End-of-life care in China: ecology of hope

Chen, Hong (2012). End-of-life care in China: ecology of hope. PhD thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.0000d58c

Abstract

In this thesis I explore the current end-of-life care provision as experienced by older people with advanced cancer in three distinct care settings in Yunnan China: a hospice, an inpatient palliative care ward and a self-help organisation. In particular, I focus on the role of "hope" at the end of life, hope having emerged as a significant aspect of participant's experiences. I took a "multiple-embedded case study" approach, employing mainly qualitative interviewing and observation to capture the richness and complexity of the experience of end-of-life care in different settings.

The findings show that mainstream health care for advanced cancer in China focused on curative western medicine and failed to alleviate prevalent pain and symptoms. Specialised palliative/end-of-life care services adapted from the western palliative care model contributed mainly to relieving cancer pain and symptoms. "Total care for the whole person" - the core of the palliative care philosophy, was an aggregate of the resources located in the family, health care and the broader sociocultural environment.

The study revealed the nature of hope as essentially affirming life in all circumstances and as situated and fostered in a "hierarchical social and cultural ecology of hope" (Feudtner 2005, p. S23) comprising an individual, his or her family, care providers and other physical, social and cultural elements. The fostering of hope, as a resource at the end of life, has implications for improving care and support at multiple levels - personal, interpersonal and social and cultural.

Hence, it is suitable to take the public health approach proposed by Kellehear (2005) to advance palliative care development in China because it endorses a compassionate approach to death and dying and loss and proposes that care for people at the end of life is a fundamental responsibility of not just health professionals, but also communities, governments and societies.