Exploring the Impact of Chinese Culture on Palliative Care Decision-Making: A Mixed-Methods Study

Question

Task: How does Chinese culture influence palliative care decision-making, and what are the cultural factors that affect the provision and reception of palliative care in the Chinese community

Answer

Introduction

The Chinese culture has a significant impact on palliative care decisions, shaping how care is provided and received. Healthcare providers must be aware of these cultural factors to effectively communicate with patients and families and provide appropriate care. It is important to provide education and training to healthcare providers so that they can understand and respect the cultural values and beliefs of Chinese patients and families, and to encourage open and honest communication about end-of-life care. In traditional Chinese society, people are expected to do everything in their power to support each other and help one another succeed. I'm conducting research to explore the impact of Chinese culture on palliative care decision-making.

My aim is to identify the cultural factors that affect the provision and reception of palliative care in the Chinese community and raise awareness among healthcare providers about these factors.

I believe that my research findings could benefit healthcare providers who work with Chinese patients and their families. By providing insights into cultural values and beliefs, I hope to help these providers to communicate more effectively and deliver better care. Additionally, I think that patients and their families may benefit from increased understanding and respect for their cultural practices and beliefs.

To conduct my research, I'm considering using a mixed-methods approach that combines surveys, interviews, and secondary data analysis. Surveys could help me collect quantitative data about cultural values and beliefs related to palliative care decision-making. Interviews with patients, family members, and healthcare providers could provide more in-depth qualitative data about experiences and perspectives. I believe that secondary data analysis could help me to contextualize my findings and compare them with existing literature on the topic. The participants of my study could include Chinese patients, their families, and healthcare providers who work with them. I will need to obtain ethics approval before conducting my research.

Aims and Objectives

The aim is to investigate how Chinese culture impacts palliative care decision-making.

Objectives:

To examine the role of family and community in palliative care decision-making in China, and how these values impact the distribution of palliative care services across the country.

To explore how cultural beliefs and strong family ties in Chinese culture influence decisions related to palliative care, including treatment options and end-of-life care.

To investigate how social expectations related to death in China impact palliative care decision-making, and how these expectations may differ from those in other cultures.

To analyze the inherent conflict between providing palliative care in rural areas versus urban centres in China, and to identify potential solutions for improving access to care in both settings.

Significance and Scope of the Study

The significance of the study lies in the fact that palliative care has become an important issue in healthcare systems worldwide, and it is essential to understand its role in different cultures, including Chinese culture. China is a rapidly ageing society with a large population, and it is crucial to study how palliative care is perceived and utilized in the country.

The scope of the study would involve exploring the cultural attitudes, beliefs, and practices towards death and dying in China and how these influence the provision and uptake of palliative care. It would also investigate the current state of palliative care services in China, including the availability, accessibility, and quality of care, as well as the challenges and barriers to its provision.

The study would provide insights into the cultural and societal factors that influence palliative care in China, which could inform policies and practices to improve the quality and access to care. It could also contribute to a better understanding of palliative care in other cultures and lead to the development of culturally sensitive approaches to care.

Contribution

The research has several important contributions. Firstly, it will provide insights into the cultural attitudes, beliefs, and practices surrounding death and dying in China, which are likely to impact the provision and uptake of palliative care. This knowledge will be valuable in informing policies and practices to improve the quality and access to care for those nearing the end of life. The study will also highlight the challenges and barriers to the provision of palliative care in China, such as the lack of awareness and education among healthcare providers and the general public. By identifying these barriers, the study can provide recommendations for improving the availability and accessibility of palliative care services in China. Secondly, the research will contribute to a better understanding of palliative care in different cultures and the need for culturally sensitive approaches to care. It will demonstrate that cultural factors play a crucial role in the provision and uptake of palliative care and highlight the importance of taking a patient-centred approach that considers the unique cultural background and beliefs of the patient and their family. The study may also provide insights into how to adapt palliative care programs to meet the needs of specific cultural groups, which could be applied to other cultural contexts.

Key Literature Review

Intrinsic perceptions of cultural practices refer to how individuals within a culture understand and interpret their cultural customs, beliefs, and values. In the context of palliative care, “intrinsic perceptions of Chinese cultural practices” can greatly influence how patients and families approach end-of-life care (Chiang et al., 2021).

