Chinese physicians' perceptions of palliative care integration for advanced cancer patients: a qualitative analysis at a tertiary hospital in Changsha, China

Ethical Dilemmas Among Oncology Nurses in China: Cross-Sectional Study

Background

Effective communication about cancer prognosis is imperative for enhancing the quality of end-of-life care and improving patient well-being. This practice is sensitive and is heavily influenced by cultural values, beliefs, and norms, which can lead to ethical dilemmas. Despite their significance, ethical challenges in nursing related to prognosis communication are understudied in China.

Objective

This study aimed to examine the ethical dilemmas relating to cancer prognosis communication and their associated factors.

Methods

A cross-sectional design was employed to survey 373 oncology nurses in mainland China. Data were collected on ethical dilemmas, attitudes, barriers, experiences with prognosis communication, sociodemographics, and practice-related information. Ordinary least squares regressions were used to identify factors contributing to ethical dilemmas.

Results

Participants reported a moderate level of ethical dilemmas in prognostic communication (mean 13.5, SD 3.42; range 5-20). Significant predictors of these dilemmas included perceived barriers (P<.001), experiences with prognosis communication (P<.001), and years of work experience (P=.002). Nurses who perceived greater communication barriers, had more negative experiences with prognosis communication, and had less work experience were more likely to encounter ethical dilemmas in prognosis-related communication.

Conclusions

Chinese oncology nurses frequently encounter ethical dilemmas, as well as barriers, in communicating cancer prognoses. This study's findings emphasize the importance of culturally tailored communication training. Collaborative interprofessional training, particularly through physician-nurse partnerships, can perhaps enhance the proficiency of cancer prognosis-related communication.

Self-Assessed Educational Needs of Chinese Pediatric Clinicians Regarding Pediatric Palliative Care: A Cross-Sectional Investigation

BACKGROUND

An important first step in enhancing professional palliative care training is to investigate the educational needs of pediatric clinicians in this field. The aims of this research were to analyze the extent of end-of-life care experience of Chinese pediatric clinicians and identify the differing educational needs of physicians and nurses as well as associated impact factors.

METHODS

A cross-sectional descriptive survey via a structural questionnaire was used in this research.

RESULTS

In total, 187 clinicians, comprising 52 physicians and 135 nurses, participated in this study. The topics "pain management", "symptom management", and "discussing the prognosis with family members" were the most expressed educational needs among both physicians and nurses. Compared to nurses, physicians placed greater emphasis on the importance of "communication" and "pain and symptom management" (p < 0.05). Clinicians with more extensive end-of-life care experience more strongly felt the importance of learning about pain management and communication regarding end-of-life care (p < 0.05).

CONCLUSIONS

Research showed that the education currently provided to pediatric clinicians does not meet their distinctive needs. Future palliative care education must be a continuing multi-level, interdisciplinary program and different education should be provided to physicians and nurses based on their respective needs.

Discussion of the do-not-resuscitate (DNR) orders with the family caregivers of cancer patients: An example from a major cancer center in Saudi Arabia

OBJECTIVES

To explore the views of the family caregivers (FCGs) about the "do-not-resuscitate" (DNR) discussions and decision-making processes that occurred during hospitalization in a Saudi cancer center.

METHODS

In this cross-sectional survey, the FCGs of inpatients with advanced cancer completed a self-administered questionnaire soon after giving the patients a DNR status designation by their oncologists.

RESULTS

Eighty-two FCGs participated in the study, with a median age of 36.5 years and male preponderance (70.7%). The FCGs were mostly sons (41.5%), daughters (14%), or brothers (11%) of patients. Only 13.4% of mentally competent patients had the chance to listen to the DNR discussion. The discussion mainly occurred in the ward corridor (48.8%) or another room away from the patients' rooms (35.4%). In 36.6% of cases, the discussion took ≤5 minutes. Half of the FCGs stated that the oncologists' justifications for the DNR decision were unconvincing. The majority (84.2%) of the FCGs felt that the healthcare providers should share the DNR decision-making with patients (1.2%), families (69.5%), or both (13.4%). FCGs ≤ 30 years of age were more supportive of giving patients' families a chance to participate in the DNR decision-making process (p = 0.012).

SIGNIFICANCE OF RESULTS

There is considerable room for improving the current practice of DNR discussions and decision-making processes in the studied setting. A readily feasible rectifying measure is to ensure the adequacy of time and privacy when planning for DNR discussions. We expect our findings to draw the attention of stakeholders to a compelling need for reviewing the current policies and processes, aiming to improve the experience of cancer patients and their FCGs.

