Informed consent and truth telling: the Chinese Confucian moral perspective

Informed consent in cancer clinical drug trials in China: a narrative literature review of the past 20 years

BACKGROUND

Although the number of cancer clinical drug trials is increasing rapidly in China, issues concerning informed consent in this research context are understudied. By performing a narrative literature review, we aim to describe the current situation and identify the most salient challenges affecting informed consent in cancer clinical drug trials among adult patients in China since 2000.

METHODS

We searched Web of Science (WOS), PubMed, Scopus, EMBASE, the Cochrane Library databases, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database on Disc (CBMdisc), Chinese Scientific Journals Fulltext Database (CQVIP), and WANFANG Data to identify relevant publications since 2000. Data were extracted by three reviewers on six items pertaining to study type, theme, and challenges.

RESULTS

We identified 37 unique manuscripts, from which 19 full texts were obtained and six were included in the review. All six studies were published in Chinese journals, and the publication years of the majority (five out of six) of the studies were 2015 or later. The authors of the six studies were all from clinical departments or ethical review committees at five hospitals in China. All of the included publications were descriptive studies. Publications reported challenges related to the following aspects of informed consent: information disclosure, patient understanding, voluntariness, authorization, and procedural steps.

CONCLUSION

Based on our analysis of publications over the past two decades, there are currently frequent challenges related to various aspects of informed consent in cancer clinical drug trials in China. Furthermore, only a limited number of high-quality research studies on informed consent in cancer clinical drug trials in China are available to date. Efforts toward improvement of informed consent practice, in the form of guidelines or further regulations in China, should draw on both experience from other countries and high-quality local evidence.

Knowledge of mental health diagnosis among patients and their family members: an inpatient survey in China

BACKGROUND

Patient-oriented information disclosure has been advocated by the National Mental Health Law (NMHL) in China since 2012; however, reporting on diagnostic disclosure to patients with mental disorders after the NMHL is limited.

AMIS

This study aims to investigate and compare the knowledge of mental health diagnosis among patients and their family members in China.

METHODS

An inpatient survey was conducted among 205 patients with mental disorders and their family members. Group differences of the correctness of self-reported mental health diagnosis were compared, and logistic regression was performed to investigate correlates among both patients and their family members.

RESULTS

Overall, 76.7% patients and 80.6% of their family members reported a correct diagnosis. Only 46.2% patients with psychotic disorders correctly knew their diagnosis, significantly lower than their family members and patients with non-psychotic disorders. Multivariate regression analysis found that the diagnosis of psychotic disorders was a risk factor of patients' diagnostic knowledge (AOR = 0.137; 95% CI = 0.044-0.429), while family members' diagnostic knowledge was associated with their employment (AOR = 6.125, 95% CI = 1.942-19.323) and parent-child relationship with patients (AOR = 3.719; 95% CI = 1.057-13.086).

CONCLUSIONS

The majority of patients with non-psychotic disorders know their diagnosis correctly and informing family members of patients' diagnosis remains a common practice in psychiatric setting after the implementation of China's NMHL.

Patients' and family members' experiences of psychiatric inpatient services in China: a comparison based on a dyadic design

PURPOSE

Due to the family-oriented cultural and legal context in China, understanding the difference between patients' and family members' experiences of psychiatric services not only enriches perspectives of service quality assessment, but also promotes service utilization. This study aimed to compare experiences of psychiatric inpatient services between patients and their family members in China.

METHODS

The study included 126 dyads of patients and family members consecutively recruited from the psychiatric inpatient department in a large hospital in China. The responsiveness performance questionnaire was used to measure the experiences of psychiatric inpatient services after patient discharge. After adjusting reporting heterogeneity based on vignettes, dyad difference was examined by intraclass correlation coefficients (ICCs) and paired Wilcoxon signed-rank tests with Bonferroni correction in multigroup testing. Subgroup analyses were conducted within strata of four selected clinical and socio-demographic factors, to test their influence on difference pattern of experiences.

RESULTS

Poor consistency was found for all responsiveness items and the total scores among the 126 dyads and in most subgroup analyses (ICC < 0.6). Paired Wilcoxon signed-rank tests found that patients rated lower than their family members on the item of "asking user's opinions" in 126-dyad comparison (P < 0.05) and 3 subgroups related to severe mental disorders and income inequality after Bonferroni correction.

CONCLUSION

Results reveal inconsistent experiences of psychiatric inpatient services within families in China. Moreover, when making medical decisions, family members' opinions, rather than patients', are more frequently taken into consideration, especially on conditions where imbalanced decision-making power exists between patients and their family members. In the future, user experience improvement should pay equal attention to patients and family members, and the benefits of family involvement and patients' rights of shared decision-making should be carefully balanced.

The Complexities of Doctor-Patient-Family Communication in an Asian Oncology Setting: Concordance and Discordance Among Patient Preferences, Family Preferences, and Perceived and Actual Communication

This article reports on a pilot study that examined the complexities of doctor-patient-family communication in an oncology setting in Singapore. Twenty consultation visits were audio-recorded and a postconsultation questionnaire was administered to patients and their accompanying person (AP) to examine their communication preferences. Patients and APs rated physician expertise and message content as highly important; supportive elements of the communication were rated as less important. Patients preferred information concerning their condition, while APs preferred information regarding treatment options. There was discordance between what was perceived by the patient/AP and actual delivery, and within patient-AP dyads. Our findings elucidate some of the complexities in communication preferences in an Asian oncology context that can inform clinical practice.