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Table 2 Theme 1 - Ambivalent perception of palliative care and palliative care education

From: Chinese medical teachers’ cultural attitudes influence palliative care education: a qualitative study

Subtheme Aspect of Subtheme Quotations
Judgement and interest Judgement on PC
→ positive, unsure, negative
- “I would like in peace go to die. […] Palliative medicine.” (T 17)
- “So, I’m confused about the palliative care and aggressive care, because if you lose confidence for a patient, so just choose the palliative care for them, but confidence is the important thing for the patients. So, if the doctors lose confidence, and what the patient should do?” (T 15)
- “Because palliative means no hope.” (T 15)
Interest in PC
→ existent, non-existent
- Field notes (FN): “[…] she was interested in the topic and interested in the way palliative medicine was developing in China” (FN 24)
- Field notes: “She just did not seem to care at all about palliative medicine” (FN 25)
Expectations for the future
→ change and need of change, little change
- “So, I think it’s, the future, the palliative medicine will be, most people will pay attention to this field.” (T 20)
“Now, it’s also the people are living longer, and have lots of the elders. And also, have lots of the cancer patients, or the Alzheimer’s disease, like this kind of disease. […] It’s we need the palliative medicine.” (T 20)
“Most of the doctors, they don’t pay much attention to this topic.” (T 24)
Interest in PC education → desire for more, contented with status quo, lack of interest - “[…] the medical school, they should arrange some course. Like the palliative medicine.” (T 20)
- “I think it’s, to be physician, if you want to be a physician, you must have this courses, because […] You’re dealing with the dying patients. So, you should have this kind of knowledge. […] You don’t need to be an expert, but you should know the knowledge about the palliative care.” (T 23)
- Interviewer (I): „Do you think this [actual way of PC] is a good way of learning it [PC] […]?” – Participant (P): “Yes. I think this is a good way to teach them student.” (T 21)
- I: “How do you think will the palliative care education develop in the future?” – P: “(moans)” (T 01)
Understanding of PC and PC education Definition of PC
→ contents: symptom control, death work, integral approach
→ usage: last option of therapy, part of oncology
- „To control the symptoms for the patient. It is the main work of palliative treatment in the ward.” (T 05)
- “Death education. […] Let each patient feel calm and calmer and accept death. He realizes that death is a process of life other than the end of life.” (T 10)
- “[…] to try my best to make patient and their family members to be calm down to face the coming of the death.” (T 05)
- “There are so many pains in patients, not only the body, but also the feelings and also some difficult situation in the society. […] And that’s also part of the palliative care.” (T 09)
- “So, for the people, for the patient who have not method to cure their diseases, […] no medicine, no other method to cure them, this Pallimed medicine is to this patients.” (T 17)
- “Palliative medicine, we usually know that from the oncology department.” (T 17)
Aims of PC
→ quality of life, respect for the patient and its will, acceptance of curative therapies
- “[…] I would say, palliative care makes living better.(T 11)
- “Pay him this respect, respect. Give some respect. And make them feel comfortable.” (T 26)
- “If the intention for this kind of patients is cure, I think palliative treatment is also an important part for this kind of patient treatment work. Because chemotherapy, radiotherapy, or the surgery, they also bring vary kind of symptoms and adverse reactions for this kind of treatment. So, palliative treatment also help these kind of patients to have a good dealt with this kind of treatment. To accept the treatment more smoothly.” (T 05)
Effects of PC
→ relief for physicians, families and hospitals
- “At that time [when first dealing with PC patients], I feel helpless myself, because not only for them, but also for myself, I feel hopeless. But later, (chuckles) then I read about […] NCCN guidelines about palliative care, use more often […] Not treat their disease but make them feel better. I feel I learned a lot. Not only to treat the disease […] but I actually helped them.” (T 15)
- “On the other hand, it’s also a great burden for the family or for the city. If everyone thinks like that, operate, drugs, it’s also very expensive. Many families living on the countryside are financially very burdened, maybe. They have to sell houses. Misery again.” (T 18)
- “On the other hand, for the family it’s also an inner burden, then they can feel well: Oh, doing such thing is no bad thing.(T 18)
- “Seeing from the point of view of society in these times, it maybe is a relief for these hospitals. Because then, the people don’t go to the hospital that often, and they won’t stay that long. “(T 18)
Handling of PC
→ grief, insecurity, tabooing, normality
- “When I know the disease can’t curable, so I’m very depressed. As a doctor I want to treat the patients. And help them get better and better.” (T 07)
- “So, [the patient] didn’t want to change the therapy, and she want to come back in two months later and you know that the circle of therapy is three weeks to four weeks. So, after two months, then maybe the lesions grows up. We tried … I tried my best. (laughs) To give her suggestions and blablabla, and … she go back. (laughs)” (T 03)
- FN: “He avoided the subject of palliative medicine […]” (FN 19)
- “I’ve seen my patients here, and like I mentioned, the most patients here are in good, you know, conditions, but only a few guys is looking for, you know …(T 01)
- FN: “[The participant] Did not seem to feel inconvenient when I was asking about incurable patients” (FN 06)
Content of PC education
→ symptom control, communication
- I: “If you would decide to teach palliative medicine […], what would you consider especially important in teaching? What would you teach?” – P: “I think most important the symptoms. And then how you deal with them. That’s it.” (T 01)
- “I think this [introduction of courses in communication] is actually very important, because communication, it’s not only communication. The background, you actually have to learn a lot.” (T 04)
Ideal realization of PC education → various ideal addressees - “But we’re very sorry, the specialist courses are more in the field of nursing, not in clinical medicine. “(T 11)
- “And I think, it’s also, first we’ll teaching the doctors.” (T 20)
- „At first for medical student, we can start. And then we slowly have to, all young doctors have to learn this.” (T 04)
- “So, I think, we should start the education in the very beginning, even in the small children. I just teach my boy, don’t scare about the death.” (T 23)
- “Especially for some oncology or hematologist, they should have this knowledges about how to deal with patients.” (T 20)
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