The Understanding of Death in Terminally Ill Cancer Patients in China: An Initial Study

The effect of sleep quality on attitudes toward death in breast cancer survivors

PURPOSE

The aim of this study was to determine the levels of sleep quality and attitudes toward death among breast cancer survivors and to examine the impact of sleep quality on attitudes toward death.

METHODS

This descriptive and correlational study was conducted with 117 patients who had been treated for breast cancer in radiation oncology. Data were collected using a Demographic Information Form, the Pittsburgh Sleep Quality Index, and the Death Attitude Profile-Revised Scale.

RESULTS

The mean score for sleep quality among breast cancer survivors was 15.17 ± 3.96, while the mean score for the Death Attitude Profile-Revised was 137.65 ± 30.74. Sleep quality was associated with marital status, place of residence, perception of economic status, presence of social support, time since diagnosis, body mass index, and other factors (p < 0.05). Attitudes toward death were associated with age, educational level, occupation, place of residence, perception of economic status, comorbidity, histopathological stage, chemotherapy status, type of breast surgery, and other factors (p < 0.05). Additionally, a moderately positive correlation was found between sleep quality and attitudes toward death among women undergoing breast cancer treatment (r = 0.368, p < 0.001). It was determined that patients' sleep quality, education status, and comorbidity had a significant effect on attitudes toward death and the variables explained 29.4% of the variance (R2 = 0.294) (p < 0.001).

CONCLUSION

This study shows that there is a significant relationship between sleep quality and attitudes toward death in cancer patients and that sleep quality affects attitudes toward death. In addition, when evaluating the sleep quality and attitudes toward death of women treated for breast cancer, taking into account their sociodemographic characteristics and treatment characteristics may contribute positively to the recovery process and quality of life.

'Only to reconcile with it'. The coping experience amongst middle-aged and older cancer survivors: A qualitative study

BACKGROUND

Cancer threat is relevant to age, and the threat of a foreshortened life coupled with a lengthy treatment process negatively affects middle-aged and older adults. Understanding the coping throughout the cancer experience in middle-aged and older cancer survivors will help develop supportive care to promote their physiological and psychological coping effects.

OBJECTIVES

To explore the cancer coping experiences of middle-aged adults aged 40-59 and older adults over 60.

DESIGN

A descriptive phenomenological study was employed.

METHODS

Face-to-face, in-depth, semistructured interviews were conducted with 22 oncology patients in a tertiary university hospital aged 40 or above from August to October 2023. The interview data were analyzed using thematic analysis procedures.

RESULTS

Five themes and 13 subthemes were formed through analysis: acceptance of cancer (considering cancer as chronic, believing in fate and attributing cancer to karma); having different information needs (desired to be truthfully informed, information-seeking behaviour, information avoidance behaviour); getting families involved (developing dependent behaviours, feeling emotional support, family members suffering worse); striving to maintain positive psychological state (positive thinking, seeking peer support) and negative experience (undesirable, low self-esteem).

CONCLUSION

Our study reveals that cancer survivors' attitudes towards having cancer have changed from a death sentence to a more positive perception of a chronic disease. Supportive programmes for developing coping strategies should consider the cultural traditions and religious beliefs, different information needs, involvement of family and promoting a positive psychological state while avoiding negative factors.

PATIENT OR PUBLIC CONTRIBUTION

Participants with experience of coping with cancer were involved in the semistructured interview.

Age does matter for hospice care: Health care providers' attitudes toward hospice care in Binzhou, China

Death is still a taboo subject in China. Consequently, hospice remains a relatively new concept in many parts of China. In addition, China is also a rapidly aging country which will likely impact health care delivery, making hospice a potentially effective addition to current healthcare systems. The goal of this study was to better understand health care providers' (physicians and nurses) views about potential hospice implementation, especially with regards to patients' age. Semi-structured, open-ended interviews were conducted with 15 health care providers in Binzhou. Most participants felt that hospice care was only appropriate for older patients and rarely, if ever, for younger ones regardless of disease or prognosis. They also mentioned the links between traditional Chinese medicine (TCM) and many hospice principles. Given deeply held cultural attitudes about dying, hospice implementation would be most successful if directed toward older patients with terminal prognosis and with an emphasis on TCM.

