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Clinicians’ practices and attitudes regarding advance care planning in mainland China: A multicenter cross-sectional survey

Published online by Cambridge University Press:  14 March 2022

Siyu Cai ,
Xianjing Wang ,
Ruixin Wang ,
Yuchen Zhou ,
Xuan Zhou Open the ORCID record for Xuan Zhou [Opens in a new window]  and
Xiaoxia Peng
Siyu Cai
Affiliation:
Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
Xianjing Wang
Affiliation:
Hematology, The Third People's Hospital of Zhengzhou, Henan 450000, China
Ruixin Wang
Affiliation:
Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
Yuchen Zhou
Affiliation:
Pediatric Oncology Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
Xuan Zhou*
Affiliation:
Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
Xiaoxia Peng
Affiliation:
Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
*
Author for correspondence: Xiaoxia Peng, Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China. E-mail: pengxiaoxia@bch.com.cn; Xuan Zhou, Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China. E-mail: bchppc@163.com
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Abstract

Objectives

This study aims to explore clinicians’ practices and attitudes regarding advance care planning (ACP) in mainland China.

Methods

This study was a multicenter cross-sectional survey. Clinicians from tertiary hospitals in Beijing, Guangxi, and Inner Mongolia were invited to participate in the study. A questionnaire was formulated based on related literature to obtain information including demographic characteristics, and practices and attitudes toward ACP.

Results

The total number of participants included 285 clinicians. The data response rate was 84.57%. Most of the clinicians had an inadequate understanding of ACP. Only a few clinicians had experience in participating or witnessing an ACP or related end-of-life discussions. Among 285 clinicians, 69.82% of clinicians were willing to introduce ACP to patients. Two hundred and thirty-eight (83.51%) clinicians wanted more education on ACP. Almost all clinicians believed that patients had the right to know about their diagnosis, prognosis, and available care options. Most clinicians (82.11%) regarded that ACP was partially feasible in mainland China. If clinicians had a serious illness, almost everyone was willing to find out their true health status and decide for themselves, and 81.40% wanted to institute an ACP for themselves. The biggest barriers to the use of ACP in mainland China were cultural factors. Statistical analysis revealed that some or good understanding level (P = 0.0052) and practical experience (P = 0.0127) of ACP were associated with the positive willingness.

Significance of results

ACP is still in its infancy in mainland China. Clinicians had inadequate understanding and minimal exposure to ACP. Most clinicians recognized the value and significance of ACP and had a positive attitude toward ACP. Clinicians need to be provided with education and training to promote their ACP practices. Culturally appropriate ACP processes and documents need to be developed based on Chinese culture and Chinese needs.

Keywords

Advance care planningCliniciansChina
Type
Original Article
Information
Palliative & Supportive Care , Volume 21 , Issue 3 , June 2023 , pp. 477 - 482
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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Footnotes

*

Xuan Zhou and Xiaoxia Peng contributed equally to this work.

