International journal of nursing studies · 2025
"The unseen struggle" - Nurses' perspectives on challenges to quality of death in rural Chinese cancer patients: A qualitative study.
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Song Changhui, Feng Min, Chen Yuting, Xie Hui
Аннотация
BACKGROUND: Cancer incidence and mortality have risen significantly worldwide, with China accounting for a substantial proportion of new cases and deaths. Despite national efforts to expand palliative care, the quality of death remains suboptimal in rural areas due to limited healthcare infrastructures, cultural barriers, and uneven rural development.
OBJECTIVE: This qualitative study aimed to explore the quality of death among advanced cancer patients in rural Henan Province, China, from the perspectives of oncology nurses. It sought to identify key challenges and inform strategies to improve palliative care in resource-constrained rural settings.
METHODS: A phenomenological approach was employed. Seventeen semi-structured interviews were conducted in July 2024 with oncology nurses from a county-level tertiary hospital in northern Henan. Respondents were recruited via purposive and snowball samplings. Thematic analysis was used to identify recurring patterns and challenges.
FINDINGS: Eight major themes were identified across individual, family, and healthcare levels. At the individual level, unmanaged symptoms (e.g., pain and dyspnea) and heightened death anxiety - exacerbated by low health literacy and health beliefs - negatively impacted end-of-life experiences. At the family level, cultural norms, such as filial piety complicated communication and medical decision-making, often resulting in overtreatment and prolonged suffering in patients. Financial constraints and limited family support further compromised care and quality of death. At the healthcare system level, staff shortages, heavy workloads, and insufficient palliative care training hindered the delivery of patient-centered palliative care.
CONCLUSIONS: The study reveals a complex interplay of economic, cultural, and systemic factors that shape quality of death from various levels in rural China from the lens of oncology nurses. Addressing these barriers requires targeted interventions, including enhanced palliative care training, financial protections, and culturally sensitive public education on death and dying in rural settings.
OBJECTIVE: This qualitative study aimed to explore the quality of death among advanced cancer patients in rural Henan Province, China, from the perspectives of oncology nurses. It sought to identify key challenges and inform strategies to improve palliative care in resource-constrained rural settings.
METHODS: A phenomenological approach was employed. Seventeen semi-structured interviews were conducted in July 2024 with oncology nurses from a county-level tertiary hospital in northern Henan. Respondents were recruited via purposive and snowball samplings. Thematic analysis was used to identify recurring patterns and challenges.
FINDINGS: Eight major themes were identified across individual, family, and healthcare levels. At the individual level, unmanaged symptoms (e.g., pain and dyspnea) and heightened death anxiety - exacerbated by low health literacy and health beliefs - negatively impacted end-of-life experiences. At the family level, cultural norms, such as filial piety complicated communication and medical decision-making, often resulting in overtreatment and prolonged suffering in patients. Financial constraints and limited family support further compromised care and quality of death. At the healthcare system level, staff shortages, heavy workloads, and insufficient palliative care training hindered the delivery of patient-centered palliative care.
CONCLUSIONS: The study reveals a complex interplay of economic, cultural, and systemic factors that shape quality of death from various levels in rural China from the lens of oncology nurses. Addressing these barriers requires targeted interventions, including enhanced palliative care training, financial protections, and culturally sensitive public education on death and dying in rural settings.