Patients', families' and healthcare providers' perspectives on end-of-life communication in Chinese hospital settings: A qualitative study protocol

BACKGROUND

Perspectives of key stakeholders should be fully considered to enhance culturally appropriate strategies in end-of-life communication and strengthen healthcare service delivery. So far, little research evidence is available on Chinese patients', families', and healthcare professionals' experiences with and perspectives of end-of-life communication in hospital settings.

AIM

The current study aims to explore experiences, perceptions and suggestions of end-of-life communication among Chinese terminally ill patients, their families and healthcare providers.

METHODS

The phenomenology qualitative approach will be adopted. Semi-structured in-depth interviews and focus group discussions will be used to collect relevant data. Eligible terminally ill patients, family caregivers and healthcare providers will be recruited in two hospitals in Mainland China via purposive sampling. Thematic analysis will be performed to analyse data. The Standards for Reporting Qualitative Research (SRQR) checklist will be followed for reporting. This study has been registered at ClinicalTrials.gov (NCT05734781).

DISCUSSION

This qualitative study is, as far as we are aware, the first to specifically address patient/family-provider end-of-life communication in the Chinese social-cultural context. The results hold the potential to enrich current knowledge of end-of-life communication, navigate culturally appropriate communication strategies, and inform the development of related training programs for healthcare providers in hospital settings.

The perception of life and death in patients with end-of-life stage cancer: A systematic review of qualitative research

PURPOSE

This study aims to clarify the perceptions on life and death among patients with the end-of-life stage cancer through a systematic review.

METHODS

The search strategy combined MeSH terminology with free text searches, and was applied to the PubMed, CINAHL, Embase, and ICHUSHI (Japan Medical Abstracts Society) databases covering from 2010 to 5/2022. To ensure the quality of the research included, the Critical Appraisal Skills Program Qualitative Studies Checklist was used. Data relating to the perceptions of life and death of patients with the end-of-life stage cancer was extracted and analyzed with reference to qualitative meta-synthesis methods.

RESULTS

Ultimately, 50 studies were included. Five themes were derived based on the perceptions of life and death of patients with the end-of-life stage cancer: despair, making sense of death, how to live the rest of life, special feelings for loved ones, and fluctuation. By making sense of death in their own way, and reconciling it with their current situation, patients with the end-of-life stage cancer, even in despair over their impending death, look ahead into the future and their surroundings and consider how they would live the remaining time they have. During this time, the special feelings they have for their loved ones make an impact.

CONCLUSIONS

An important new finding from this study lies in the fact that the patients' desire to live as ordinary people who were not patients were expressed as a face that they hid from their families. Further research is needed in low-income countries/regions.

Transiting Back Home: Caregivers' Lived Experiences in Caring for Loved Ones on the Nasogastric Tube in the Home-Setting in Singapore

INTRODUCTION

Little is understood about caregivers' lived experiences when first caring for patients on the nasogastric tube at home in an Asian setting. To enhance understanding, our study aimed to chart these caregivers' psycho-emotional evolutions felt during such caregiving experiences in Singapore.

METHOD

Utilizing purposive sampling, a descriptive phenomenological study was performed, with semi-structured interviews of 10 caregivers of persons on nasogastric tube feeding conducted. Thematic analysis was utilized.

RESULTS

Our findings chart four psycho-emotional transitions of a caregiver's journey in nasogastric tube feeding and the cultural dynamics involved-(a) Disruption of Caregivers' Normality: Attempting to Grasp Reality, (b) Encountering Road-Blocks: Despondency Arises and Frustrations Abound, (c) Adjusting to the New Normal: Reclaiming Confidence and Positivity, (d) Thriving and Integrating into the New Normal, and (e) Cultural Dynamics At Play.

DISCUSSION

Our findings illuminate the understanding of caregivers' varying needs, guiding delivery of culturally-congruent caregiver support targeted at each psycho-emotional evolution.

To Tell or Not: Chinese Older Adults' Preferences for Disclosing or Concealing Serious Illness Diagnoses

BACKGROUND AND OBJECTIVES

Knowledge of one's medical diagnosis is critical for end-of-life decision making. However, a patient's right to know their diagnosis is neither guaranteed nor protected by law in China. Doctors typically inform family members of the patient's illness diagnosis and prognosis and let the family decide whether to disclose this information to the patient. This study examines midlife and older Chinese adults' preferences for disclosure of their own and significant others' diagnoses, and the sociodemographic, economic, and cultural factors associated with these preferences.