As Zhu et al. (2020) put forward- an individual from a culture that places a strong emphasis on filial piety may feel a strong sense of duty to care for their ageing parents and may be more likely to choose in-home care rather than hospice or palliative care facilities. On the other hand, an individual from the same culture who has had negative experiences with caregiving may have a different perspective and may be more inclined to seek professional care for their loved ones (Zhu et al., 2020).

Cultural practices can also impact how individuals understand and interpret traditional healing practices. Lin et al. (2019) give the example of an individual who has had positive experiences with traditional Chinese medicine may have a strong belief in its ability to alleviate symptoms and prolong life, while another individual from the same culture may have had negative experiences and may be more sceptical of its effectiveness (Lin et al., 2019). This highlights the importance of understanding and respecting the diverse perspectives within a culture, rather than making assumptions based on stereotypes or generalizations (Pun et al., 2020). One of the most significant cultural factors that influence palliative care in China is the emphasis on filial piety. Kwok et al. (2020) say that this Confucian principle holds that children have a moral duty to care for their parents in old age and in times of illness. This can lead to a focus on in-home care rather than hospice or palliative care facilities and can make it difficult for healthcare providers to communicate and coordinate care with families (Kwok et al., 2020).

In addition, as Jia et al. (2020) writes, traditional Chinese medicine (TCM) has a significant impact on palliative care decisions. Many Chinese people believe that TCM can cure any illness and that Western medicine is not as effective. This can lead to families refusing Western treatments and instead relying on TCM, even when Western medicine may be more effective in controlling symptoms (Jia et al., 2020).

Huang et al. (2020) show that effective communication and a sensitive approach are key in palliative care. Healthcare professionals should take time to understand the patient’s and family’s cultural background and work with them to develop a care plan that respects their cultural beliefs and values while also addressing the needs of the patient (Huang et al., 2020).

Despite these cultural differences, it is still possible to implement advanced care planning in a way that respects and incorporates Chinese cultural values. Willemsen et al. (2021) write that healthcare providers can involve family members and educate them about the importance of patient autonomy. They can also use culturally sensitive language and approach the subject of advanced care planning in a way that does not challenge cultural norms (Willemsen et al., 2021).

He et al., (2021) show in Chinese culture, there is also a strong belief in the importance of maintaining harmony within the family. This can lead to a reluctance to discuss end-of-life care and death openly, as it is seen as a potentially divisive or upsetting topic. This can make it difficult for families to make informed decisions about care and can lead to misunderstandings or disagreements.

Additionally, in traditional Chinese culture, there is a strong emphasis on the importance of maintaining bodily integrity (He et al., 2021). This can lead to resistance to aggressive medical interventions, such as amputations or invasive procedures, as they are seen as a violation of the body. This can make it difficult for some Chinese families to accept palliative care measures that may be seen as hastening death.

Lou et al. (2021) show that there are also cultural differences in how Chinese patients and families view pain management. In traditional Chinese medicine, pain is often seen as a natural part of the healing process and is not always viewed as something that needs to be aggressively treated. This can lead to a reluctance to use strong pain medications and a preference for more holistic approaches to managing pain (Lou et al., 2021).

Conclusion of Literature Review

The studies discussed above highlight the significant impact of Chinese culture on palliative care decisions. Cultural factors such as filial piety, traditional healing practices, communication styles, beliefs about bodily integrity, and attitudes towards pain management can all influence how patients and families approach end-of-life care. Healthcare professionals must take the time to understand and respect the diverse perspectives within Chinese culture and work with patients and families to develop care plans that respect their cultural beliefs and values. While there may be challenges in implementing advanced care planning and providing palliative care in a culturally sensitive manner, the studies suggest that it is still possible to do so by involving family members, using culturally sensitive language, and approaching the topic in a way that does not challenge cultural norms.

Knowledge Gap

The gap in the knowledge regarding how the intersection of Chinese culture and healthcare provider communication affects palliative care decisions. While some studies have touched on the importance of effective communication and a culturally sensitive approach in palliative care, there is limited research on how this specifically applies to Chinese culture. Therefore, the contribution of this research will be to explore how healthcare providers can communicate with Chinese patients and their families in a way that respects and incorporates their cultural values while also addressing their palliative care needs. This will involve conducting interviews or surveys with Chinese patients and families as well as healthcare providers to gain a better understanding of their perspectives on effective communication in palliative care decision-making.

