and their own views on and needs for palliative care, which could provide a basis for the popularization of palliative care among them. Methods: A total of 20 elderly people were recruited to participate in the semi-structured, and in-depth interviews. Participants were from communities and nursing homes in Chongqing, China. The interview transcripts were coded using the method of thematic analysis. Results: Finally, 4 themes and 10 subthemes were identified, that is: unawareness of the concept of palliative care (never heard of palliative care, confusion between euthanasia and palliative care), motivations for accepting palliative care (personal perspective: less suffering; family perspective: relieving the burden), factors influencing palliative care decision (cost of palliative care, knowledge of palliative care, opinion of decision-making agents), and necessity and preferences for publicizing palliative care (eagerness to know more about palliative care, focusing on policy and charges, preference for Electronic Media Advertising). Conclusions: Palliative care publicity among the elderly is important and necessary. Findings in this study could provide some insights into how to popularize palliative care among the elderly. Considering the preference of the elderly for access to palliative care information, simultaneous publicity through TV and online channels is suggested. Since the elderly would like to choose their doctors and adult children as decision-making agents, more communication between community, health professionals and family is advocated.

Ethical Decision-making of Health Professionals Caring for People Living with HIV/AIDS in Hunan, China: A Qualitative Study

Numerous ethical issues surged the moment acquired immunodeficiency syndrome (AIDS) was discovered. As advocates of people living with HIV/AIDS (PLWHA), health professionals encounter many ethical dilemmas in clinical practice. However, it remains unclear how health professionals solve these issues. The descriptive qualitative research was conducted through semi-structured interviews with 22 health professionals from May to August 2018. Three themes emerged from data analyses of the interviews: (1) real ethical dilemma experienced by health professionals, (2) factors influencing ethical judgment, (3) ethical motivations. About two-thirds of participants failed to recall ethical dilemmas experienced in their clinical practice. Emotions, gender, occupation, and difficulty balancing different roles may influence the ethical judgments of health professionals. In the ethical decision-making (EDM) process, most participants took other people’s interests into consideration and conformed to law and professional codes of conduct. However, the fear of medical disputes (conflicts with families and others) was experienced by many participants, influencing their ethical behaviors.

Who breaks bad news: Doctors, family caregivers or cancer patients? A qualitative study in Southern China

This qualitative study was conducted among the family caregivers of cancer patients treated in a hospital in Shenzhen, southern China, to elucidate the truth-telling process. Thirteen participants were recruited, and the data were thematically analyzed. The five major themes are as follows: Who discloses the truth to cancer patients? How do patients react to being informed of their true condition? What happens to cancer patients after they learn the truth? What are the impacts of family relationships and Chinese culture on truth telling? How do cancer patients behave after learning the truth?

Inpatient Dignity Scale: Mandarin translation and psychometric characteristics evaluation

Aim

The aim of this paper was to translate the English version of the Inpatient Dignity Scale into Mandarin and to test the psychometric properties of the Mandarin version of the Inpatient Dignity Scale.

Design

This research is a cross‐sectional survey, using convenience sampling.

Methods

The English version of the Inpatient Dignity Scale was translated into Mandarin Chinese. From June–August 2020, 736 inpatients from 50 tertiary hospitals in Guangzhou were recruited to assess the psychometric attributes of the Inpatient Dignity Scale.

Results

The Mandarin version of the Inpatient Dignity Scale consists of expectation and satisfaction subscales. It differs from the English language version, as the expectation subscale includes three dimensions and the satisfaction subscale includes two dimensions. The total Cronbach alpha coefficient of the expectation subscale and the satisfaction subscale were .820 and .965, respectively, and the split‐half reliability of the expectation subscale and the satisfaction subscale were 0.740 and 0.928, respectively, indicating good internal consistency and effectiveness. Known‐groups validity was established, as 70% of the hypotheses were supported.

Truth-Telling to Terminal Stage Cancer Patients in India: A Study of the General Denial to Disclosure

Telling the truth to the terminal-stage cancer patients differs socio-culturally based on the priorities assigned to patients' autonomy and the principles of beneficence and non-maleficence. After conducting in-depth interviews with 108 terminal-stage adult cancer patients, 306 family members, and 25 physicians, in private and public hospitals in both rural and urban areas, in the state of West Bengal, India it has been found that even though 85.60% of the patients prefer full disclosure, only 22.03% are actually informed. Though demographic characteristics, like age, gender, education etc., have marginal influences over the pattern of truth-telling, the main factor behind non-disclosure is the family members' preference for principles of beneficence and non-maleficence over patient autonomy. Hence, only 9.32% of those 118 patients' family members have agreed to full disclosure. Physicians comply with this culture of non-disclosure as family, in India, is the centre of decision-making and acts as the primary unit of care.