RESEARCH DESIGN AND METHODS

We surveyed 571 adults ages 50+ in Shanghai from 2021 to 2022. Our outcome measures are preferences for diagnosis disclosures, including whether and to whom diagnoses should be disclosed. We characterize preference types using latent class analysis, and estimate multinomial logistic regression to identify the covariates associated with each preference type.

RESULTS

Three latent classes were identified. The transparent group (34%) believed patients, whether self or a significant other, should be informed of their own diagnoses. The contradictory group (50%) held conflicting attitudes; they preferred to know their own diagnosis but preferred that significant others not be informed of their diagnoses. The avoidant group (16%) preferred not to know their own diagnosis and similarly preferred not to disclose significant others' diagnoses to them. Familism attitudes were positively associated with holding contradictory views. Experiences with hospitalization and medical decision making for family members were associated with holding transparent views.

DISCUSSION AND IMPLICATIONS

We discuss the importance of illness disclosure for honoring patients' autonomous decision making.

Psychometric Properties of the Knowledge, Attitude, and Practice Behavior of Oncology Nurses on Advance Care Planning Instrument

OBJECTIVE

Advance care planning has been practiced in Western countries for several years, but non-Western cultures face challenges in implementation. This study was dedicated to translating the instrument measure into Chinese, examining its psychometric qualities and exploring the relationships among knowledge, attitudes, and practicing behaviors in advance care planning among oncology nurses in China.

DATA SOURCES

The research adopted a cross-sectional design from September 3 to October 5, 2021. After translation and cultural adaptation, oncology nurses (N = 249) were involved. The research used psychometric evaluation to verify that the content validity, structural validity, internal consistency, and test-retest reliability enhanced the analytical rigorous instrument.

CONCLUSION

The translated and adapted instruments showed reasonable psychometric properties. The Chinese version of the KAB-ACP for oncology nurses is a consistent, valid, and reliable instrument for assessing knowledge, attitude, and practice behavior of Chinese-speaking nurses who work in advance care planning by researchers or clinicians.

IMPLICATIONS FOR NURSING PRACTICE

Measures of oncology nurses' knowledge, attitudes, and practice behaviors will allow for more targeted interventions that will improve end-of-life care outcomes.

The 'good death' in Mainland China - A Scoping Review

Background

Since the mid 80'ies, the western palliative care philosophy has influenced the development of palliative care in mainland China. However, it has caused several challenges.

Objective

To explore the understanding of the 'good death' among authorities, professionals, patients, and their relatives in end-of-life care settings in mainland China.

Design

Scoping review. The PRISMA-ScR checklist was used. The study is not registered.

Settings

End-of-life care settings, Mainland China.

Participants

Authorities, healthcare professionals, adult patients, and general population in mainland China.

Method

Literature searches were performed through Medline, CINAHL, PsycInfo, and Web of Sciences from 2001-2021, last search 21.4.2021. Inclusion criteria were: Empirical research studies investigating 'good death' or political documents about 'good death', perspectives from authorities, professionals, patients, and/or relatives, and studies following the Declaration of Helsinki. Exclusion criteria were: Literature reviews, languages other than English and Chinese, editorials, letters, comments, and children's death/dying.The analysis consisted of analysing the data including a descriptive numerical summary analysis and a qualitative thematic analysis.

Results

Nineteen articles and two political documents were included. The 19 studies were carried out from 2003-2020, with data collected from 1999 to 2019. The political documents were written in 2012 and 2017, respectively. The thematic analysis resulted in three themes: 'Medicalisation of death', 'Communication about death - a clash between two philosophies', and 'Dying and death were socially dependent'. The medicalisation of death meant the understanding of the 'good death' primarily focused on physical symptoms and treatments. The good death was understood as painless and symptom-free, where all symptoms could be measured and assessed. Dignity and shared decision-making were connected to the understanding of the 'good death'. However, the contents of the 'good death' varied across the different actors. The understanding of the 'good death' in mainland China was a negotiation between Chinese traditional philosophy and contemporary western medicine practice. There was a tension between openness and silence about death, which reflected the importance of death education. The understanding of the 'good death' consisted partly of a timely and practical preparation for the death and afterlife, partly of a matter of social and financial issues.

