Abstract
Context
There is rapidly increasing need for palliative care in Greater China because of rapidly
aging populations.
Objectives
This study aimed to systematically review and appraise evidence for palliative care
needs, models of care, interventions, and outcomes in Greater China.
Methods
Four databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) were searched, with hand searching
of local journals and databases. Narrative synthesis was applied to the qualitative
and quantitative evidence.
Results
Nineteen qualitative studies and 47 quantitative studies were retained. With respect
to care needs, nine themes were synthesized: pain control, reduced aggressive end-of-life
care, truth telling, physical, emotional, and spiritual supports, and achieving preferred
place of care/death. Informal caregivers expressed their needs for education and burden
reduction. Health care professionals called for training and national policy support.
Twenty-four studies evaluated interventions, mostly among patients with advanced cancer.
Positive effects were suggested for improvements in quality of life, pain, anxiety
and depression, readmission rate, and costs. Models of care evaluated were mostly
specialist palliative care delivered in various settings (hospitals, residential care,
and home). Outcome measures used were grouped into six categories of construct: quality
of life, pain, physical assessment, psychospiritual assessment, quality of care, and
implementation assessment. Limited rigorous randomized controlled trials are available
to document intervention outcomes, and some problems (such as high attrition rates)
reduced the strength of the evidence.
Conclusion
Palliative care services within Greater China should pay more attention to management
of nonmalignant disease and to integration into primary services. Policy support is
key to establishing culturally appropriate person-centered services.
Key Words
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References
- Advancing palliative care as a human right.J Pain Symptom Manage. 2009; 38: 767-774
- Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report.Lancet. 2018; 391: 1391-1454
- The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions.Lancet Glob Health. 2019; 7: e883-e892
- Universal health coverage.(Available from)http://www.who.int/mediacentre/factsheets/fs395/en/Date accessed: April 29, 2020
- The 58th World Health Assembly adopts resolution on cancer prevention and control.(Available from)http://www.who.int/mediacentre/news/releases/2005/pr_wha05/en/index.htmlDate accessed: April 29, 2020
- Developing a concept of workplace well-being for greater China.Social Indicators Res. 2009; 91: 59-77
- Initial job choice in the greater China region: the role of corporate social responsibility.J Gen Manage. 2016; 41: 53-70
- Work stressors, Chinese coping strategies, and job performance in Greater China.Int J Psychol. 2010; 45: 294-302
- Randomized, controlled trials, observational studies, and the hierarchy of research designs.N Engl J Med. 2000; 342: 1887-1892
- Cardiopulmonary resuscitation in a super-aging society- is there an age limit for cardiopulmonary resuscitation?.Circ J. 2016; 80: 1102-1103
- Exploring the challenges of implementing palliative care in China.Eur J Palliat Care. 2017; 24: 12-17
- Palliative care in South Asia: a systematic review of the evidence for care models, interventions, and outcomes.BMC Res Notes. 2015; 8: 172
- The needs, models of care, interventions and outcomes of palliative care in the Caribbean: a systematic review of the evidence.BMC Palliat Care. 2016; 15: 9
- Palliative care in sub-Saharan Africa.Lancet. 2005; 365: 1971-1977
- A systematic review of palliative care intervention outcomes and outcome measures in low-resource countries.J Pain Symptom Manage. 2018; 55: 1382-1397.e7
- End-of-life care research in Hong Kong: a systematic review of peer-reviewed publications.Palliat Support Care. 2015; 13: 1711-1720
- Hospice and palliative care research in mainland China: current status and future direction.Palliat Med. 2019; 33: 1127-1128
- Current research status of palliative care in mainland China.J Palliat Care. 2018; 33: 215-241
- Connor S.R. Sepulveda Bermedo M.C. Global atlas of palliative care at the end of life. Worldwide Palliative Care Alliance and World Health Organization, London2014
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Ann Intern Med. 2009; 151 (W64): 264-269
- Discovering the hidden benefits of cognitive interviewing in two languages.Palliat Med. 2016; 30: 599-610
