Lin Huijing, Huang Yanhua, Wang Yunling
Department of Head and Neck Surgery, Tongji Medical College, Hubei Cancer Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Nursing, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
BMC Palliat Care. 2025 Jul 24;24(1):211. doi: 10.1186/s12904-025-01848-6.
Palliative care improves the quality of life and quality of death, yet in China, existing resources remain largely concentrated in urban areas. Limited access to palliative care exacerbates the sufferings of patients with life-threatening diseases such as cancer in rural regions.
This study aimed to explore the facilitators and barriers to palliative care delivery in rural China, based on the perceptions and experiences of rural healthcare professionals.
Between July and August 2024, semi-structured interviews were conducted with 25 participants from rural areas, including 18 village doctors and 7 staff from township health centers (5 doctors and 2 nurses). A thematic analysis approach was used to identify key themes and subthemes.
Three themes were identified, including (1) the necessity of rural palliative care: highlighting the growing population of left-behind older individuals, and poor quality of death in rural areas; (2) facilitators of rural palliative care: including door-to-door service provided by village doctors, close doctor-patient relationships, support from families and neighbors, and care in familiar environment; and (3) barriers of rural palliative care: such as heavy workloads for village doctors, limited professional authority and high perceived legal risk, unbalanced healthcare resources allocation, poor economic conditions, lack of service standards, death-related taboo and stigma, performative filial piety, and limited understanding of palliative care.
Palliative care in rural China remains underdeveloped. There is an urgent need to establish home-based palliative care services in low-resource regions. Implementing hospital-community-home care model can support more equitable allocation of healthcare resources. Expanding insurance reimbursement and promoting culturally adapted death education may further facilitate the delivery and acceptance of rural palliative care.
姑息治疗可提高生活质量和死亡质量，但在中国，现有资源仍主要集中在城市地区。农村地区获得姑息治疗的机会有限，这加剧了癌症等危及生命疾病患者的痛苦。
本研究旨在基于农村医疗专业人员的认知和经验，探讨中国农村姑息治疗实施的促进因素和障碍。
2024年7月至8月，对25名农村地区参与者进行了半结构式访谈，其中包括18名乡村医生和7名乡镇卫生院工作人员（5名医生和2名护士）。采用主题分析法确定关键主题和子主题。
确定了三个主题，包括（1）农村姑息治疗的必要性：强调农村留守老年人人口不断增加以及农村地区死亡质量较差；（2）农村姑息治疗的促进因素：包括乡村医生提供的上门服务、密切的医患关系、家人和邻居的支持以及在熟悉环境中的照料；（3）农村姑息治疗的障碍：如乡村医生工作量大、专业权限有限且法律风险认知高、医疗资源分配不均衡、经济条件差、缺乏服务标准、与死亡相关的禁忌和污名、表面的孝道以及对姑息治疗的理解有限。
中国农村的姑息治疗仍不发达。迫切需要在资源匮乏地区建立居家姑息治疗服务。实施医院 - 社区 - 家庭护理模式可支持更公平地分配医疗资源。扩大保险报销范围并推广符合文化背景的死亡教育可能会进一步促进农村姑息治疗的提供和接受。
