A qualitative study of caring in hospice wards in Shanghai

Chen, Shu Hui; Lai, Xiao Bin; Chen, Liqun; Xia, Hai Ou; Chen, Chun Yan

doi:10.1111/nhs.12797

Cited by 5 publications

(6 citation statements)

References 34 publications

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“…The lowest utilization rate among the 16 districts was less than 20% [ 8 ]. Similar findings were echoed in other studies [ 9 , 10 ]. Thus, the utilization of hospice care is unsatisfactory.…”

Section: Introductionsupporting

confidence: 92%

Hospice preference of the family decision-makers for cancer patients in China: an exploratory study

2022

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Background The reasons for hospice underuse in China need exploration from the perspective of patients with cancer and their families. Furthermore, existing literature about hospice decision-making among Chinese families with cancer patients is limited. This study aimed to investigate the awareness of hospice care among families with cancer patients, their preference for healthcare at the end-of-life stage of care, and the predictors of hospice preference. Methods This was an exploratory study conducted between July 2021 and January 2022. Overall, 300 decision-makers of cancer patients were recruited from the oncology ward of seven hospitals in Shanghai, China. Of these, 285 valid responses were included in the data analysis. A self-developed questionnaire about their preference for healthcare when the patient was at the end-of-life stage was completed. Descriptive analysis, t-test, chi-square test, and multivariable logistic regression were conducted to analyze the data. Results Only 46.0% of the participants have heard of hospice care. Most participants (78.2%) reported no introduction to hospice care from their doctors. More than half of the participants (58.2%) did not have a preference for healthcare at the end-of-life stage. Seventy-eight (65.5%) of the 119 participants who had a preference chose hospice care, and the other 41 participants (34.5%) refused hospice care. Having heard of hospice care had a significant impact on preferring healthcare at the end-of-life stage (adjusted OR = 14.346, 95%CI 7.219–28.509, p < 0.001). Not being sure whether the doctor introduced hospice care before had a significant impact on having no preference for healthcare at the end-of-life stage (adjusted OR = 0.180, 95%CI 0.052–0.617, p = 0.006). Another family member being cared for at home had a significant impact on the participants’ hospice preference (adjusted OR = 2.739, 95%CI 1.159–6.470, p = 0.022). Conclusion The end-of-life communication between healthcare providers and the families of cancer patients is insufficient. More efforts should be made in increasing the awareness of hospice care among patients with cancer and their families. Further study is needed to explore the reasons for a lack of discussion on hospice options between healthcare providers and the patients’ families. Additionally, the impact of the at-home care burden on the hospice choice of families with cancer patients requires further study.

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Section: Introductionsupporting

confidence: 92%

Hospice preference of the family decision-makers for cancer patients in China: an exploratory study

2022

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“…Similar ndings were echoed in other studies [8,9]. Thus, the utilization of hospice care is unsatisfactory.…”

supporting

confidence: 87%

“…A local study found that the di culty of the hospice service came from the aspects of patients and their families, healthcare providers, the healthcare system, and policy and regulations from the perspective of hospice care providers were some factors contributing to the underuse of hospice services [10]. Hospice care providers suggested that the unawareness of hospice care of the patients and their families as well as their unacceptance was a key factor impending their use of hospice care [10]. However, this must be further analyzed from the perspective of the patients and their families.…”

mentioning

confidence: 99%

Hospice preference among families with cancer patients in China: An exploratory study

