Chinese perspective on end-of-life communication: a systematic review

Pun, Jack; Cheung, Ka Man; Chow, J.C.H.; Chan, Wai-Yip

doi:10.1136/bmjspcare-2019-002166

Cited by 27 publications

(37 citation statements)

References 43 publications

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“…This complicates processes related to obtaining advanced directives, arranging for hospice care and palliative medications, and ensuring that critically ill AAPI patients are supported by loved ones. 66,70,71 Importantly, the field of psychiatry has taken steps to incorporate the cultural formulation interview into the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition), aiming to center the patient’s perspective and cultural contexts as critical in the therapeutic relationship between the patient and psychiatrist. 72 While this has so far only been implemented in psychiatry, the core foundations of the cultural formulation interview are applicable to all medical specialties and could serve to strengthen patient–provider relationships.…”

Section: Aapi Illness Experiencesmentioning

confidence: 99%

The Model Minority Myth, Data Aggregation, and the Role of Medical Schools in Combating Anti-Asian Sentiment

Liu¹,

Wang²,

Nguyen³

et al. 2022

Academic Medicine

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The COVID-19 pandemic has resulted in an alarming increase in hate incidents directed toward Asian Americans and Pacific Islanders (AAPIs), including verbal harassment and physical assault, spurring the nationwide #StopAsianHate movement. This rise in anti-Asian sentiment is occurring at a critical time of racial reckoning across the United States, galvanized by the Black Lives Matter movement, and of medical student calls for the implementation of antiracist medical curricula. AAPIs are stereotyped by the model minority myth, which posits that AAPIs are educated, hardworking, and therefore able to achieve high levels of success. This myth acts as a racial wedge between minorities and perpetuates harm that is pervasive throughout the field of medicine. Critically, the frequent aggregation of all AAPI subgroups as one monolithic community obfuscates socioeconomic and cultural differences across the AAPI diaspora while reinforcing the model minority myth. Here, the authors illustrate how the model minority myth and data aggregation have negatively affected the recruitment and advancement of diverse AAPI medical students, physicians, and faculty. Additionally, the authors discuss how data aggregation obscures health disparities across the AAPI diaspora and how the model minority myth influences the illness experiences of AAPI patients. Importantly, the authors outline specific actionable policies and reforms that medical schools can implement to combat anti-Asian sentiment and support the AAPI community.

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Section: Aapi Illness Experiencesmentioning

confidence: 99%

The Model Minority Myth, Data Aggregation, and the Role of Medical Schools in Combating Anti-Asian Sentiment

Liu¹,

Wang²,

Nguyen³

et al. 2022

Academic Medicine

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“…Moreover, bad news discussion is highly varied among individuals. Apart from doctorpatient communication, patients' expectations on bad news conversations can be shaped by gender, age and the type of disease [12]. Better patient reactions are observed for the medical students demonstrating an understanding of the role of family members during their delivery of bad news.…”

Section: Medical Studentmentioning

confidence: 99%

“…While communication protocols and frameworks are increasingly integrated into Western medical education, such approaches as those outlined above may not be applicable to bad news delivery communication in non-Western cultures [10]. This is because sociocultural factors play an important role in patients' communication preferences and understanding of emotionally challenging issues such as end-of-life care and death [11,12].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, doctors should be equipped with both effective communication skills and increased awareness and sensitivity to patients' needs in specific sociocultural contexts. Some communication frameworks have been modified and adapted for the Chinese cultural context, such as the Calgary-Cambridge Guide and the SEGUE (set the stage, elicit information, give information, understand the patient's perspective and end the encounter) framework [12,16,17]. The SEGUE framework, which stemmed from Western ideologies have yet adjusted to tailor to particular Chinese cultural elements such as collectivism, aims to facilitate practitioners' communication skills and reflect cultural differences between Chinese society and the West [18].…”

Section: Introductionmentioning

confidence: 99%

“…Second transcript about directly disclosing bad news to patients12 Medical Student Um, actually, this piece of news might be more serious than you think. I want you to be mentally prepared for the news...…”

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confidence: 99%

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A study of Chinese medical students’ communication pattern in delivering bad news: an ethnographic discourse analysis approach

Pun

2021

BMC Med Educ

Self Cite

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Background Breaking bad news is inevitable for prospective doctors, it is important for medical students to learn how to humanely communicate devastating news to patients. This study explores the discourse strategies used by Chinese medical students when conducting critical conversations via role-play scenarios. Methods Fifty Year-6 medical students attending the ‘Serious Illness Communication Module’ were recruited from a local medical school in Hong Kong. They were asked to participate voluntarily in two role-play scenarios requiring them to break bad news to a simulated patient in Cantonese. The verbal interactions were video-recorded and analysed using an ethnographic discourse approach to unpack the quality of the observed interaction sequences and identify the discourse strategies strategically used by the medical students to overcome any communication breakdowns (e.g. linguistic expressions conveying diagnoses) and show empathy to patients. Results Six discourse strategies for delivering bad news were identified in the Chinese context: (1) placing great emphasis on patients’ emotional needs; (2) informing patients with a balanced focus on medical and emotional needs; (3) directing patients’ attention to treatment options; (4) acknowledging concerns about dying patients’ physical discomfort and wishes; (5) directing bad news disclosure to patients; and (6) addressing the family expectations of patients. The majority of the Chinese medical students in this study used a patient-oriented approach to cater to the patients’ emotional and physical needs. They also often informed and acknowledged the patients’ family members. Conclusions When delivering bad news, medical students should be equipped with discourse strategies that effectively balance interpersonal communication with the communication of medical expertise, which is integral to ensuring patients’ participation, their understanding and satisfaction with their clinicians. This is in accordance with the existing communication frameworks for critical conversation and demonstrates awareness of the needs in the Chinese context. However, some students demonstrated poor sensitivity to non-verbal cues, such as tone, manners and attitude. Thus, more training using a culturally appropriate model of communication for critical conversation should be promoted.

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Patient participation in treatment decision-making of prostate cancer: a qualitative study

Pan

Mao

Wang

et al. 2022

Support Care Cancer

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Chinese perspective on end-of-life communication: a systematic review

Cited by 27 publications

References 43 publications

The Model Minority Myth, Data Aggregation, and the Role of Medical Schools in Combating Anti-Asian Sentiment

The Model Minority Myth, Data Aggregation, and the Role of Medical Schools in Combating Anti-Asian Sentiment

A study of Chinese medical students’ communication pattern in delivering bad news: an ethnographic discourse analysis approach

Patient participation in treatment decision-making of prostate cancer: a qualitative study

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