Cheng Hon Wai Benjamin
1 Medical Palliative Medicine (MPM) Team, Department of Medicine and Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong SAR, China.
J Palliat Care. 2018 Oct;33(4):242-246. doi: 10.1177/0825859718763644. Epub 2018 Mar 23.
In traditional Chinese culture, death was sensitive and mentioning it was sacrilegious and to be avoided. Many Chinese families object to telling the patient a "bad" diagnosis or prognosis, which may hinder the chance in advance care planning (ACP) discussion. While death remains an inevitable consequence of being born, as such, it is important that human beings recognize its inevitability and plan ahead of a good death. Advance care planning enables patients to assert their care preferences in the event that they are unable to make their own medical decisions. In China, a rapidly aging demographic presents additional challenges to quality end-of-life care. The adoption of palliative care in China has been slow, with a curative approach dominating health-care strategies. In this article, we would summarize China's current situation in population aging, palliative care development, and Chinese cultural values on death and dying and review the advance directive and end-of-life care preferences among Chinese elderly patients. Current literature recommended the use of indirect communication approaches to determine Chinese seniors' readiness. In individual practice, using depersonalized communication strategies to initiate the discussion was recommended to determine older Chinese seniors' readiness.
在中国传统文化中，死亡是敏感的话题，提及它被视为亵渎神灵，应予以回避。许多中国家庭反对告知患者“不好的”诊断结果或预后情况，这可能会阻碍提前护理规划（ACP）讨论的机会。虽然死亡仍是出生不可避免的结果，但重要的是，人类要认识到其不可避免性，并提前为安详离世做好规划。提前护理规划能使患者在无法自行做出医疗决策时表达自己的护理偏好。在中国，人口快速老龄化给优质临终关怀带来了额外挑战。姑息治疗在中国的采用进展缓慢，治疗方法主导着医疗保健策略。在本文中，我们将总结中国在人口老龄化、姑息治疗发展以及关于死亡和临终的中国文化价值观方面的现状，并回顾中国老年患者的预立医嘱和临终护理偏好。当前文献建议使用间接沟通方法来确定中国老年人的意愿。在个人实践中，建议采用非个性化沟通策略来开启讨论，以确定中国老年患者的意愿。