Yao

Chen

Lai

2022

Preprint

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Background: The reasons for hospice underuse in China needs exploration from the perspective of patients with cancer and their families. Furthermore, existing literature about hospice decision-making among Chinese families with cancer patients is limited. This study aimed to investigate the awareness of hospice care among families with cancer patients, their preference of healthcare at the end-of-life stage of care, and the predictors of hospice preference.Methods: This was an exploratory study conducted between July 2021 and January 2022. Overall, 300 decision-makers of cancer patients were recruited from the oncology ward of seven hospitals in Shanghai, China. Of these, 285 valid responses were included in the data analysis. A self-developed questionnaire about their preference of healthcare when the patient was at the end-of-life stage was completed. Descriptive analysis, t-test, chi-square test, and logistic regression were conducted to analyze the data.Results: Only 29.7% of the participants had heard of hospice care. Most participants (78.2%) reported no introduction of hospice care from their doctors. More than half of the participants (58.2%) did not have a preference of healthcare at the end-of-life stage. Seventy-eight (65.5%) of the 119 participants who had a preference chose hospice care, and the other 41 participants (34.5%) refused hospice care. Having heard of hospice care had a significant impact on having a preference for healthcare at the end-of-life stage (OR=14.346, 95%CI 7.219-28.509, p<0.001). Not being sure whether the doctor introduced hospice care before had a significant impact on having no preference for healthcare at the end-of-life stage (OR=0.180, 95%CI 0.052-0.617, p=0.006). Another family member being cared for at home had a significant impact on the participants’ hospice preference (OR=2.739, 95%CI 1.159-6.470, p=0.022).Conclusion: The end-of-life communication between healthcare providers and the families of cancer patients is insufficient. More efforts should be made in increasing the awareness of hospice care among patients with cancer and their families. Further study is needed to explore the reasons for a lack of discussion on hospice options between healthcare providers and the families. Additionally, the impact of at-home care burden on the hospice choice of families with cancer patients requires further study.

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“…Locating a hospice ward in a community health service center undoubtedly will affect people’s willingness to use the service. Meanwhile, the limited drug supply and medical equipment in the community health service centers also contribute to some families avoiding hospice services in the community [ 19 ]. There seems to be a gap between the patients’ and their families’ preferences and hospice service supply.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have discussed the use of hospice services in Shanghai and the challenges of frontline hospice care providers [ 2 , 17 , [19] , [20] , [21] , [22] , [23] ]. Previous local studies have demonstrated that the community-based, city-covered hospice services have not been fully functioning [ 2 , 19 , 21 , 23 ]. Hospice care should be an inseparable part of the whole healthcare system in the city.…”

Section: Discussionmentioning

confidence: 99%

The decision for hospice care in patients with terminal illness in Shanghai: A mixed-method study

Chen

Lai

Xu³

et al. 2022

International Journal of Nursing Sciences

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Objectives To investigate why patients with terminal illness and their families in Shanghai choose the hospice ward and their decision-making process. Methods This was a mixed-method study consisting of a cross-sectional survey and a descriptive qualitative study. Medical decision-makers for patients hospitalized in hospice wards were recruited between September 2019 and July 2021. A medical decision-maker is a family member who makes medical decisions for a patient. All 146 participants completed a self-developed 10-item questionnaire that included five items about their demographic characteristics and five items about the decision-making process. The semi-structured interviews were conducted with nine participants to understand the family’s decision-making process when they chose a hospice ward. The interviews were analyzed using qualitative content analysis. Results The mean age of the 146 participants was 57.6 years old. Of the decision-makers, 56.85% were the patients’ children. Family-dominated discussions involving other family members were the main decision-making mode (84.93%). Patient participation in the decision-making process was reported in 43.15% of families. The participation of doctors (17.81%) and nurses (2.05%) were reported in a small number of families. The most common reason for choosing the hospice ward was the inability to find any other hospital for the patients (82.19%). The most common ways to learn about the service were neighbors and friends (38.36%) and social media (28.77%). Two themes and six categories emerged from the interviews. The first theme was reasons for choosing hospice wards. The reasons included being unable to care for the patients at home, staying in a hospice ward could reduce the psychological stress for home care, being unable to be admitted into tertiary/secondary hospitals, and thinking a hospice ward was a suitable place for the family. The second theme was the decision process of choosing a hospice ward. This theme included the following two categories, i.e., ways to learn about the hospice ward and family-discussion decision mode. Conclusion To most families having dying patients, a hospice ward is a reasonable and balanced choice after the families experience huge care stress and practical difficulties. The participation of patients should be encouraged in the family discussion so that their wishes can be known. More efforts will be needed to guide the families with dying patients to make reasonable medical choices. Social media can be a good way to improve public awareness of hospice services in the future. Meanwhile, healthcare providers should be more involved in the decision-making process.

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A qualitative study of caring in hospice wards in Shanghai

Cited by 5 publications

References 34 publications

Hospice preference of the family decision-makers for cancer patients in China: an exploratory study

Hospice preference of the family decision-makers for cancer patients in China: an exploratory study

Hospice preference among families with cancer patients in China: An exploratory study

The decision for hospice care in patients with terminal illness in Shanghai: A mixed-method study

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