Keywords

Palliative care, End-of-life care, Death, Chinese culture, Quality of life, Healthcare policy, Access to care, Elderly care, Terminal illness, Caregiving, Spirituality and religion.

Literature

In the United States, advanced care planning is a method of facilitating patient autonomy by allowing individuals to make medical decisions. However, in China, where traditional culture is dominant, individual independence is subordinate to other authorities including family values. This conflict between Western-influenced medicine and Chinese traditional medicine could be problematic for those who have advanced care planning as part of their medical treatment plan (Chung et al., 2021). The traditional Chinese medical model focuses on prevention and early diagnosis, as well as treatments that are simple and easy to administer. Hahne et al. (2020) show rather than focusing on curing disease or treating symptoms, it places more importance on preventing illness through lifestyle changes. Because of this, many Chinese people believe that Western medical approaches are not as effective when it comes to treating chronic illnesses like cancer and dementia (Hahne et al., 2020). They also worry that Western medicine will interfere with their religious beliefs or practices. As a result, many people prefer to seek out alternative forms of care such as acupuncture or herbal supplements rather than rely on Western methods. This can lead to delays in treatment due to lack of access or knowledge about available options; however, these delays may be worth it if they help ensure a person can live out their remaining days in comfort as opposed to suffering unnecessarily long periods without adequate treatment options available at home.

It is important to note that Chinese culture does not always negatively affect palliative care decisions. Many positive aspects of Chinese culture can make it easier for patients to accept their treatment options. For example, Chinese people have the "wuxing" concept, which means they believe that each person's body has its energy and essence. They also have a strong belief in the power of "qi," or life energy. This concept explains why many Chinese people use acupuncture and herbal medicine as treatment options for various illnesses. The fact that Chinese culture is not always negative when it comes to palliative care decisions may be because of their strong religious beliefs (Liu et al., 2021). Many Chinese people believe in a form of Buddhism called "Taoism," which states that life is sacred and should be treated with respect and dignity. Therefore, it would be somewhat hard for them to accept any type of terminal illness without some sort of spiritual or religious intervention from friends or family members who may be able to help them deal with their situation more effectively than doctors could alone.

Badanta et al. (2022) write that family members may make decisions about the care of their loved ones based on traditional Chinese values such as filial piety and the desire to maintain a positive image and reputation in the eyes of others. In the context of palliative care, this can lead to care recipients expecting and preparing for care that prioritizes the wishes of their family members over their preferences. They may also be reluctant to discuss their palliative care wishes with healthcare professionals out of a desire to preserve their family's reputation and avoid the taboo subject of death (Badanta et al., 2022).

The challenges of palliative care decisions in China can be difficult to navigate. The Chinese culture places a great deal of emphasis on the importance of respect for elders, and palliative care is often seen as a way to preserve the dignity of the elderly (Cheung et al., 2020). However, there is no clear consensus on what constitutes appropriate palliative care in China. Some believe that “comfort care” should be provided only as long as it does not interfere with a patient's quality of life or ability to make their own decisions about treatment; others believe that comfort care should not be provided at all. Cheung et al, (2020) show there's a language barrier. Many Chinese people don't speak English, so it can be difficult to explain exactly what they need and why. Another challenge is that Chinese culture has a strong emphasis on tradition and family values. This means that patients may not want to accept hospice care—even if they're in pain or experiencing great suffering—because they believe their family will be better off if they die at home with loved ones around them.

One major challenge is access to palliative care services. Palliative care is still a relatively new concept in China, and there is a shortage of trained palliative care providers and specialized facilities.

Moreover, determining the best course of treatment for the individual, as well as managing symptoms and addressing the emotional and spiritual needs of both the care recipient and their family members. This can be further complicated by cultural and linguistic barriers and different beliefs about death and palliative care.

Shi et al. (2019) write how in Chinese culture, there is a strong emphasis on filial piety, which can influence the decision-making process for palliative care. Filial piety is the moral duty and respect that children owe to their parents, and it can be difficult for children to let go of their parents or make decisions that may hasten their death. Additionally, many Chinese individuals may not be open to discussing death and palliative care, as it is often seen as a taboo topic. This can lead to patients receiving care that is not in line with their wishes, or receiving less care than they need (Shi et al., 2019).

