Background: Family-oriented medical decision-making in China is founded on Confucian family-determination. The value and necessity of individual autonomy are marginalized in theory and practice. However, the dilemma in end-of-life (EOL) decision-making caused by the lack of advance care planning (ACP) has been increasingly concerned by the public. This study explores the value and necessity of ACP practice in China from the perspective of healthcare professionals (HCPs).
Methods: We conducted semi-structured interviews with five neurological physicians and five neurological nurses from a Grade 3 Class A hospital in Beijing.
Results: The results showed that in situations with a poor prognosis, respondents tended to believe that as part of ACP regarding, a patient's right to refuse invasive treatments should be followed, although all ten interviewees agreed that nasogastric feeding tubes (NGTs) should be maintained. Factors influencing a families' considerations in EOL decision making included prognosis and age, prior similar experiences, others' moral judgement, and the advice of HCPs. Four respondents had experienced patients expressing their wishes for EOL treatments and reported some obstacles in considering these wishes. Seven respondents considered creating an ACP themselves, two respondents doubted it would work in practice, and one respondent thought it was unnecessary.
Conclusions: The differences in the concept and practice of palliative care may be significantly related to the differences in the idea of ACP between Chinese and Western. The family-oriented decision-making model under Confucian culture cannot replace the ACP practice. Clinical situations and therapeutic measures that reveal the necessity and value of ACP should be the priority exploration to advance ACP practice. The practice of ACP and palliative care should be promoted simultaneously at the national level, and legislation for advance directives (ADs) is necessary for mainland China.
Keywords: Advance care planning (ACP); Confucian family-determination; end-of-life (EOL); nasogastric feeding tube (NGT).