What a Hug Does: A Qualitative Study of Chinese Immigrant Families' Experiences with Inpatient Palliative Care Specialists.

Abstract

Background: Compared with non-Chinese adults in high-income countries, ethnically Chinese patients are more likely to encounter palliative care (PC) closer to death and in hospital settings. Yet, Chinese families' experiences and perception of inpatient PC remain unknown.

Objective: Identify barriers and facilitators to culturally respectful PC for Chinese immigrant inpatients and their caregivers.

Design: Prospective, exploratory qualitative design involving phenomenological interviews.

Setting/subjects: We consecutively recruited (n = 15) Chinese immigrant patients and their caregivers (n = 14) referred to PC at one Canadian academic teaching hospital. We collected participant self-reported sociodemographics and Suinn-Lew acculturation level and conducted semi-structured interviews (n = 10) in Mandarin and/or English. The interviews were recorded, transcribed, translated, and thematically analyzed using Tan's Health Communication framework.

Results: Patients were older-aged (mean = 73.5 ± 16.2 years), 53.3% female, 60% college-educated, 66.7% nonreligious, and 93.3% diagnosed with cancer and had low acculturation (mean = 1.8 ± 0.9/5.0). Caregivers were middle-aged (mean = 50.6 ± 15.5 years), 78.6% children, 57.1% female, 85.7% college-educated, and 71.4% nonreligious and had moderate acculturation (mean = 2.5 ± 1.2/5.0). We identified four themes from post-consultation interviews: abandonment and alienation mark past experiences with serious illness care; emphasizing expertise and symptom relief may help overcome initial ambivalence toward PC; PC brokers competing priorities within the family unit; and PC alleviates time-related distress by addressing illness understanding.

Conclusion: Chinese patients and caregivers may prefer a PC approach that is sensitive to historical mistrust, leverages expertise in symptom management to inspire confidence, and accommodates the information and care preferences of the family unit. Further research is needed to examine the impact of these PC strategies on clinical outcomes for Chinese families.