Institute for Global Health, UCL, London, UK.
Marie Curie Palliative Care Research Department, UCL, London, UK.
BMJ Glob Health. 2020 Dec;5(12). doi: 10.1136/bmjgh-2020-003232.
A sizeable cohort of Chinese migrants in high-income non-Asian countries is reaching old age and many will develop life-limiting illnesses. They may benefit from palliative care, which is integrated into universal health coverage in many of these countries, but the uptake of this care among migrant communities remains low. Cultural differences between the Chinese and the host community, and poor language skills may be barriers to access, yet understanding the reasons hindering uptake are obscure.
To understand the cultural perspective of how first generation Chinese migrants and their families perceive the provision of palliative care, to identify what exists which may limit their access in high-income non-Asian countries.
A systematic review and three-stage thematic synthesis of qualitative studies. Citations and full texts were reviewed against predefined inclusion criteria. All included studies were appraised for quality.
MEDLINE, EMBASE, PsycINFO, CINAHL and PubMed were searched to July 2019.
Seven qualitative studies were identified (from USA, UK, Canada and Australia). Across the studies analytical themes that impacted on the use of palliative care services were identified: (1) migrants' intrinsic perceptions of cultural practices, (2) their expectations of and preparation for care at the end of life, (3) perspectives and influences of family and (4) knowledge and communication with palliative care providers in the host country. Key elements found that challenge access to palliative care services in the host countries were: Chinese culture is rooted in the core values of the family as opposed to the individual; migrants' limited experience in their place of origin in accessing healthcare; and practical issues including a lack of language skills of their host country.
Palliative care services do not always match the needs of Chinese migrants in non-Asian high-income countries. Engagement and education on multiethnic cultural awareness in both the host non-migrant and the migrant communities is needed.
相当数量的中国移民在高收入非亚洲国家已经步入老年，许多人将患上危及生命的疾病。他们可能受益于姑息治疗，这种治疗在许多这些国家已纳入全民健康覆盖范围，但移民群体对这种治疗的接受程度仍然较低。中西方文化差异以及语言能力差可能是获得治疗的障碍，但阻碍接受治疗的原因尚不清楚。
了解第一代中国移民及其家属对姑息治疗的看法，确定在高收入非亚洲国家可能限制他们获得姑息治疗的因素。
对定性研究进行系统评价和三阶段主题综合。根据预先设定的纳入标准对引文和全文进行了审查。对所有纳入的研究进行了质量评估。
检索 MEDLINE、EMBASE、PsycINFO、CINAHL 和 PubMed 数据库，检索时间截至 2019 年 7 月。
共确定了 7 项定性研究（来自美国、英国、加拿大和澳大利亚）。在这些研究中，确定了影响姑息治疗服务使用的分析主题：（1）移民对文化习俗的内在看法；（2）他们对临终关怀的期望和准备；（3）家庭的观点和影响；（4）与东道国姑息治疗提供者的知识和沟通。发现挑战在东道国获得姑息治疗服务的关键因素有：中国文化根植于家庭的核心价值观，而不是个人；移民在原籍国获得医疗保健的经验有限；以及实际问题，包括缺乏语言技能。
姑息治疗服务并不总是满足非亚洲高收入国家中国移民的需求。需要在东道国的非移民和移民社区中开展多民族文化意识的参与和教育。