- Palliative care model of care - western Australia health.(Available from)https://ww2.health.wa.gov.au/∼/media/Files/Corporate/general%20documents/Health%20Networks/Palliative%20care/Palliative-Care-Model-of-Care.pdfDate: 2008Date accessed: December 23, 2019
- Thinking outside the black box: the importance of context in understanding the impact of a preoperative education nursing intervention among Chinese cardiac patients.Patient Education Couns. 2014; 95: 365-370
- Using thematic analysis in psychology.Qual Res Psychol. 2006; 3: 77-101
- Preoperative education interventions to reduce anxiety and improve recovery among cardiac surgery patients: a review of randomised controlled trials.J Clin Nurs. 2015; 24: 34-46
- Self-management education programs for age-related macular degeneration: a systematic review.Australas J Ageing. 2008; 27: 170-176
- The Perceived needs of the hospitalized terminal cancer patients.Tzu Chi Med J. 1997; 9: 295-305
- Defining the content domain of health-related quality of life for terminally ill cancer patients.Nurs Res. 1999; 7: 129-144
- Accepting the timing of one's death: an experience of Chinese hospice patients.Omega: J Death Dying. 2002; 45: 245-260
- Perceptions of dyspnea and helpful interventions during the advanced stage of lung cancer: Chinese patients' perspectives.Cancer Nurs. 2007; 30: E1-E8
- The lived experiences of spiritual suffering and the healing process among Taiwanese patients with terminal cancer.J Clin Nurs. 2008; 17: 735-743
- Spiritual needs of Taiwan's older patients with terminal cancer.Oncol Nurs Forum. 2009; 36: E31-E38
- Healthcare professionals' perceptions of existential distress in patients with advanced cancer.J Adv Nurs. 2010; 66: 1510-1522
- The meaning of spirituality and spiritual care among the Hong Kong Chinese terminally ill.J Adv Nurs. 2010; 66: 360-370
- Attitudes of oncology medical staff on advance directives for advanced cancer patients: a qualitative study.Med Philos. 2011; 32: 1-4
- Perceptions of a life review programme among Chinese patients with advanced cancer.J Clin Nurs. 2012; 21: 564-572
- Dignity amidst liminality: healing within suffering among Chinese terminal cancer patients.Death Stud. 2013; 37: 953-970
- Clinical presentations and mechanisms of fear of death in patients with terminal cancer on admission at a palliative care unit.Taiwan J Hosp Palliat Care. 2014; 19: 125-137
- Caring for dying cancer patients in the Chinese cultural context: a qualitative study from the perspectives of physicians and nurses.Eur J Oncol Nurs. 2016; 21: 189-196
- Psychological reactions and needs for dying cancer patients: a qualitative study.Guide China Med. 2017; 15: 50-52
- A preliminary study on patients with dementia's end-of-life caring pattern.Taiwan J Hosp Palliat Care. 2017; 22: 27-43
- Beyond death and dying: how Chinese spouses navigate the final days with their loved ones suffering from terminal cancer.Support Care Cancer. 2018; 26: 261-267
- The understanding of death in terminally ill cancer patients in China: an initial study.Camb Q Healthc Ethics. 2018; 27: 421-430
- The experience of caring for patients at the end-of-life stage in non-palliative care settings: a qualitative study 11 medical and health sciences 1117 public health and health services 11 medical and health sciences 1110 nursing.BMC Palliat Care. 2018; 17: 116
- The experience of caregivers participating in terminal cancer patient's family conferences: a qualitative study.J Nurs Sci. 2018; 24: 5-7
- Patient-related barriers to cancer pain management in a palliative care setting in Hong Kong.Cancer Nurs. 1999; 22: 196-203
- The impact of hospice inpatient care on the quality of life of patients terminally ill with cancer.Cancer Nurs. 1999; 22: 350-357
- Holistic outcome measurement for terminally ill cancer patients in medical centers in Taiwan.J Nurs Res. 2001; 9: 43-56
- Terminal cancer patients' wishes and influencing factors toward the provision of artificial nutrition and hydration in Taiwan.J Pain Symptom Manage. 2004; 27: 206-214
- Why Taiwanese hospice patients want to stay in hospital: health-care professionals' beliefs and solutions.Support Care Cancer. 2004; 12: 285-292
- Concordance of preferences for end-of-life care between terminally ILL cancer patients and their family caregivers in Taiwan.J Pain Symptom Manage. 2005; 30: 510-518
- Congruence of knowledge, experiences, and preferences for disclosure of diagnosis and prognosis between terminally-ill cancer patients and their family caregivers in Taiwan.Cancer Invest. 2006; 24: 360-366
- Quality of life of patients with terminal cancer receiving palliative home care.J Palliat Care. 2006; 22: 261-266