Ethical dilemmas and legal ambiguity in China: a chain mediation model linking suicide rumination, legitimization, and acceptance among acutely-ill adults

Background

This study explores the complex intersection of euthanasia, legal ambiguities, cultural attitudes, and the psychology of suicide among seriously ill patients in China. It addresses the lack of clear legislation on euthanasia and doctor-assisted killing, the impact of cultural and philosophical beliefs, and the evolution of legal and ethical perspectives on suicide. Additionally, it examines the psychological aspects of suicide ideation in acutely-ill patients, focusing on factors like familial burden and loss of dignity.

Method

A survey was conducted with 356 Chinese adults, aged 23 to 64 years, using popular social media platforms in China. The study aimed to reflect a broad spectrum of the adult population in terms of age, education, and professional sectors. The research model involves suicide rumination as an independent variable, acutely-ill patients' suicide acceptance as a dependent variable, and three mediators: cognitive depression, ethical suicide acceptance, and suicide legitimization.

Results

The findings reveal a significant total effect of Suicide Rumination on Acutely-ill Patients' Suicide Acceptance, underlining a robust direct relationship that supports Hypothesis 1. The analysis indicates that Suicide Rumination is a significant predictor of Cognitive depression, explaining approximately 8.05% of its variance, thereby fully supporting Hypothesis 2a. However, the effect of Suicide Rumination on Ethical Suicide Acceptance did not emerge as significant, failing to support Hypothesis 2b, while its impact on Suicide Legitimization was also non-significant, not supporting Hypothesis 2c. Cognitive depression was found to have a substantial effect in the models for both Ethical Suicide Acceptance and Suicide Legitimization, supporting Hypotheses 3a and 3b. In the comprehensive model assessing Acutely-ill Patients' Suicide Acceptance, incorporating all mediators, a significant variance (R-squared = 0.6625) was explained. Notably, Suicide Rumination, Ethical Suicide Acceptance, and Suicide Legitimization all emerged as significant predictors of this acceptance, with varying effects, thus supporting Hypotheses 4a and 4b. The role of Cognitive depression in this model was marginally significant, offering limited support for Hypothesis 4c. Crucially, the indirect effects of Suicide Rumination on Acutely-ill Patients' Suicide Acceptance through different mediational paths varied in significance and impact. The indirect effect via Cognitive depression alone, and through the sequential combination of Cognitive depression and Ethical Suicide Acceptance, were significant, highlighting the nuanced role of these mediators. These findings underscore the importance of considering multiple pathways in understanding the dynamics of Suicide Rumination and its influence on the acceptance of suicide among acutely-ill patients.

Conclusion

This paper presents a comprehensive analysis of the legal, cultural, ethical, and psychological dimensions of euthanasia, doctor-assisted killing, and suicide in China. The findings highlight the significant direct and mediated effects of suicide rumination on the acceptance of suicide among acutely-ill patients. The study contributes valuable insights into the evolving bioethics and the interplay of various factors in the context of end-of-life decision-making in modern Chinese society.

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.

Global Research Trend and Bibliometric Analysis of Current Studies on End-of-Life Care

The growing emphasis on evidence-based practice has led to a need for more research on healthcare disciplines, and for the synthesis and translation of that research into practice. This study explored the global research trend in regard to End-of-Life Care (EoLC), and assessed the impact and influence, on the scientific community, of relevant EoLC publications EoLC. Over 350,000 related publications on EoLC were retrieved from three databases (PubMed, Scopus, and Web of Science). Our analysis of the global research trend revealed an exponential rise in the number of related publications on EoLC since the year 1837. This study assessed the bibliometric information of 547 current journal publications on EoLC, sorted by relevance, from the three databases. The USA (47.3%) and the UK (16.1%) were the most productive countries, in terms of the number of relevant publications. The bibliometric analysis also revealed which EoLC research was most impactful and influential, from different parameters including documents, authors, sources, and organisations. The keyword analysis further suggested the growing importance of advance care planning and decision-making in regard to EoLC, as well as an episodic upsurge of EoLC publications related to the COVID-19 pandemic. There were few collaborations among the prolific research on EoLC. This study recommends increased research collaboration across the globe, for wider wisdom-sharing on EoLC issues.