Hospice and Palliative Care Acceptance in Chinese American Communities
According to the NHPCO hospice facts and figures report published in 2016, there are about 1.7 million patients were served
by hospice care, among them about 3.1% are Asian, Hawaiian or Pacific Islanders, while Asians Americans comprise 5.6% of
the total U.S. population.
Among Medicare beneficiaries who died in 2010, 45.8% of whites used hospice compared to 34% of African Americans, 37% of Hispanics, 28.1% of Asian Americans.
There are certain barriers in Chinese American communities to accept hospice palliative care due to various reasons: racial and ethnic differences in knowledge, cultural beliefs, and treatment preferences. Various Studies showed a disproportionate gap in knowledge about palliative care among Chinese American older adults.
It is key to develop more cultural appropriate resources and materials along with deeper community outreach programs to advocate the benefits of hospice palliative care in terms of improving quality of care in Chinese American communities.
Hospice and Palliative Care in China: Hugely Unmet Need
The need for hospice and palliative care in mainland China is beyond overwhelming – but we strive to focus on the help we can offer to make a difference in the lives of people with life-limiting illnesses and their families.
We focus on what we can do, not what we cannot.
In 2010, the Economist Intelligence Unit (EIU) in conjunction with the Lien Foundation published a research report profiling end of life care around the world. In comparison to other developed countries, China’s capabilities and approaches to end-of-life care were ranked very low.
In 2012, an estimated 2.5 million people died of late stage cancer in China, representing 30 percent of the death caused by cancer globally, with 3.5 million new cancer diagnosis reported in that year alone. That number increased in 2015, with an estimated 2.82 million people died of late stage cancer, with 4.3 million new cancer diagnoses reported.
Many Chinese patients pass away in hospitals after receiving intensive care which consists of aggressive futile medical treatments that only prolong their death, along with a huge financial burden upon their family members and the healthcare system. It is estimated that 80% of medical cost is spent on the last 30 days of life in hospital on life-prolonging treatment. Other patients die at home with no access to care that can relieve their symptoms and help them pass away with peace and comfort. This situation must change.
Lack of Public Health Policy Support
Absence of Integration into Healthcare System
For the overwhelming majority of Chinese who currently endure progressive, life-limiting illnesses, access to culturally appropriate holistic palliative and hospice care (including effective pain management) is simply not available. A survey of hospice and palliative care services found that there are only a handful of identified hospice or palliative care facilities in metropolitan cities like Beijing, let alone in the hundreds of smaller cities. There are only a few municipal governments that have integrated hospice and palliative care into the local healthcare coverage and allocated funding to support community healthcare facilities building and establishing hospices for late stage cancer patients. The cities include Shanghai, Changchun, and Jilin.
At the national level, the central government still has not come up with strategies, policy frameworks and guidelines to integrate hospice and palliative care into the healthcare system.
The country still faces an extreme shortage of health care professionals specializing in palliative care.
Palliative care was developed in China by motivated ‘pioneer’ individuals, rather than through mainstream national health systems. This has resulted in isolated centres of excellence. Along with other such centers dotted across the country, these provide some excellent demonstration sites for replication, but still are not adequate to reach all those in need. Palliative care remains absent from the vast majority of local governments’ health policies or basic care packages, with almost half of Chinese provinces identifying no hospice or palliative care activity. NGOs, hospices, and other organizations are left with the impossible task of filling the gap.
Opportunities For Change
This vast unmet need for palliative care can only be addressed by the public health approach to palliative care delivery advocated by the WHO and supported by HPCA Foundation. This ensures that the right policy frameworks, resourcing and educational structures are in place for palliative care to reach every man, woman and child in need.