Mixed-method evaluation of a culturally-adapted basic palliative care curriculum for practicing physicians in mainland China.

Abstract

Background: China's aging population will escalate palliative care (PC) needs in the next decade. Scalable and culturally-adapted training is necessary to equip practicing clinicians with essential PC skills. The objective of this study is to evaluate a culturally-adapted basic PC training course in mainland China.

Methods: A total of 29 practicing physicians from Zhejiang Province, China, were selected to participate in an in-person training program that spanned six days. We analyzed pre- and post-course quantitative surveys on knowledge, self-efficacy, and behavior using descriptive statistics. We also thematically analyzed post-course semi-structured participant interviews.

Results: The majority of participants were aged 41-50 (51.7%), trained in internal medicine (55.2%), worked at tertiary medical centers (93.1%), and did not have clinical PC experience (65.5%). After the course, participants' PC knowledge (p < 0.01) and self-efficacy (p < 0.01) increased, especially in the domains of PC philosophy and physical symptom management. Although statistically significant, changes in participants' self-perceived behaviors were less profound. Thematic analysis of the participant interviews revealed concordant themes, including recognition of cohesiveness between PC principles with traditional Chinese philosophy, and acquisition of actionable clinical knowledge. Key points that expanded beyond the meta-inferences were: 1) emotional resonance with the teaching team is necessary to create a transformational learning experience; and 2) a longitudinal, relationship-centered mentorship process may aid in participants' implementation of PC skills.

Conclusion: The results of this study indicate that our culturally adapted PC training can increase practicing physicians' PC knowledge and self-efficacy. Scalable basic PC training should preserve and facilitate emotional resonance between participants and instructors to ensure uptake of PC principles. Efforts to understand and overcome the implementation challenges of new PC champions should also be prioritized.