Conclusions

There seemed to be a clash between two different cultures in the understanding of a good death in Mainland China, where western philosophy seemed to rule the political medical actors while traditional Chinese philosophy seemed to rule parts of the population.

The possibility of impossibility: The hope for a cure among terminally ill cancer patients in China

OBJECTIVE

Although the medical potential of the hope for a cure has been fiercely debated within academia, few researchers have approached this topic from the perspective of terminally ill cancer patients themselves. As such, this article aims to help bridge the gap by exploring how terminally ill cancer patients in China construct the hope for a cure.

METHODS

Seventeen terminally ill cancer patients were recruited from the department of oncology at a tertiary hospital, where data were collected through individual interviews and participatory observation from April to December 2020 and analysed via thematic analysis.

RESULTS

The respondents experienced a dynamic swing between construction and denial of the hope for a cure. Furthermore, the patients negotiated between three forms of hope, including the hope for a cure, the hope for prolonged life expectancy and the hope of living in the moment. Meanwhile, family-oriented hope was centred on intergenerational relationships, which further shaped the construction of the hope for a cure.

CONCLUSION

Medical staff needs to be sensitive to terminally ill cancer patients' dynamic swing, negotiation and motivation during the process of constructing the hope for a cure.

Using a mediating model of death attitude and meaning in life to understand nursing students attitude about hospice care

BACKGROUND

Nurse-led hospice teams are an emerging trend in contemporary health care practice in China. However, Chinese nursing students are often ill-prepared to work in hospice care. Study findings on the attitude of nursing students toward the care of people who are dying and death varied among different countries and regions.

OBJECTIVES

To propose and empirically test a mediating model that examines how death attitude and meaning in life interact to affect Chinese undergraduate nursing students and their attitude toward the care of people who are dying.

DESIGN

A cross-sectional study.

PARTICIPANTS

A convenience sample of 1410 Chinese undergraduate nursing students.

METHODS

Data were collected from July to December 2020 using Chinese versions of the Frommelt Attitude Toward Care of the Dying Scale, Form B (FATCOD-B-C), Death Attitude Profile-Revised (DAP-R-C), and Purpose in Life Test (CPLT-C). SPSS version 22.0 and AMOS version 24.0 were used for statistical analysis.

RESULTS

The average FATCOD-B-C score was 98.28 ± 8.02. Death attitude and meaning in life were positively correlated with attitude toward care of the dying (p < 0.001), but death attitude was negatively correlated with meaning in life (p < 0.001). Pathway analysis showed that fear of death was significantly and positively correlated with attitude toward care of people who are dying. A mediating role was found among neutral acceptance, escape acceptance, and meaning in life to some extent. Meaning in life suppressed effects among the model.

CONCLUSION

This study revealed that Chinese undergraduate nursing students' attitude toward care of the dying was a positive nurturing process. Future nurse education should first identity the fear of death, neutral acceptance, or escape acceptance of nursing students' death attitude, and then develop a hospice curriculum based on fear management.

A systematic scoping review on patients' perceptions of dignity

Background

A socioculturally appropriate appreciation of dignity is pivotal to the effective provision of care for dying patients. Yet concepts of dignity remain poorly defined. To address this gap in understanding and enhance dignity conserving end-of-life care, a review of current concepts of dignity is proposed.

Methods

To address its primary research question “How do patients conceive the concept of dignity at the end of life?”, this review appraises regnant concepts and influences of dignity, and evaluates current dignity conserving practices. To enhance accountability, transparency and reproducibility, this review employs the Ring Theory of Personhood (RToP) as its theoretical lens to guide a Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) of patient perspectives of dignity. Three independent teams of reviewers independently analysed included articles from a structured search of PubMed, Embase, PsycINFO, Scopus, CINAHL and Cochrane Databases using thematic and content analyses. The themes and categories identified were compared and combined using the Funnelling Process to create domains that guide the discussion that follows.

Results

Seventy-eight thousand five hundred seventy-five abstracts were identified, 645 articles were reviewed, and 127 articles were included. The three domains identified were definitions of dignity, influences upon perceptions of dignity, and dignity conserving care.

Conclusions

This SSR in SEBA affirms the notion that dignity is intimately entwined with self-concepts of personhood and that effective dignity conserving measures at the end of life must be guided by the patient’s concept of dignity. This SSR in SEBA posits that such personalised culturally sensitive, and timely support of patients, their family and loved ones may be possible through the early and longitudinal application of a RToP based tool.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-01004-4.