Furthermore, traditional Chinese medicine is often a part of Chinese culture. The Chinese culture also has a holistic approach to health and illness, which includes physical, emotional, social, and spiritual aspects. This holistic approach can be challenging to incorporate into Western-style palliative care, which is primarily focused on symptom management and the physical aspects of care.

It is also important to note that Chinese culture is diverse and there are different dialects, customs and traditions across different regions. Moreover, Chinese immigrants living in other countries may have different preferences and expectations for end-of-life care than those living in China.

La et al. (2021) write that to provide effective palliative care for Chinese individuals, healthcare providers should make an effort to understand and respect the cultural beliefs and practices of their patients and work with them to develop a care plan that addresses their physical, emotional, and spiritual needs. This may involve involving a translator, culturally-competent healthcare providers, or traditional Chinese medicine practitioners in the care team (La et al., 2021).

This means that palliative care professionals have to be careful when deciding what kind of care they should give to their patients. They need to make sure that they're providing good care while also respecting cultural norms and traditions around death.

Family caregivers often face challenges when it comes to receiving information about palliative care. Many Chinese people are not aware that palliative care is an option for their loved ones, or they believe that it will be too expensive or too burdensome for them. And even if they do know about palliative care, they may not have access to it. This lack of awareness can lead to misunderstandings between family members and medical professionals, which can make things difficult for both parties. When families don't understand what palliative care is and why their loved ones need it, they may feel that there's nothing more they can do for them than just spending time with them during their final days or weeks before death. But this does not help anyone—it just adds stress and pressure on both sides. The family members that these patients have left behind are often concerned about how their loved ones will be cared for in the final stages of their lives, which is why many families seek out palliative care. In some cases, however, there are serious issues with communication between patient and doctor. Patients' families may not be aware that their loved one has been diagnosed with a terminal illness or do not know how serious their condition is until it is too late. In this situation, it can be difficult for family members to decide whether or not they should seek out palliative care on behalf of their loved one.

In Chinese culture, it is common for people to rely on their immediate family for support when they become ill or disabled. This tradition of relying on one's family extends to caring for those who are deceased. While it is not uncommon for families to request payment from funeral homes, there are few options available to pay for the cost of caring for the deceased during their final days (Ngan et al., 2020).

The Chinese culture has a long history of respecting and honouring the elderly. From ancient to the present day, it is believed that elders are to be treated with respect and dignity, and they are expected to make their own decisions regarding their care. In China, palliative care is not as well-known as in other countries. The elderly are also valued members of society. One study found that 86 per cent of people surveyed said they would prefer to see an old person treated with respect rather than ignored or ostracized by others. This sense of respect is reflected in Chinese culture's view on death. While most Western cultures view dying as a process that must be accepted, many Chinese hold strong beliefs about how to die well.

In recent years, however, there has been an increase in awareness of palliative care among the general population. With this increasing demand for information about palliative care, family carers must also become more aware of what it is and what it can do for them and their loved ones.

Palliative care helps family carers who are experiencing feelings of anxiety or distress by providing them with a place where they can share these feelings with others who understand what they're going through. Through sharing experiences with others who have similar experiences or who have experienced similar situations in their lives, family members gain insight into what they are going through themselves which helps them cope with their emotions better (Chan et al., 2019).

Family carers are often concerned that palliative care is not affordable or accessible to them. The reason for this can be traced back to Chinese culture, which values family relationships as highly as it does the individual autonomy of its citizens. In Chinese society, palliative care providers are seen as "outsiders" who come into the patient's home and interfere with their traditional way of life. This leads to a feeling of distrust, which can make families reluctant to seek out such services, even when they are necessary. Family carers also feel that they have been given less respect than other members of the family in terms of quality of life during illness and death. They worry about being treated poorly by health professionals and losing control over their bodies and minds during this time. Because these concerns are rooted in cultural norms, it may be difficult for them to overcome them on their behalf or through support from health professionals.

The Chinese culture has a strong emphasis on tradition and maintaining harmony with the past. This has led to a lack of formal training in palliative care within the country, which is compounded by the fact that many hospitals are run by the government rather than private organizations. However, this lack of training does not mean that palliative care is not being practised in China. While many hospitals have no formal training programs for palliative care, they have an informal system of communication between doctors and families about end-of-life issues. Deng et al. (2019) show how the emphasis on achieving harmony through avoidance of conflict makes it difficult for patients with terminal illnesses to communicate their needs openly and honestly with their caregivers. This can be especially problematic when patients do not fully understand their situation or are unable to express their needs clearly.