References

REFERENCES

Best, M, Butow, P and Olver, I (2014) The doctor's role in helping dying patients with cancer achieve peace: A qualitative study. Palliative Medicine 28(9), 1139–1145.CrossRefGoogle ScholarPubMed
Brown, BA (2003) The history of advance directives. A literature review. Journal of Gerontological Nursing 29(9), 4–14.CrossRefGoogle ScholarPubMed
Cai, S, Guo, Q, Luo, Y, et al. (2020) Spiritual needs and communicating about death in nonreligious theistic families in pediatric palliative care: A qualitative study. Palliative Medicine 34(4), 533–540.CrossRefGoogle ScholarPubMed
Chaitin, E and Rosielle, DA (2013) Responding to requests for nondisclosure of medical information. Journal of Palliative Medicine 16(3), 320–321.CrossRefGoogle ScholarPubMed
Cheng, HW, Li, CW, Chan, KY, et al. (2014) Bringing palliative care into geriatrics in a Chinese culture society—Results of a collaborative model between palliative medicine and geriatrics unit in Hong Kong. Journal of the American Geriatrics Society 62(4), 779–781.CrossRefGoogle Scholar
Cheng, HB, Shek, PK, Man, CW, et al. (2019) Dealing with death taboo: Discussion of do-not-resuscitate directives with Chinese patients with noncancer life-limiting illnesses. American Journal of Hospice & Palliative Care 36(9), 760–766.CrossRefGoogle ScholarPubMed
Coleman, AM (2013) Physician attitudes toward advanced directives: A literature review of variables impacting on physicians attitude toward advance directives. American Journal of Hospice & Palliative Care 30(7), 696–706.CrossRefGoogle ScholarPubMed
Gu, X, Chen, M, Liu, M, et al. (2016) End-of-life decision-making of terminally ill cancer patients in a tertiary cancer centre in Shanghai, China. Supportive Care in Cancer 24(5), 2209–2215.CrossRefGoogle Scholar
Heyland, DK, Cook, DJ, Rocker, GM, et al. (2010) Defining priorities for improving end-of-life care in Canada. Canadian Medical Association Journal 182(16), E747–E752.CrossRefGoogle ScholarPubMed
Howard, M, Bernard, C, Slaven, M, et al. (2020) Primary care clinicians’ confidence, willingness and participation in advance care planning discussions: A multi-site survey. Family Practice 37(2), 219–226.Google ScholarPubMed
Juliá-Sanchis, R, García-Sanjuan, S, Zaragoza-Martí, M, et al. (2019) Advance healthcare directives in mental health: A qualitative analysis from a Spanish healthcare professional's viewpoint. Journal of Psychiatric and Mental Health Nursing 26(7–8), 223–232.CrossRefGoogle ScholarPubMed
Kang, L, Liu, XH, Zhang, J, et al. (2017) Attitudes toward advance directives among patients and their family members in China. Journal of the American Medical Directors Association 18(9), 808.e7–808.e11.CrossRefGoogle ScholarPubMed
Lee, MC, Auth, R, Hinderer, KA, et al. (2017) Challenges to advance care planning among multidisciplinary health professionals in China. International Journal of Palliative Nursing 23(11), 552–557.CrossRefGoogle ScholarPubMed
Luk, Y, Ngai, C, Chau, SS, et al. (2015) Clinicians’ experience with and attitudes toward discussing advance directives with terminally ill patients and their families in a Chinese community. Journal of Palliative Medicine 18(9), 794–798.CrossRefGoogle Scholar
Nakazawa, K, Kizawa, Y, Maeno, T, et al. (2014) Palliative care physicians’ practices and attitudes regarding advance care planning in palliative care units in Japan: A nationwide survey. American Journal of Hospice & Palliative Care 31(7), 699–709.CrossRefGoogle ScholarPubMed
Sinuff, T, Dodek, P, You, JJ, et al. (2015) Improving end-of-life communication and decision making: The development of a conceptual framework and quality indicators. Journal of Pain and Symptom Management 49(6), 1070–1080.CrossRefGoogle ScholarPubMed
Sudore, RL, Lum, HD, You, JJ, et al. (2017) Defining advance care planning for adults: A consensus definition from a multidisciplinary Delphi panel. Journal of Pain and Symptom Management 53(5), 821–832.CrossRefGoogle ScholarPubMed
Tang, MY, Li, XL, Shi, ZY, et al. (2020) Knowledge of and willingness to promote advanced care planning among oncology nurses in southwest China. International Journal of Palliative Nursing 26(4), 175–182.CrossRefGoogle ScholarPubMed
Teno, J, Lynn, J, Wenger, N, et al. (1997) Advance directives for seriously ill hospitalized patients: Effectiveness with the patient self-determination act and the SUPPORT intervention. Journal of the American Geriatrics Society 45(4), 500–507.CrossRefGoogle ScholarPubMed
Xu, Y (2007) Death and dying in the Chinese culture: Implications for health care practice. Home Health Care Management & Practice 19(5), 412–414.CrossRefGoogle Scholar
Ye, G, Mao, J, Hu, J, et al. (2019) Palliative care medical student education: A cross-sectional medical school survey in mainland China. BMJ Supportive and Palliative Care, bmjspcare-2019-002044.Google ScholarPubMed
Zadeh, S, Pao, M and Wiener, L (2015) Opening end-of-life discussions: How to introduce voicing My CHOiCES, an advance care planning guide for adolescents and young adults. Palliative & Supportive Care 13(3), 591–599.CrossRefGoogle ScholarPubMed