Influencing factors of attitudes towards death and demands for death education among community-dwelling Chinese older adults: a cross-sectional study

Background

Considering older adults are getting closer to the end-of-life and face death more directly. Attitudes to death not only affect the physical and mental health of older adults, but also affect their acceptance of hospice care, even the quality of death. This study aims to explore the status, influencing factors of attitudes toward death and demands of death education among the community-dwelling older adults in southwestern China.

Methods

A cross-sectional survey was adopted to investigate 683 community-dwelling older adults in Chongqing, China. Non-parametric test and multiple linear regression analysis was used to explore the influencing factors of different attitudes toward death of older adults in community.

Results

The multiple linear regression models showed that different dimensions of death attitudes were affected by one or more factors including number of diseases, discussion about life and death, marital status, and average income per month. And community-dwelling older adults have high level demand for death education.

Conclusions

Under the taboo culture of death in China, this study is one of the few studies on the attitudes toward death and the demands for death education of the community-dwelling older adults. This study contributes to enrich the global death studies and provide reference for the death education for older adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13655-2.

Effects of the Heart to Heart Card Game for Patients with Advanced Cancer Receiving Home-Based Palliative Care: A Clinical Randomized Controlled Trial

The Heart to Heart Card Game improves psychological health outcomes in hospitalized patients with advanced cancer, but effectiveness studies for patients at home are rare. This randomized controlled study was conducted to determine the effectiveness of the Heart to Heart Card Game on patients with advanced cancer receiving home-based palliative care. Sixty-six participants were randomly assigned to the intervention group (n = 34) and control group (n = 32). The quality of life, dignity, and psychological distress were considered as outcomes, which were assessed pre-intervention and six weeks after the intervention. There was a statistical difference in the quality of life (global health statues) between the intervention group and the control group after intervention (z = 2.017, p < 0.05). A significant difference was found in the quality of life (emotional, social function), dignity (symptom distress dimension), and psychological distress in the intervention group through intragroup comparison before and after the intervention. This randomized trial showed that the Heart to Heart Card Game likely alleviates barriers to end-of-life conversations and helps patients with advanced cancer maintain a more stable mental state. This trial has been registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2100049933).

Death Acceptance Process in Thai Buddhist Patients With Life-Limiting Cancer: A Grounded Theory

Cancer patients with life-limiting illnesses have varied levels of death acceptance pervarious scales. Nevertheless, the process of developing death acceptance in patients with life-limiting cancer remains unclear. This study explores the death acceptance process among patients with life-limiting cancer. We used grounded theory methodology. Data were collected through in-depth interviews of 13 patients with cancer in a palliative care setting, and researchers completed field notes. Data were analyzed using constant and comparative methods. Thai Buddhist patients with cancer in palliative care process death acceptance through three dynamic phases: engaging suffering, being open-minded about death, and adhering to Buddhist practices for increasing death consciousness. The death acceptance process described in this study could serve as a guideline to support death acceptance in Thai Buddhist patients with cancer, and other patients with cancer in palliative care, to improve peaceful life and attain good death.

Cultural implications for disclosure of diagnosis and prognosis toward terminally ill cancer patients in China: A literature review

OBJECTIVE

Health professionals in China tend to avoid open communication with terminally ill cancer patients concerning their diagnosis and prognosis. This review aims to explore Chinese cultural beliefs and attitudes concerning disclosure and death among health professionals and cancer patients in China and to investigate preferences of terminally ill cancer patients for a "good death."

METHOD

A narrative literature review was conducted in May 2020 on MEDLINE, EMBASE, and WEB OF SCIENCE to include all studies with clear study design which presented its own study data or referred to data within underlying studies, published between January 2000 and May 2020, having cancer patients and/or healthcare professionals as participants, conducted in Mainland China, Hong Kong, or Taiwan and containing relevant data concerning "medical disclosure" or "good death." Quality assessment of publications was conducted using the NIH and CASP checklists.

RESULTS

Primary database search revealed a total of 108 papers of which 9 were ultimately included. The additional hand search led to the inclusion of eight further papers. In total, there were 11 quantitative studies, 4 qualitative studies and 2 literature reviews included in this review. Our findings indicated that most terminally ill cancer patients in China want to know the truth about their diagnosis and prognosis and preferred to be informed by their doctors. Terminally ill cancer patients valued a good relationship with family and medical staff as well as being respected as an individual and wanted to be able to prepare for death.

