BackgroundOnly a small number of patients have utilized the home-based end-of-life care service in Shanghai that has been offered since 2012. This study explores how home-based end-of-life care is delivered in community health service centers in Shanghai and examines the difficulties in the delivery of the care.MethodsThis was a qualitative study in which data were collected from interviews and analyzed using qualitative content analysis. Nineteen health care providers with experience in delivering home-based end-of-life care in 12 community health service centers were recruited. The interviews were conducted between August 2018 and February 2019.ResultsFour themes emerged from the interviews: (i) Patients under home-based end-of-life care: Patients receiving the care were cancer patients with less than 1 year of life expectancy. The criteria for patients were broad. (ii) Service structure: The service was delivered regularly by the physicians and nurses using the approaches of home visits and/or telephone follow-ups. (iii) Service process: The service consisted of multiple components, including monitoring the patient’s condition, managing the patient’s symptoms, giving daily care instructions, performing nursing procedures, and giving psychological support. However, most of the care focused on monitoring the patients and managing their physical discomfort. (iv) Difficulties in delivering care: Being unable to provide the service and feeling powerless when facing psycho-spiritual problems were the two major difficulties. Three factors contributed to the suspension of the service: The gap between the service and the needs of the patients, a lack of patients, and low work motivation. The demand that the truth be concealed from the families and their attitude of avoiding talking about death were the key factors of the failure of psycho-spiritual care.ConclusionsSeveral issues should be addressed before the service can be further developed, including fully understanding the needs and preferences of local patients and their families, securing more financial support and a better supply of drugs, delivering better training for staff, and ensuring greater rewards for individuals and institutions providing the service.

Aim To explore the experience of dealing with defecation dysfunction by changing the eating behaviours of people with rectal cancer following sphincter‐saving surgery. Design The descriptive qualitative design was applied. Methods Individual semi‐structured interviews were conducted with 36 purposively selected rectal cancer survivors who had experienced sphincter‐saving surgery. All interviews were recorded and transcribed verbatim. The thematic analysis was used to structure the data analysis. Results Three major themes, namely “have motivations to change diet”; “need strategies to change diet” and “face barriers to change diet” were generated along with 12 subthemes. Overall, needing to change one's dietary behaviour is the most important theme in addressing defecation dysfunction in patients following sphincter‐saving surgery. Future studies need to focus more on the specific relationship between different food types and the degree of defecation dysfunction. Systematic, scientific and continuous instructions on eating behaviour are in great need for patients after sphincter‐saving surgery.

Despite the large number of people with cancer who need hospice care, utilization rates at community hospice service in Shanghai are low. This study aimed to review the care provided in these hospice wards and examine the difficulties in delivering service. Fourteen hospice care providers were interviewed, and the data analyzed using qualitative content analysis. Three themes emerged from the interviews: (i) characteristics of hospice patients, mostly cancer patients at the end-of-life stage (within 3-months of life expectancy) who were admitted without awareness of their condition; (ii) components of care, from physicians and nurses who focused mainly on physical problems as psycho-spiritual care stagnated at a superficial level; and (iii) difficulties in care, including a lack of patients as well as inadequacies in service, along with suggestions for the future. Efforts at improvement should be made in both the health care system and society. To address the lack of patients, doctors in secondary/tertiary care hospitals need improved skills in discussing end-of-life care, while the general public needs better awareness and acceptance of hospice care. Solutions should respect the perspective of patients and their families, while hospice care providers must also enhance their skills of communication and psycho-spiritual care. K E Y W O R D S health care delivery, health service administration, hospice care, qualitative studies end of life communication psychosocial care 1 | INTRODUCTION Hospice care, as a part of palliative care which focuses on patients at the end-of-life stage and their families, has been drawing attention with an increasing number of patients worldwide. However, not all patients receive hospice care at the end-of-life stage even in areas where the service is well developed. A population-based study found that 64.6% of patients received the service at the end-of-life stage in a metropolitan city of the United Kingdom (Craigs, West, Hurlow, Bennett, & Ziegler, 2018). Another population-based study in the United States reported that 76.1% of Texas Medicare beneficiaries received hospice care in their last month (Elting, Liao, Giordano, & Guadagnolo, 2019). A retrospective study reported that 50% of 7857 cancer decedents received hospice care in a hospital in Taiwan (Shih et al., 2017). A nationalwide study reported that 57% of patients in France received inpatient palliative care during their last month (Janah et al., 2019). A Belgian survey found that 63% of the older people who had died had used palliative care in the last few months (Penders, Gilissen, Moreels, Deliens, & Van den Block, 2017). These findings suggest that underutilization of hospice care is a common phenomenon in different countries. Low utilization of hospice care was found in Shanghai, the target city of this study, a metropolis in mainland China of 24 million people.

Dietary self-management is an important strategy for controlling bowel symptoms after sphincter-saving surgery; however, the dietary factors influencing bowel symptoms are not completely clear. This study aimed to explore the relationship between the specific consumption of food components and bowel symptoms. This study applied a cross-sectional study design. Using convenience sampling, a total of 169 patients with rectal cancer after sphincter-saving surgery were selected from a tertiary hospital. Data were collected through three questionnaires, including general and treatment-related questionnaires, the Memorial Sloan Kettering Cancer Center (MSKCC) bowel function scale—Chinese version, and the Food Frequency Questionnaire. Multiple linear regression analysis was used to analyze the collected data. It was found that the consumption of fruit, cholesterol, and protein and the interaction of cereals and milk products were the main dietary factors affecting bowel symptoms in patients after sphincter-saving surgery. The consumption of protein and fruit was negatively correlated with the symptoms of frequent and urgent defecation, and the consumption of fruit and protein was negatively correlated with general bowel function. The consumption of fruit was negatively correlated with the abnormal feeling of defecation, and the interaction between cereals and milk products was positively correlated with the abnormal feeling of defecation. The results of this study provide evidence for medical staff to further develop scientific dietary education programs to relieve bowel symptoms and promote the quality of life of patients in the future. More research is also needed to explore the mechanisms of the effects of different food components on bowel symptoms in patients after sphincter-saving surgery in the future.

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