Chinese physicians' experiences with end-of-life communication and hospice care transition: a qualitative study with content analysis.

BACKGROUND

Mainland China's end-of-life care system remained underdeveloped marked by underutilization of hospice care services. Physicians-initiated end-of-life communication is likely to result in immediate enrollment in hospice care. However, there is a lack of empirical evidence on how physicians in China undertake end-of-life communication in advanced cancer. This qualitative study aimed to explore physicians' experiences on discussing end-of-life matters and facilitating hospice care transition within families of patients with advanced cancer.

METHODS

A descriptive qualitative study was conducted. Using the purpose sampling, physicians were recruited from 8 hospitals in Shanghai, China. Physicians were eligible if they had experiences in treating patients with advanced cancer and were ineligible if they did not directly participate in end-of-life discussions with patients/families. Semi-structured interviews were conducted from August 2022 to February 2023. Qualitative data were analyzed by content analysis approach.

RESULTS

Among 18 physicians, three major themes emerged regarding barriers to effective end-of-life communication at physician, family, and system levels: (1) Physician avoidance in disclosing terminal prognosis: Prognostic uncertainty, Skill deficiency, Emotional burden, Concerns about therapeutic hope, and Systematic avoidance; (2) Family priority in end-of-life decision-making: Complex family dynamics, Cultural stigma, and Unstructured family coping; (3) Systematic fragmentation in hospice care integration: Limited awareness and understanding, Ineffective referral mechanisms, and Insufficient leadership support.

CONCLUSION

End-of-life communication in Shanghai is hindered by physician challenges, cultural norms favoring family decisions, and systemic gaps. Targeted training for non-hospice physicians, balanced approaches to patient autonomy and family roles, and strengthened referral/reimbursement policies are needed to improve hospice transitions.