SIGNIFICANCE OF RESULTS

Terminally ill cancer patients in China often have a substantial need for information about their condition while their preferences are widely consistent with those in Western societies. Training for health professionals needs to focus on communication skills in order to overcome barriers in patient interaction.

Palliative Care in the Greater China Region: A Systematic Review of Needs, Models, and Outcomes

CONTEXT

There is rapidly increasing need for palliative care in Greater China because of rapidly aging populations.

OBJECTIVES

This study aimed to systematically review and appraise evidence for palliative care needs, models of care, interventions, and outcomes in Greater China.

METHODS

Four databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) were searched, with hand searching of local journals and databases. Narrative synthesis was applied to the qualitative and quantitative evidence.

RESULTS

Nineteen qualitative studies and 47 quantitative studies were retained. With respect to care needs, nine themes were synthesized: pain control, reduced aggressive end-of-life care, truth telling, physical, emotional, and spiritual supports, and achieving preferred place of care/death. Informal caregivers expressed their needs for education and burden reduction. Health care professionals called for training and national policy support. Twenty-four studies evaluated interventions, mostly among patients with advanced cancer. Positive effects were suggested for improvements in quality of life, pain, anxiety and depression, readmission rate, and costs. Models of care evaluated were mostly specialist palliative care delivered in various settings (hospitals, residential care, and home). Outcome measures used were grouped into six categories of construct: quality of life, pain, physical assessment, psychospiritual assessment, quality of care, and implementation assessment. Limited rigorous randomized controlled trials are available to document intervention outcomes, and some problems (such as high attrition rates) reduced the strength of the evidence.

CONCLUSION

Palliative care services within Greater China should pay more attention to management of nonmalignant disease and to integration into primary services. Policy support is key to establishing culturally appropriate person-centered services.

A comparative study of death metaphors in Han and Tibetan ethnic groups

We compared 385 Han participants and 302 Tibetan participants' death metaphors and investigated the associations between death metaphors and death attitudes. The results show that the death metaphor "Separation from loved ones" was the most common among both groups. Both groups scored highest in the Empty death metaphor subscale. Ethnicity had a significant effect on the Empty subscale and age had a significant effect on the Sorrowful death metaphor subscale. Death metaphor is significantly positively correlated with approaching acceptance and escape acceptance attitudes to death. Our comprehensive exploration of death metaphors enables a better understanding the Chinese concept of death.

Death acceptance from a Thai Buddhist perspective: A qualitative study

PURPOSE

To have more in-depth understanding of death acceptance among patients with terminal cancer in Thailand.

METHODS

A qualitative descriptive research approach was used to capture the perspectives of patients with terminal cancer about death acceptance. Purposive sampling was used to recruit the participants. A semi-structured interview guide was used during data collection to obtain in-depth interviews with 12 patients diagnosed with terminal cancer. An interpretive descriptive method was used for analyzing data. Analysis of the data for this study was conducted by the analytic team beginning at initial data collection.

RESULTS

The findings of this study revealed six major themes relating to death acceptance: 1) perceiving death as a natural part of life; 2) perceiving that death cannot be controlled; 3) thinking that death can come at any time; 4) letting everything go before dying: finding a calmness; 5) additional Buddhist practices: clean living and making merit; and 6) additional means for attaining a peaceful death and peaceful life before death.

CONCLUSION

Understanding death acceptance is important for nurses providing care for patients with terminal cancer in order to find strategies and support for patients to accept death and live peacefully with their family in the time they have left.

Prevalence and correlates of unmet palliative care needs in dyads of Chinese patients with advanced cancer and their informal caregivers: a cross-sectional survey

OBJECTIVES

To examine palliative care needs of advanced cancer patients and their informal caregivers and correlates of their needs within Chinese context.