In the past, palliative care was mainly provided by hospitals, but as the Chinese government began to encourage people to retire from their jobs earlier than they would have previously, fewer people have access to healthcare facilities at home. This means that families are forced to seek treatment elsewhere—typically at a hospital in another city or province—which can be very expensive and often difficult to arrange. Palliative care is not included in standard medical insurance plans even though it can be extremely beneficial for patients and their families. Due to these factors, many Chinese people do not know how valuable palliative care is or how it can help them deal with life-threatening illnesses like cancer or heart failure.

Instead, Chinese culture tends to rely on family members or friends as a source of information about how they should treat their loved ones at the end of their lives. While this approach may seem like it would provide families with the best possible option for their loved ones during their final days on earth, it can lead to complications when dealing with serious illnesses such as cancer or other forms of terminal disease that require specialized treatment options outside (Deng et al., 2019).

Research Approach

The Methodological Stance

The “overarching methodological stance” for this research is to use qualitative research methods, specifically in-depth interviews and observations. The interviews will be with professionals working in palliative care and the observations will be of patients and families who have been impacted by palliative care decisions. I am using this method because it allows me to explore the intricacies of Chinese culture and how it affects palliative care decisions. This topic is important because it can help us understand what cultural factors might be contributing to these challenges, and it also has implications for other cultures that may face similar issues.

Philosophical Consideration

The research on how Chinese culture affects palliative care decisions requires a critical examination of the underlying assumptions and beliefs that shape our understanding of both culture and palliative care. This entails recognizing that our knowledge of culture and its impact on healthcare is not fixed, but rather, is constructed through ongoing interactions and interpretations. It requires acknowledging the diversity of cultural beliefs and practices within the Chinese population and the importance of avoiding generalizations and stereotypes. Additionally, it involves recognizing the role of power and privilege in shaping our understanding of culture and healthcare and taking steps to address these power imbalances. Finally, it requires an openness to new perspectives and the willingness to engage in ongoing dialogue and reflection to deepen our understanding of the complex interplay between culture and healthcare. Thus, the research should prioritize cultural sensitivity, ethical considerations, and a reflective approach to the philosophical foundations of the study.

The Approach Taken-Qualitative Or Inductive

In the context of studying the impact of “Chinese culture on palliative care decisions,” an inductive approach is more appropriate. This is because the study aims to explore the experiences and perspectives of individuals within the culture and to generate new insights and understanding about the topic. The use of in-depth interviews and observations allows for a rich and detailed understanding of the cultural factors that shape palliative care decisions and allows for the identification of patterns and themes within the data.

Use of Case Study

Using a case study of smaller organizations would be an appropriate design choice for studying the impact of Chinese culture on palliative care decisions. Conducting a case study of smaller organizations also allows for the examination of the specific context of each organization, including the organizational culture and structure, the types of services provided, and the population served. This can provide valuable insights into how cultural factors are translated into concrete practices and policies within the organizations and how these may vary across different types of organizations.

Methods Chosen

For this research, I have chosen to use mixed methods, which is a suitable choice for studying the impact of Chinese culture on palliative care decisions as it allows for a comprehensive understanding of the topic from multiple perspectives. By using mixed methods, I can triangulate data from different sources and gain a more holistic understanding of the topic. Additionally, mixed methods can also provide a way to test and validate findings from one method with the other.

Research Methods- The Strength and Weakness

The strengths are as follows:

A comprehensive understanding of the topic: By using both quantitative and qualitative methods, mixed methods research allows for a more holistic understanding of the topic.

Detailed examination of the specific context: Conducting a case study of smaller organizations allows for the examination of the specific context of each organization, including the organizational culture and structure, the types of services provided, and the population served. This can provide valuable insights into how cultural factors are translated into concrete practices and policies within the organizations.

Rich and detailed understanding of the cultural factors: Using in-depth interviews and observations allows for a rich and detailed understanding of the cultural factors that shape palliative care decisions and practices within the organizations.

The weaknesses are as follows:

The findings from a case study of smaller organizations may not be generalizable to a larger population or other organizations.

