EAPC Blog

Looking east: China’s oncologists engage in palliative care education

pallcare

Esther Schmidlin, EAPC board member, and a nurse consultant, Equipe Mobile en Soins Palliatifs, Plateforme Santé Haut-Léman, Vevey, Switzerland.

When the Chinese Committee of Rehabilitation and Palliative Care (CRPC) launched the Wuhan Declaration (the equivalent of the Budapest Commitments) in November 2009, one of their main goals was to enhance palliative care education for medical students, nurses and physicians involved in the care of cancer patients. Last weekend, the first National Cancer Specialist Palliative Care Training Class took place in Wuhan and, to my delight, I was invited to give a presentation on behalf of the EAPC.

The two-day education programme, attended by about 50 oncologists and a few nurses from all over the country, covered a variety of interesting topics. Lectures on the importance and the implications of the IAHPC list of essential medications, and the use of opioids and adjuvant analgesics, were some of the highlights. Symptoms such as cachexia, nausea and respiratory distress were addressed, as well as communication around death and dying. In my presentation, I discussed the Prague Charter and the human rights aspect of access to palliative care, as well as the results generated by some of the EAPC task forces. I also presented the healthcare model I am most familiar with – community-based palliative care – and described my work in a mobile palliative care team in Switzerland. Judging from the subsequent questions and discussions, this aspect of my presentation seemed to spark the most interest.

The nursing team working on the cancer ward in the Wuhan Tongji Hospital

In China, community-centered primary care and home care are hardly developed at all. When people are ill, they travel to an often-distant hospital for diagnosis and treatment. The burden of cancer is high and is expected to continue to rise owing to ageing and lifestyle changes. Patients are often diagnosed in advanced stages of cancer when cure is no longer possible. The government’s health insurance is underfunded; in resource-poor regions and rural areas the patient and his family must cover up to 80% of the expenditure. Oncological treatment is often not available at all. A trip to a bigger city is necessary, substantially adding to the financial hardship, so that many cancer patients and their families can’t afford the cancer treatment. They are forced to make difficult choices between, for example, sustaining their family, paying for a child’s education, or pursuing the oncological treatment. In this context, the availability of palliative care, which has the potential to relieve the burden of symptoms and responds to the needs of the patient and the family, should be the main focus of the treatment. However, the government and most healthcare providers have not recognised the significance of palliative care, neither in the hospital alongside affordable cancer treatment, nor as a community-based approach. Our Asian colleagues are faced with substantial barriers in their quest to develop palliative care.

Wuhan Tongji hospital: Esther (left) with nursing colleagues (Fengling Zhang is on the far right)

You can imagine that I had no easily ready answer when a participant and nurse specialist, Fengling Zhang, asked me, “But how do you do it? How can you provide palliative care to people in their homes, outside of the hospitals? How do you provide it in the cancer ward? What can nurses do?”

There is no single answer. A medical culture in which quality of life considerations are valued needs to be developed, basic healthcare provision (primary care) and essential medication need to be made affordable to all, and yes, education is a great start. Continuing to work together within a committed group of professionals, and networking beyond that core group, is vital. Fengling Zhang and her colleagues can count on all the support I can give them through the EAPC and as a fellow nurse.

I would like to thank Professor Yuan Chen, Professor Shiying Yu and the Chinese Committee of Rehabilitation and Palliative Care (CRPC) for the invitation to go to Wuhan. My special thanks to Dr Qi Mei for organising this trip and also for being such a being terrific tour guide and translator, together with Ms Liva Hu. I also thank Ms Fengling Zhang for the tour of the cancer ward in the Wuhan Tongji hospital, and the patients and nurses for allowing me to take pictures.  I am very grateful for the interesting and open conversations I’ve enjoyed with all of you!

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