Research

Challenges to advance care planning among multidisciplinary health professionals in China

Abstract

Background:

Advance care planning (ACP) is a critical component of quality end-of-life care. Little is known regarding the cultural influences on health professionals' attitudes toward the discussion of ACP in China.

Objective:

To better understand attitudes toward ACP among Chinese healthcare professionals in China and the influence of cultural factors such as filial piety, or xiào.

Methods:

A mixed methods study was used. This study reports the results of a descriptive cross-sectional survey of physicians, nurses and social workers with experience in palliative and end-of-life care.

Results:

Some 102 completed surveys were obtained. Most Chinese health professionals had an overall positive attitude toward ACP, acknowledging that these discussions should occur. However, there was a general lack of confidence and sense of reluctance among participants to engage in ACP discussions.

Conclusion:

The lack of statistical difference between the various health professionals suggests that they all faced challenges in participating in ACP discussions. Future research should focus on the influences of cultural factors such as xiào on ACP discussion, and develop culturally sensitive strategies to facilitate these discussions in the Chinese community.

References

Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991 Dec; 50(2):179–211. https://doi.org/https://doi.org/10.1016/0749-5978(91)90020-t Google Scholar
Bowman KW, Singer PA. Chinese seniors' perspectives on end-of-life decisions. Soc Sci Med. 2001 Aug; 53(4):455–464. doi:https://doi.org/10.1016/S0277-9536(00)00348-8 Crossref, Medline, Google Scholar
Brinkman-Stoppelenburg A, Rietjens JAC, van der Heide A. The effects of advance care planning on end-of-life care: a systematic review. Palliat Med. 2014 Sep; 28(8):1000–1025. https://doi.org/https://doi.org/10.1016/s0277-9536(00)00348-8 Crossref, Medline, Google Scholar
Chan CLW, Ho AHY, Leung PPY et al.. The blessings and the curses of filial piety on dignity at the end of life: lived experience of Hong Kong Chinese adult children caregivers. J Ethn Cult Divers Soc Work. 2012 Oct; 21(4):277–296. https://doi.org/https://doi.org/10.1080/15313204.2012.729177 Crossref, Google Scholar
Chan HYL, Pang SMC. Let me talk—an advance care planning programme for frail nursing home residents. J Clin Nurs. 2010 Nov; 19(21-22):3073–3084. https://doi.org/https://doi.org/10.1111/j.1365-2702.2010.03353.x Crossref, Medline, Google Scholar
Coolen P. Cultural relevance in end-of-life care. 2012. https://tinyurl.com/k8ktz38 (accessed 22 December 2015) Google Scholar
Dong X, Zhang M, & Simon M. The expectation and perceived receipt of filial piety among Chinese older adults in the Great Chicago area. J Aging Health. 2014 Oct; 26(7):1225-47. doi: https://doi.org/10.1177/0898264314541697 Crossref, Medline, Google Scholar
Fisher RJ. Social desirability bias and the validity of indirect questioning. J Consum Res. 1993 Sep; 20(2):303–315. https://doi.org/https://doi.org/10.1086/209351 Crossref, Google Scholar
Ho D. Filial piety and its psychological consequences. In: Bond, M.H, ed. The handbook of Chinese psychology, Hong Kong: Oxford University Press. pp.155-165, 1996 Google Scholar
Hornung CA, Eleazer GP, Strothers HS III, et al.. Ethnicity and decision-makers in a group of frail older people. J Am Geriatr Soc. 1998; 46(3):280–286. https://doi.org/https://doi.org/10.1111/j.1532-5415.1998.tb01038.x Crossref, Medline, Google Scholar
Ivo K, Younsuck K, Ho YY et al.. A survey of the perspectives of patients who are seriously ill regarding end-of-life decisions in some medical institutions of Korea, China and Japan. J Med Ethics. 2012; 38(5):310–316. https://doi.org/https://doi.org/10.1136/medethics-2011-100153 Crossref, Medline, Google Scholar
Kataoka-Yahiro MR, Conde FA, Wong RS, Page V, Peller B. Advance care planning among Asian Americans and Native Hawaiians receiving haemodialysis. Int J Palliat Nurs. 2010; 16(1):32–40. https://doi.org/https://doi.org/10.12968/ijpn.2010.16.1.46181 Link, Google Scholar
Kwak J, Haley WE. Current research findings on end-of-life decision making among racially or ethnically diverse groups. Gerontologist. 2005 Oct; 45(5):634–641. https://doi.org/https://doi.org/10.1093/geront/45.5.634 Crossref, Medline, Google Scholar
Lee MC, Hinderer KA, Kehl KK. A systematic review of advance care planning and advance directives in Chinese people from eastern and western cultures. J Hosp Palliat Nurs. 2014; 16(2):75–85. https://doi.org/https://doi.org/10.1097/NJH.0000000000000024 Crossref, Google Scholar
Levi BH, Green MJ. Too soon to give up: re-examining the value of advance directives. Am J Bioeth. 2010 Apr;10(4):3–22. https://doi.org/https://dx.doi.org/10.1080/15265161003599691 Crossref, Medline, Google Scholar
Lien Foundation. The quality of death: ranking end-of-life care across the world. 2015. https://tinyurl.com/gnflkzq (accessed 18 May 2017) Google Scholar
Luk Y, Ngai C, Chau SS, Lam MYA, Wong OW, Holm M. Clinicians' experience with and attitudes toward discussing advance directives with terminally ill patients and their families in a Chinese community. J Palliat Med. 2015; 18(9):794–798. https://doi.org/https://doi.org/10.1089/jpm.2015.0104 Crossref, Medline, Google Scholar
Lyon ME, Jacobs S, Briggs L, Cheng YI, Wang J. Family-centered advance care planning for teens with cancer. JAMA Pediatr. 2013; 167(5):460–467. https://doi.org/https://doi.org/10.1001/jamapediatrics.2013.943 Crossref, Medline, Google Scholar
United Nations (UN), UN News Centre. New UN report identifies unmet need for palliative care worldwide. January 28, 2014 https://tinyurl.com/y9x8phrh (accessed 22 December 2015) Google Scholar
Yeh KH, Bedford O. Filial belief and parent-child conflict. Int J Psychol. 2004 Apr; 39(2):132–144. https://doi.org/https://doi.org/10.1080/00207590344000312 Crossref, Medline, Google Scholar
Xue D, Wheeler JL, Abernethy AP. Cultural differences in truthtelling to cancer patients: Chinese and American approaches to the disclosure of bad news. Prog Palliat Care. 2011 May; 19(3):125–131. https://doi.org/https://doi.org/10.1179/1743291x11y.0000000004 Crossref, Google Scholar
Zimmermann C. Death denial: obstacle or instrument for palliative care? An analysis of clinical literature. Sociol Health Illn. 2007 Mar; 29(2):297–314. https://doi.org/https://doi.org/10.1111/j.1467-9566.2007.00495.x Crossref, Medline, Google Scholar
Zou M, O'Conner M, Peters L, Jiejun W. Palliative care in mainland China. Asia Pacific J Health Manag. 2013; 8(1):9–13 Google Scholar

International Journal of Palliative Nursing

2 November 2017Volume 23Issue 11

ISSN (print): 1357-6321
ISSN (online): 2052-286X

Metrics

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History

Published online 25 November 2017

Published in print 2 November 2017

Information

Keywords

Acknowledgments

This research was funded by Interprofessional Global Health Grant Award, Global Health Interprofessional Council and Center for the Global Education Initiatives, University of Maryland, Baltimore.

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