Collecting and analyzing data through in-depth interviews and observations can be time-consuming and resource-intensive.

The interpretation of the data is subjective, and it's based on the researcher's perspective, which may limit the objectivity of the findings.

The integrity of Research and Ethical Issues

I have to be sure of the integrity of the secondary research. The researcher needs to verify that the data has been collected and recorded in an ethical and unbiased manner and that it has been properly stored and maintained. Additionally, to ensure the validity of the data, it is important to assess whether the data is relevant and appropriate for the research question and whether it has been collected using appropriate methods. To ensure the currency of the data, it is important to check the date of data and verify that it is still relevant and up-to-date for the research question. It is also important to consider if there are any recent developments or changes that may have an impact on the data. It is crucial to have a thorough understanding of the data collection methods, sampling techniques, and any limitations of the data set. Additionally, it is important to compare multiple sources of secondary data to triangulate findings and ensure that the data is consistent and reliable.

Method of Analysing the Data

The first step in analysing my data will be to categorize each interview according to its content. This will allow me to identify what types of topics were discussed, as well as how these topics were discussed by each participant and their family members. After categorizing each interview, I will then be able to compare these conversations to see if there are any similarities or differences between them. This will help me determine whether or not any patterns emerge from the data set I have collected from both cultures. Once I have completed this process, I will then be able to compare my findings with other similar studies done in other countries such as America or Australia. This will allow me to conclude whether or not Chinese culture has an effect on palliative care decisions in general.

Research Plan

The research plan should be to identify key events and activities in the research plan that will help understand what Chinese culture means to palliative care patients and their families. The first step in this research plan would be to find out what kind of information people want from a doctor. The researcher could do this by asking people at the Chinese community centre or from any other place where you might find Chinese people. The researcher could also ask people at a hospital if they have any questions about palliative care for their patients. Chapter three will focus on the research methodology. Chapter four will further discuss the results of the sample characteristics, themes and patterns identified in the data with examples and quotes from the data to illustrate key findings. Chapter Five will focus on discussions around the interpretation of the results in light of the literature review. implications for healthcare policy and practice in China and other countries, limitations and strengths of the study and will provide suggestions for future research.

Organization of the Study

The dissertation will be structured in the following manner: chapter one will be the introduction which will discuss the background of the study, research questions and objectives and the significance of the study, chapter two will discuss the overview of palliative care and its development in China, cultural attitudes, beliefs, and practices towards death and dying in China, theoretical frameworks and models for understanding the role of culture in palliative care, challenges and barriers to the provision of palliative care in China, examples of culturally sensitive approaches to palliative care in China and other countries.

Project Plan

The first step in the project plan is to clearly define the research questions and objectives. This will involve a review of the literature on palliative care in China and consultation with experts in the field to identify key areas of inquiry. Determine the study design: The study design will depend on the research questions and objectives. Possible designs include qualitative interviews with patients, caregivers, and healthcare providers, surveys of attitudes towards palliative care, and case studies of palliative care programs in China. Develop a sampling strategy: The sampling strategy will involve identifying the target population, defining inclusion and exclusion criteria, and determining the sample size. Sampling may be stratified by region, ethnicity, and other relevant factors to ensure diversity in the sample. Obtain ethical approval: Ethical approval will need to be obtained from an institutional review board (IRB) before the study can begin. This will involve submitting a detailed protocol that outlines the research questions, study design, sampling strategy, and data collection methods. Recruit study participants: Recruitment will involve reaching out to potential participants through social media, community groups, and healthcare providers. Incentives may be offered to encourage participation. Collect data: Data collection methods will depend on the study design. Qualitative interviews may be conducted in person or over the phone, while surveys may be administered online or in person. Analyze data: Data analysis will involve coding and categorizing qualitative data and conducting statistical analysis of survey data. Interpretation of the data will be guided by the research questions and objectives. Develop a report: The final step will be to develop a report that summarizes the study findings, interprets the data, and makes recommendations for policy and practice. The report may also include a literature review, methodology section, and appendices with data tables and interview transcripts. Disseminate the findings: The findings of the study will be disseminated through academic conferences, peer-reviewed publications, and other relevant outlets. This will help to raise awareness of the role of palliative care in Chinese culture and inform policy and practice,

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