- Appropriateness of cancer pain management for non-hospice terminally ill cancer patients in Taiwan.J Chin Oncol Soc. 2006; 22: 1-29
- Attitude of families of advanced cancer patients in Macau towards prognosis disclosure.Macau J Nurs. 2007; 6: 9-14
- Prevalence, detection and treatment of delirium in terminal cancer inpatients: a prospective survey.Jpn J Clin Oncol. 2008; 38: 56-63
- Patient awareness of prognosis, patient-family caregiver congruence on the preferred place of death, and caregiving burden of families contribute to the quality of life for terminally ill cancer patients in Taiwan.Psychooncology. 2008; 17: 1202-1209
- Symptom burden and quality of life in end-stage renal disease: a study of 179 patients on dialysis and palliative care.Palliat Med. 2009; 23: 111-119
- What really matters in pain management for terminally ill cancer patients in Taiwan.J Palliat Care. 2010; 26: 151-158
- Being aware of the prognosis: how does it relate to palliative care patients' anxiety and communication difficulty with family members in the Hong Kong Chinese context?.J Palliat Med. 2011; 14: 997-1003
- Quality of life in Chinese home-based advanced cancer patients: does awareness of cancer diagnosis matter?.J Palliat Med. 2011; 14: 1104-1108
- The meaning of life intervention for patients with advanced-stage cancer: development and pilot study.Oncol Nurs Forum. 2012; 39: E480-E488
- Report on quality of life for 691 patients with advanced cancer accepting hospice care in mainland China.Tumor. 2012; 10: 828-832
- A survey of terminal cancer patients' truth telling and their emotional distress.Taiwan J Hosp Palliat Care. 2012; 17: 288-299
- Development and pilot evaluation of a novel dignity-conserving end-of-life (EoL) care model for nursing homes in Chinese societies.Gerontologist. 2013; 56: 578-589
- Hospice offers more palliative care but costs less than usual care for terminal geriatric hepatocellular carcinoma patients: a nationwide study.J Palliat Med. 2013; 16: 780-785
- The evaluation of a palliative care programme for people suffering from life-limiting diseases.J Clin Nurs. 2014; 23: 113-123
- Determinants of preference for home death among terminally ill patients with cancer in Taiwan: a cross-sectional survey study.J Nurs Res. 2014; 22: 37-44
- The preference of place of death and its predictors among terminally ill patients with cancer and their caregivers in China.Am J Hosp Palliat Care. 2015; 32: 835-840
- The relationship between pain management and psychospiritual distress in patients with advanced cancer following admission to a palliative care unit Cancer palliative care.BMC Palliat Care. 2015; 14: 69
- Preferences for aggressive end-of-life care and their determinants among Taiwanese terminally Ill cancer patients.Cancer Nurs. 2015; 38: E9-E18
- Impact of home hospice care on patients with advanced lung cancer: a longitudinal population-based study in Taiwan.J Palliat Med. 2016; 19: 380-386
- Symptom severity of patients with advanced cancer in palliative care unit: longitudinal assessments of symptoms improvement.BMC Palliat Care. 2016; 15: 32
- Associations of prognostic awareness/acceptance with psychological distress, existential suffering, and quality of life in terminally ill cancer patients' last year of life.Psychooncology. 2016; 25: 455-462
- Preferences for life-sustaining treatments and associations with accurate prognostic awareness and depressive symptoms in terminally Ill cancer patients' last year of life.J Pain Symptom Manage. 2016; 51: 41-51
- Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial.Heart. 2016; 102: 1100-1108
- Spiritual well-being may reduce the negative impacts of cancer symptoms on the quality of life and the desire for hastened death in terminally ill cancer patients.Cancer Nurs. 2016; 39: E43-E50
- Improvement in pain control in palliative/hospice home care: experience of a single hospital.Taiwan J Pain. 2016; 26: 1-8
- Impact of high self-perceived burden to others with preferences for end-of-life care and its determinants for terminally ill cancer patients: a prospective cohort study.Psychooncology. 2017; 26: 102-108
- The effect of using an electric fan on dyspnea in Chinese patients with terminal cancer: a randomized controlled trial.Am J Hosp Palliat Med. 2017; 34: 42-46
- Changes in and modifiable patient- and family caregiver-related factors associated with cancer patients' high self-perceived burden to others at the end of life: a longitudinal study.Eur J Cancer Care. 2018; 27: e12942
- Effects of a home-based palliative heart failure program on quality of life, symptom burden, satisfaction and caregiver burden: a randomized controlled trial.J Pain Symptom Manage. 2018; 55: 1-11
- Cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure.Palliat Med. 2018; 32: 476-484
- The effect of music therapy on pain in palliative care gynecologic cancer patients.Med Philos. 2018; 39: 94-97
- The effectiveness of a nurse-led short term life review intervention in enhancing the spiritual and psychological well-being of people receiving palliative care: a mixed method study.Int J Nurs Stud. 2019; 91: 134-143
- Advance care planning improves psychological symptoms but not quality of life and preferred end-of-life care of patients with cancer.JNCCN J Natl Compr Cancer Netw. 2019; 17: 311-320
- Accurate prognostic awareness and preference states influence the concordance between terminally ill cancer patients' states of preferred and received life-sustaining treatments in the last 6 months of life.Palliat Med. 2019; 33: 1069-1079
- Nurse-rated good death of Chinese terminally ill patients with cancer: a cross-sectional study.Eur J Cancer Care (Engl). 2019; 28: e13147
- The effect of nutritional support combined with palliative care on the nutritional status and quality of life for cancer patients.Lab Med Clinic. 2019; 16: 2550-2553
- The interventional effect of advanced care planning on patients with terminally malignancies.Chin J Gerontol. 2019; 7: 1739-1741
- Consistency on end-of-life decision-making in terminal stage patients and their families.J Nurs Sci. 2019; 10: 80-83
- Preferences for place of death and predictors among patients with advanced malignant cancer.J Nurs Sci. 2019; 15 (94): 78-80
- Cross-cultural validation of the McGill quality of life questionnaire in Hong Kong Chinese.Palliat Med. 2001; 15: 387-397
- Elements of effective palliative care models: a rapid review.BMC Health Serv Res. 2014; 14: 136
- Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, The Netherlands, Portugal and Spain.Ann Oncol. 2012; 23: 2006-2015
- Effect of specialist palliative care services on quality of life in adults with advanced incurable illness in hospital, hospice, or community settings: systematic review and meta-analysis.BMJ. 2017; 357: j2925
- Improving access to adequate pain management in Taiwan.Acta Anaesthesiol Taiwan. 2015; 53: 62-65
- Concurrent use of conventional drugs with Chinese herbal products in Taiwan: a population-based study.J Tradit Complement Med. 2013; 3: 256-262
- Prescribed opioids adherence among Taiwanese oncology outpatients.Pain Manag Nurs. 2013; 14: 155-160
- Cross sectional study of use of alternative medicines in Chinese cancer patients.Jpn J Clin Oncol. 1997; 27: 37-41
- Chinese herbal medicine for symptom management in cancer palliative care: systematic review and meta-analysis.Medicine (Baltimore). 2016; 95: e2793
- Systematic review of the Face, Legs, Activity, Cry and Consolability scale for assessing pain in infants and children: is it reliable, valid, and feasible for use?.Pain. 2015; 156: 2132-2151
- Advance directive and end-of-life care preferences among Chinese nursing home residents in Hong Kong.J Am Med Dir Assoc. 2011; 12: 143-152
- From cure to care: the development of hospice care in Taiwan.Hosp Palliat Med Int J. 2018; 2: 286-289
- Has end-of-life decisions or advance directives become an economic strategy to contain health care cost as much as a way to respect patientá s informed consent and private autonomy rights?-what can we learn from the american advance care model?.(Available from)https://repositorio.ucp.pt/bitstream/10400.14/27119/1/Raquel_Alves_Master_Thesis_MTL_30-04-2018.pdfDate accessed: April 29, 2020
- Palliative care in mainland China.Asia Pac J Health Manag. 2013; 8: 9
- Palliative and end-of-life care in the African American community.JAMA. 2000; 284: 2518-2521
- Feasibility and acceptability of a culturally adapted advance care planning intervention for people living with advanced cancer and their families: a mixed methods study.Palliat Med. 2020; 34: 651-666
- The conceptual models and mechanisms of action that underpin advance care planning for cancer patients: a systematic review of randomised controlled trials.Palliat Med. 2019; 33: 5-23
- Theoretical issues associated with cultural readiness for end-of-life care planning in Taiwan.J Social Behav Personal Int J. 2015; 43: 1385-1393
- Casebook on ethical decision-making in end-of-life care of older adults.(Available from)
- Attitudes towards advance care planning and healthcare autonomy among community-dwelling older adults in Beijing, China.Biomed Res Int. 2015; 2015: 453932
Article info
Publication history
Published online: September 08, 2020
Accepted:
August 24,
2020
Identification
Copyright
© 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
