Advance Directive Preferences Among Terminally Ill Older Patients and Its Facilitators and Barriers in China: A Scoping Review

Liao, Jing; Wu, Bei; Ni, Ping; Mao, Jing

doi:10.1016/j.jamda.2019.05.013

Cited by 21 publications

(17 citation statements)

References 52 publications

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“…2 However, the Confucian concept of filial piety and the taboo of talking about death in the Chinese culture further complicate EOL discussions in China. 4,5…”

Section: Introductionmentioning

confidence: 99%

“…2 However, the Confucian concept of filial piety and the taboo of talking about death in the Chinese culture further complicate EOL discussions in China. 4,5 An easy-to-use tool that could help Chinese health-care providers to initiate EOL discussions with patients is the Heart to Heart Card Game (HHCG; https://caccc-usa.org/en/activi ties/heart2heart.html) developed by Chinese American Coalition for Compassionate Care (CACCC). The HHCG was originally designed for Chinese Americans as a communication tool to identify EOL wishes, values, and preferences.…”

Section: Introductionmentioning

confidence: 99%

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Identifying End-of-Life Preferences Among Chinese Patients With Cancer Using the Heart to Heart Card Game

Pei

Chen

et al. 2020

Am J Hosp Palliat Care

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Background: Understanding the preferences for end-of-life (EOL) care is imperative in providing quality care to patients with life-threatening illness. However, it is difficult for patients, families, and health-care providers to initiate EOL conversations in China. An easy-to-use tool that could help health-care providers initiate EOL discussions is the Heart to Heart Card Game (HHCG), originally designed for Chinese Americans. Objective: To evaluate the EOL preferences among Chinese patients with cancer using the HHCG. Methods: We conducted a descriptive study to assess EOL preferences using HHCG among patients at the oncology chemoradiotherapy department of a Chinese tertiary hospital. Results: We recruited 58 patients in total of which 40 (69%) patients completed HHCG. The most frequently selected card was “I want my family to get along,” followed by “I don’t want to be a burden to my family,” and “I want to maintain my dignity.” Among the 3 cards selected, social needs were rated as the most important (36.7%), followed by spiritual needs (35.8%), physical needs (20.0%), and financial needs (7.5%). The evaluation of the HHCG revealed that more than 70% of the participants highly valued HHCG. Conclusion: The HHCG can be used as a communication tool to encourage EOL discussions between cancer patients and health-care providers in China. Moreover, Chinese patients with cancer attach significant importance to their family and maintaining dignity at the EOL.

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“…2 However, the Confucian concept of filial piety and the taboo of talking about death in the Chinese culture further complicate EOL discussions in China. 4,5…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Identifying End-of-Life Preferences Among Chinese Patients With Cancer Using the Heart to Heart Card Game

Pei

Chen

et al. 2020

Am J Hosp Palliat Care

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“…Thirdly, Chinese public lack knowledge of EOL care, most had never heard of “advance directives” [ 30 ]. Fourthly, there is no law regarding EOL care in China, which may also prevent Chinese patients from gaining knowledge of EOL care [ 22 ]. Reinforcing education about EOL care, as well as EOL care communication between medical staff and advanced cancer patients can help them avoid futile EOL treatments.…”

Section: Discussionmentioning

confidence: 99%

“…These studies cannot represent patients in mainland China and be simply implemented as they have different social nature and medical systems [ 18 , 19 ]. In mainland China, few studies concerning about attitudes towards LST have been conducted [ 20 , 21 ]; however, research focusing on the specific issue of aggressive EOL care is lacking, while there has been an urgent need for better EOL care [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Preference for Aggressive End-of-Life Care among Advanced Cancer Patients in Wuhan, China: A Cross-Sectional Study

Liao

Mao

et al. 2020

IJERPH

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Life-sustaining treatments (LSTs) and end-of-life (EOL) care’s goal for prolonging one’s life are defined as aggressive EOL care among critically ill patients. They have limited effects and add unnecessary financial burden to advanced cancer patients. A questionnaire survey was conducted to collect information on demographics, disease conditions, preference for LSTs, and goal of EOL care among advanced cancer patients of comprehensive grade-A tertiary hospitals in Wuhan, mainland China. Most patients preferred to accept LSTs when they were in a critical condition, including cardiopulmonary resuscitation (89.9%), mechanical ventilation support (85.7%), nasogastric tube feeding (84.1%), blood transfusion (89.8%), general surgery (87.5%), and hemodialysis (85.8%). Most (88%) preferred prolonging life as the goal of EOL care. Logistic regression showed common influencing factors were participants who completed junior high/high school or below and were financially adequate had higher reference for aggressive EOL care. Patients whose physician had accurately disclosed prognosis; however, showed a decrease trend for aggressive EOL care. Most advanced cancer patients preferred to accept aggressive EOL care. Discussions about prognosis disclosure among physicians and patients should be improved. Education about LSTs’ limitations and comfort-oriented care’s benefits should be promoted among the advanced cancer patients in mainland China.

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“…[4][5][6][7][8][9] However, promoting advance care planning remains challenging because of socio-cultural barriers. [10][11][12] The perceived unpleasant nature of discussions about death and dying is a key reason for this challenge. 13,14 Many existing successful advance care planning interventions, such as the Community-based Respecting Choices programme and Physician Orders For Life Sustaining Treatment programme, 15,16 still struggle to overcome this barrier.…”

Section: Introductionmentioning

confidence: 99%

Gamification for promoting advance care planning: A mixed-method systematic review and meta-analysis

et al. 2021

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Background: Gamification has been adopted in the health care field for broaching sensitive topics and increasing motivation for behavior changes. Games developed to stimulate discussion surrounding end-of-life issues, and thereby promoting advance care planning also emerged. Aim: The aim is to integrate the quantitative evidence and qualitative evidence to understand the effectiveness of and experience with games for advance care planning. Design: A mixed-methods systematic review and meta-analysis (PROSPERO ID: CRD42020163312) was undertaken. Joanna Briggs Institute Critical Appraisal tools were used for quality appraisal. Data were synthesized and pooled for meta-analysis or meta-aggregation when appropriate. Data sources: We searched MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library, WanFang, China Knowledge Resource Integrated Database, and Chinese Biomedical Literature Database from the inception of the databases for qualitative, quantitative, and mixed-method studies. Results: Eleven articles of ten studies were included, six of which were feasibility studies. The quality of the quantitative component of most included studies (7/8) was rated as low, and the qualitative component of most included studies (7/8) was rated as moderate. The meta-analysis showed that games for advance care planning are effective to increase self-efficacy, readiness, knowledge, and process of advance care planning behaviors. The meta-aggregation showed that games for advance care planning are highly acceptable and the participants perceived the game experience as fun and enjoyable. Conclusions: Advance care planning games seem to be a promising intervention for increasing the uptake of advance care planning behaviors. Well-designed randomized controlled trials evaluating the effectiveness of games for advance care planning are needed in the future.

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Advance Directive Preferences Among Terminally Ill Older Patients and Its Facilitators and Barriers in China: A Scoping Review

Cited by 21 publications

References 52 publications

Identifying End-of-Life Preferences Among Chinese Patients With Cancer Using the Heart to Heart Card Game

Identifying End-of-Life Preferences Among Chinese Patients With Cancer Using the Heart to Heart Card Game

Preference for Aggressive End-of-Life Care among Advanced Cancer Patients in Wuhan, China: A Cross-Sectional Study

Gamification for promoting advance care planning: A mixed-method systematic review and meta-analysis

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