#  Rethinking Palliative Care 

 



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China’s growing elder and chronically ill populations signal significant palliative care (PC) needs in the coming decade. At the end of 2019, older adults (>65 years old) numbered 167 million people and accounted for 11.9 percent of the total population in China. In the same year, approximately 10 million individuals died, of whom only 283,000 received formal PC. The documented and anticipated gaps in end-of-life (EoL) services echo recent scholarly work highlighting the health disparities that Chinese patients and caregivers receive at the EoL. When compared to EOL care processes and outcomes in Western countries, patients and caregivers in China experience higher intensity of disease-modifying and life-sustaining treatment, were more dissatisfied with communication and decision making and had more unaddressed physical, psychosocial and spiritual needs. These findings support the pressing need to innovate toward integration of high-quality, culturally appropriate  
PC into China’s health care system to address the unique needs of Chinese patients and caregivers.

According to the Medium and Long-term Plan for Proactive National Response to Population Aging and Healthy China 2030, China aims to adopt policies to provide integrated elder care and accelerate the development of supportive medical care programs in both the public and private sector. Yet, at the end of 2019, only 354 medical institutions had dedicated PC or hospice units. Despite the national interest in expanding palliative care services, ground-level implementation efforts encountered many barriers, including perceptions of conflict between PC and cultural or ethical norms, lack of health literacy, and structural barriers such as a lack of funding for PC, of necessary policies and laws to enable PC implementation, of insurance coverage for PC in institutions and in the home, and of training in PC for all clinicians who care for frail elders and the seriously ill. While clinical competencies and training programs have been developed for palliative care specialist nursing staff systematic clinical training in palliative care for physicians does not exist in China.

We aim to:  
a. Create a manual of basic palliative care for China to guide palliative care provision throughout the country and as a basis for PC training.  
b. Develop and implement Chinese palliative care workshops and curricula, including a train-the-trainers curriculum.  
c. Understand the predictors and variables to consider in designing culturally tailored advance care planning for seriously ill, older Chinese patients  
d. Understand the perception and predictors of high-quality end-of-life care

We aspire to use social science research and concepts and information technology to integrate high-quality, culturally appropriate PC into China’s healthcare system so as to maximize opportunities for China’s elderly to live meaningfully and comfortably where they wish to be.