Perspectives of patients, family caregivers and healthcare providers on end-of-life communication in Chinese acute care settings : a qualitative study

Abstract

Aims: To explore key stakeholders' experiences and perceptions of end-of-life communication in acute care settings. Design: A qualitative descriptive study. Methods: Data were collected from 4 May to 31 October 2023. Patients with terminal illness, family caregivers and healthcare providers were recruited from two Chinese hospitals via purposive sampling. Individual interviews were conducted with patients and family caregivers, whereas healthcare providers participated in focus group discussions. Thematic analysis was conducted. Results: Nineteen patients, 22 family caregivers and 25 healthcare providers participated. Five themes emerged: (1) protective end-of-life communication, characterised by dominant family involvement, truth concealment and restricted end-of-life topics; (2) open end-of-life communication, characterised by dominant patient involvement, truth disclosure and diverse end-of-life topics; (3) patient-related factors, including comfort level in talking about end-of-life, burden and treatment engagement; (4) family-related factors, including comfort, burden, expectations, values and trust in healthcare providers and (5) healthcare provider-related factors, including comfort, time availability and clinical priorities, end-of-life communication awareness and skills and end-of-life care knowledge. Conclusion: End-of-life communication in Chinese acute care settings oscillates between protective and open approaches, influenced by several individual factors. Implications for the Profession and Patient Care: Healthcare providers must overcome stereotypes rooted in cultural values and adopt a proactive approach to end-of-life communication. Enhanced training and institutional procedures are needed to improve end-of-life communication in acute care settings. Impact: The study provides nuanced insights into end-of-life communication dynamics in Chinese acute care settings, complementing global evidence. Coexisting protective and open communication approaches highlight the need for context-sensitive approaches to end-of-life communication. Multifocal interventions addressing patient-, family- and healthcare provider-related factors are warranted.