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Culture understanding of the discrepancy in end-of-life care implementation in China

Background Considering the particularity of Chinese culture, with a long history of traditional ethics rooted in Confucianism, significant differences between Chinese and Western cultures exist in clinical practice. Following the western recommendations is a tough process for palliative care implementation in China. Therefore, it is essential to present some important experience for implementing the palliative care for Chinese terminally ill cancer patients from the aspect of culture understanding. Method 648 patients received palliative care in our department between 2007–2011 (342 patients died in the ward). The authors summarised the understanding of Chinese culture difference as physician servicing in palliative care Department in Shanghai Cancer Centre Fudan University since March, 2007. Results The authors rooted the Chinese cultural differences from four aspects: the truth telling, the decision-making, issues about the survival length, the acceptance of death of cancer. Concealing the serious diagnoses from patients in China is common. The decision-making occurred always together with the patients' family. For serious diagnoses or fatal prognoses, physicians usually first inform a close member of the patient's family. It then becomes the family's decision whether to tell the patients the truth. So this is actually a barrier to conduct the research to understand the perception about death among Chinese terminally ill cancer patients themselves. As for acceptance of death, nearly 43% patients' caregivers asked for not resuscitate medication and asked for stopping the hydration, 26.90% died patients' relatives asked for sedation to relieve the suffering on their own initiative. Conclusion The discrepancy do existed in the implementation of palliative care between China and Western countries. The rooted cultural reasons maybe: the value and appreciation of filial duty connotation, obscurity, responsibility and the deep-rooted traditional Chinese death attitudes.