Palliative care in Mainland China: Past, present and future

Dr Ping Guo, Project Manager and Research Associate, Cicely Saunders Institute, King’s College London, UK, explains the background to her longer article published in the January/February issue of the European Journal of Palliative Care.

Dr Ping Guo at the 2nd annual conference of the Chinese Association for Humanistic and Palliative Care

China faces a high demand for palliative care resulting from a rapidly aging population, increased chronic diseases and cancer. Aimed at enhancing quality of life for every patient and family, and ensuring dignified death, palliative care, however, still confronts many obstacles hindering its development in China.

Compared to the UK and other developed countries, palliative care in China is still in its infancy. The slow adoption of palliative care in China is associated with limited national policy and guidelines, lack of financial support and limited professional training. However, the most important reason is the public’s misunderstanding of death and palliative care.

Traditionally, most Chinese people believe that as long as there is a glimmer of hope for living a few days longer, it is worth paying a huge price, or even dignity, for it. This is reflected in a famous Chinese saying: To live is better than to die.

Once patients are diagnosed with advanced and end stage diseases, family members usually tend to conceal the patients’ real conditions. Lack of information about their own conditions will significantly increase the psychological burden of the patients, which leads to worse results. Some patients and families think that death is the result of treatment failure, rather than the natural life cycle. Palliative care is normally considered as giving up treatment, giving up hope for life, and not prolonging life.

Dr Ping Guo presenting ‘Measuring complexity of needs and outcomes in palliative care’ at the 2nd annual conference of the Chinese Association for Humanistic and Palliative Care (CAHPC) in Wuhan, China on 17-18 November 2016

Because of these misunderstandings, it becomes even more challenging to accept and implement palliative care in China. Many patients with advanced cancer still suffer from endless surgery, radiotherapy and chemotherapy. Overtreatment not only wastes resources, but it also increases the suffering of the patients, and significant financial burdens of the families. For this group of patients with advanced illness, including cancer and non-cancer conditions, palliative care is the best choice, which should be involved early and throughout the disease trajectory. It can help patients to manage their pain and other distressing symptoms, and also provides psychological, social, spiritual, and information support for patients and their families or carers.

To develop and implement palliative care in China, a key step is to raise public awareness of palliative care and to promote death education at all levels. Changing people’s minds, particularly about life and death, is not easy and takes a long time. In November 2016, I was invited to deliver a plenary talk at the 2nd annual conference of the Chinese Association for Humanistic and Palliative Care (CAHPC) in Wuhan, China. Raising public awareness and promoting death education was one of the main topics of discussion.

As reported in the 2015 quality of death index, China’s poor performance in palliative care provision has raised concern about its quality. China urgently needs palliative care leaders. With government support, I believe that more doctors, nurses, other allied health professionals and volunteers in China will be specially trained to work and research in the field of palliative care.

Exploring the appropriate models of palliative care applicable in China has a long way to go. Traditional Chinese medicines have unique advantages in reducing pain and improving quality of life, which could be integrated into routine palliative care practice. However, their effectiveness and cost-effectiveness need to be further investigated in future research.

Chinese colleagues should work collaboratively with colleagues across the world to achieve our common goal – helping patients to live as well as possible until they die, and to die with dignity.

Read the full article in the European Journal of Palliative Care
This post relates to a longer article, ‘Exploring the challenges of implementing palliative care in China’ by Wei Liu and Ping Guo, published in the January/February 2017 edition of the European Journal of Palliative Care (vol. 24.1). If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.

Read more posts relating to articles published in the European Journal of Palliative Care on the EAPC Blog

EJPC Palliative Care Development Award 2017 – Last chance to nominate before closing date on 31 March

Do you know someone who has made a major contribution to palliative care policy development? Why not nominate them for the EJPC Palliative Care Policy Development Award? Click here to nominate. Launched by the European Journal of Palliative Care in collaboration with the European Association for Palliative Care, the award is aimed at professionals working in palliative care worldwide who have made a substantial contribution to policy development through research, clinical practice or as policy activists. The 2017 Award will be presented at the 15th World Congress of the EAPC in Madrid, Spain (18–20 May 2017). Deadline for applications: 31 March 2017.

 

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