Identifying End-of-Life Preferences Among Chinese Patients With Cancer Using the Heart to Heart Card Game

Abstract

Background: Understanding the preferences for end-of-life (EOL) care is imperative in providing quality care to patients with life-threatening illness. However, it is difficult for patients, families, and health-care providers to initiate EOL conversations in China. An easy-to-use tool that could help health-care providers initiate EOL discussions is the Heart to Heart Card Game (HHCG), originally designed for Chinese Americans. Objective: To evaluate the EOL preferences among Chinese patients with cancer using the HHCG. Methods: We conducted a descriptive study to assess EOL preferences using HHCG among patients at the oncology chemoradiotherapy department of a Chinese tertiary hospital. Results: We recruited 58 patients in total of which 40 (69%) patients completed HHCG. The most frequently selected card was “I want my family to get along,” followed by “I don’t want to be a burden to my family,” and “I want to maintain my dignity.” Among the 3 cards selected, social needs were rated as the most important (36.7%), followed by spiritual needs (35.8%), physical needs (20.0%), and financial needs (7.5%). The evaluation of the HHCG revealed that more than 70% of the participants highly valued HHCG. Conclusion: The HHCG can be used as a communication tool to encourage EOL discussions between cancer patients and health-care providers in China. Moreover, Chinese patients with cancer attach significant importance to their family and maintaining dignity at the EOL.

Symptom Burden and Palliative Care Needs of Patients with Incurable Cancer at Diagnosis and During the Disease Course

“…While an increasing number of studies shed light on needs and symptom burden, care needs and preferences of patients at the end of life [21,22], surprisingly little is known about the time period immediately after diagnosis of incurable cancer and how these change over the disease trajectory. This knowledge is important to provide adequate, individualized palliative care.…”

Gamification for promoting advance care planning: A mixed-method systematic review and meta-analysis

“…29,33 Two study only evaluated participants’ satisfaction with the intervention without multiple measurements of the study outcomes before and after the intervention. 27,29 The outcomes of one study were measured using multiple methods (i.e. interview and card-sorting results) for baseline assessment and only through an interview for follow up assessment.…”

“…For the quantitative component of the included studies (n = 8), only one study was rated as moderate quality, 31 whereas the other seven were rated as low quality. [27][28][29][32][33][34][35] Only one randomized controlled trial was found, but it lacked detailed information about the randomization procedure used to allocate the participants, blinding to treatment assignment, and the reliability of measurement. 35 The remaining six studies were quasi-experimental studies using single-arm pretest-posttest or posttest only designs.…”

“…35 The remaining six studies were quasi-experimental studies using single-arm pretest-posttest or posttest only designs. [27][28][29][32][33][34] Analysis was not conducted for the participants who withdrew from the study, which accounted for 11.8%-40.1% of the sample size in four out of seven studies. 27,28,32,34 Two studies used self-developed instruments for outcome assessment without reporting the psychometric properties.…”

“…Finally, 11 English articles from 10 studies were included for review (Figure 1). [27][28][29][30][31][32][33][34][35][36][37]…”