肿瘤护理专业人员实施临终预立医疗照护计划的文化和伦理障碍：对开放式问题的内容分析

Cultural and ethical barriers to implementing end-of-life advance care planning among oncology nursing professionals: a content analysis of open-ended questions.

作者信息

Shih Yi-An, Wang Cheng, Ding Jiahui, Zhou Yuhong, Lu Qian

机构信息

School of Nursing, Inner Mongolia Medical University, Hohhot, China.

School of Nursing, Peking University, Beijing, China.

出版信息

BMC Med Ethics. 2025 Jul 11;26(1):96. doi: 10.1186/s12910-025-01261-x.

DOI:10.1186/s12910-025-01261-x

PMID:40646488

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12247472/

Abstract

BACKGROUND

Advance care planning (ACP), a cornerstone of ethical end-of-life care, upholds patient autonomy. However, its practice in Confucian-influenced societies, like China, is significantly shaped by cultural norms where family preferences often precede individual choice. This study explored cultural and ethical barriers to ACP implementation among oncology nursing professionals, focusing on tensions between patient-centered care and deeply rooted social norms.

METHODS

A qualitative thematic analysis was conducted on open-ended responses from oncology hospitals across 22 provinces, 4 municipal cities, and 5 autonomous regions in China. Data were collected via a cross-sectional online survey and analyzed using Braun and Clarke's framework to identify patterns in cultural, ethical, and communicative challenges.

RESULTS

A total of 838 oncology nursing professionals participated in the study. Three main interdependent barriers emerged: (1) Cultural norms, including filial piety (15.6% of codes) and death-related taboos (11.0%), often led to family-mediated decision-making (33.1%) over patient autonomy; (2) Ethical dilemmas involved neglecting patient preferences (24.3%) and conflicts between life-prolonging treatments and quality-of-life considerations (8.1%); (3) Communication challenges arose from information asymmetry (7.9%) and power imbalances, which often silenced patient voices. These factors collectively created systemic obstacles to ACP implementation.

CONCLUSIONS

Context-specific ACP strategies in China should integrate Confucian ethics into nursing education, support ethics consultation, and develop culturally sensitive communication models. Future research must assess these interventions' impact on balancing cultural values and patient autonomy, advancing equitable end-of-life care in culturally diverse healthcare systems.

TRIAL REGISTRATION

Not applicable.

摘要

背景

预先护理计划（ACP）是临终护理伦理的基石，维护患者自主权。然而，在受儒家思想影响的社会，如中国，其实施受到文化规范的显著影响，家庭偏好往往优先于个人选择。本研究探讨了肿瘤护理专业人员实施ACP的文化和伦理障碍，重点关注以患者为中心的护理与根深蒂固的社会规范之间的紧张关系。

方法

对来自中国22个省、4个直辖市和5个自治区的肿瘤医院的开放式回复进行了定性主题分析。通过横断面在线调查收集数据，并使用布劳恩和克拉克的框架进行分析，以确定文化、伦理和沟通挑战的模式。

结果

共有838名肿瘤护理专业人员参与了该研究。出现了三个主要的相互依存的障碍：（1）文化规范，包括孝道（编码的15.6%）和与死亡相关的禁忌（11.0%），往往导致家庭主导决策（33.1%），而非患者自主权；（2）伦理困境涉及忽视患者偏好（24.3%）以及延长生命治疗与生活质量考量之间的冲突（8.1%）；（3）沟通挑战源于信息不对称（7.9%）和权力不平衡，这常常使患者的声音被压制。这些因素共同为ACP的实施造成了系统性障碍。