METHODS

This was a cross-sectional survey conducted in two study sites in Mainland China. Patients and caregivers were recruited in dyads. Patients completed the following questionnaires: Problems and Needs in Palliative Care-short version, Hospital Anxiety and Depression Scale (HADS), Edmonton Symptom Assessment Scale (ESAS), Medical Outcomes Study-Social Support Survey (MOS-SSS), Brief Coping Orientation to Problems Experienced Scale (Brief-COPE), and Quality-of-Life Questionnaire Core 15-Palliative Care Scale. Questionnaires for caregivers were as follows: Comprehensive Needs Assessment Tool in Cancer for Caregivers, HADS, ESAS, MOS-SSS, Brief-COPE, and Caregiver Quality of Life Index-Cancer. All of the outcome variables were selected based on a conceptual framework of palliative care needs assessment.

RESULTS

Four hundred nineteen patient-caregiver dyads completed this survey. Patients' unmet palliative care needs were mainly related to financial (85.2%), informational (82.3%), physical (pain) (69.7%), and psychological (64.9%) domains. Caregivers' commonly reported unmet needs mainly focused on the domains of healthcare staff (95.0%), information (92.1%), and hospital facilities and services (90.5%). Patients' greater severity of symptom distress, presence of anxiety and/or depression, use of coping strategies particularly the less use of problem-focused coping, and caregivers' poorer quality of life were identified as key negative predictors of the needs of both patients and caregivers (p < 0.05).

CONCLUSIONS

Both patients and caregivers had context-bounded palliative care needs. In addition to increasing the amount of external asistance, more emphasis should be placed on screening for physical and psychological distress, the use of coping strategies, and the well-being of caregivers to help identify those in need for more clinical attention and specific interventions.

Is Death Taboo for Older Chinese Immigrants?

Much of the scholarly literature sees death as a taboo topic for Chinese. To test this assumption, this study held seven focus groups in the Greater Toronto Area in 2017. It found that the majority of the older Chinese immigrant participants talked about death freely using either the word death or a euphemism. They talked about various issues including medical treatment and end-of-life care, medical assistance in dying, death preparation, and so on. A small number did not talk about death, but it seemed their reluctance was related to anxiety or discomfort or simply reflected a choice of words. The study concludes death as taboo could be a myth, at least for older Chinese immigrants.

Identifying End-of-Life Preferences Among Chinese Patients With Cancer Using the Heart to Heart Card Game

Background:

Understanding the preferences for end-of-life (EOL) care is imperative in providing quality care to patients with life-threatening illness. However, it is difficult for patients, families, and health-care providers to initiate EOL conversations in China. An easy-to-use tool that could help health-care providers initiate EOL discussions is the Heart to Heart Card Game (HHCG), originally designed for Chinese Americans.

Objective:

To evaluate the EOL preferences among Chinese patients with cancer using the HHCG.

Methods:

We conducted a descriptive study to assess EOL preferences using HHCG among patients at the oncology chemoradiotherapy department of a Chinese tertiary hospital.

Results:

We recruited 58 patients in total of which 40 (69%) patients completed HHCG. The most frequently selected card was “I want my family to get along,” followed by “I don’t want to be a burden to my family,” and “I want to maintain my dignity.” Among the 3 cards selected, social needs were rated as the most important (36.7%), followed by spiritual needs (35.8%), physical needs (20.0%), and financial needs (7.5%). The evaluation of the HHCG revealed that more than 70% of the participants highly valued HHCG.

Conclusion:

The HHCG can be used as a communication tool to encourage EOL discussions between cancer patients and health-care providers in China. Moreover, Chinese patients with cancer attach significant importance to their family and maintaining dignity at the EOL.

Preferences for Feeding Tube Use and Their Determinants Among Cognitively Intact Nursing Home Residents in Wuhan, China: A Cross-Sectional Study

Introduction: Standard advance care planning practice is yet to be established in Mainland, China, and little is known about feeding tube preferences among Chinese nursing home residents. The purpose of the study was to examine preferences for feeding tube use and its predictors among frail and cognitively competent nursing home residents in Wuhan, China. Method: A cross-sectional sample of 682 nursing home residents were interviewed face-to-face using a structured questionnaire from 2012 to 2014. Results: A total of 54.5% of participants would accept feeding tube. Participants who reported greater quality of life (odds ratio [OR] = 2.67), having health insurance (OR = 2.09) were more willing to accept feeding tube. Participants with greater impairment in physical health (OR = 0.94) were less willing to accept it. Discussion: Health care professionals need to routinely assess nursing home residents' feeding tube preferences. It is imperative to consider sociocultural perspectives in understanding Chinese older adults' decision making for end-of-life care.