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Table 3 Theme 2 - Cultural attitudes

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

Subtheme Aspect of subtheme Quotations
General culture of communication Little communication about feelings - “So, I think Chinese patient is very … they are very ashamed to express their feelings. And some Chinese patient, they don’t want to take much trouble to the family members, so I think many patient concealed their feelings.” (T 05)
- I: “Can you describe me more about this feeling?” – P: “(laughs)” (T 02)
Euphemism and indirectness - “Because Chinese … (types on smartphone for translation) […] Euphemistic! […] In general, they are euphemistic and indirect. […] When they face the incurable disease […]” (T 22)
- “I will give him [the patient] some choice to choose, for example, to treat very positively or, it’s not abandon, but it’s softly treat.” (T 02)
Death culture Important role of the family
→ in handling disease
→ as decision maker
→ high social value of family as moral guide
- “For example, they [relatives] also are in Chinese clinic. All family members are there, yes. […] But in Germany … […] Totally different. The patients stay in bed alone, maybe once the family visits in the hospital.” (T 04)
- “But in my experience, mostly it’s the family makes decision.” (T 07)
- “So, if your parents are ill, you cannot give them up. Because you will feel suffer yourself, you will think you are a bad person, and people around you will criticize you. Because you did the worst thing.” (T 17)
Negative death perception through spirituality - “Death, to death, is horrible to us, that is eastern people. But in the west, they can more peaceful to this situation, to see dying, to see God.” (T 17)
- “So, in China, many, many patients is afraid of death. It’s not like the west. And many of this patient, they don’t have religion, they don’t believe. […] So, we can’t talk too clear direct to the patients: You have no time, six months or so … like so.” (T 08)
- “[…] most of them have this religion in Buddhism. But yours are Christian […] You know, in Christian, maybe from your child, you’re educated that death is part of your life. […] But for Chinese people, most of them think death is very difficult to accept.” (T 24)
Tabooing death - “So, they [Chinese people] don’t think it’s good things to discuss death with others. Not polite. Very impolite.” (T 24)
The desire not to die as a fundamental characteristic of humans
→ consequence of absolute cultural request for healing and curative treatment
→ hospitals as answer to this request
- “Because people don’t want to die, right?” (T 02)
- “And following our tradition, the relatives, especially the daughters and sons, who simply … they think that keeping the patient alive, that’s important. “(T 04)
- “[…] at the beginning, as young doctors, they only pay attention to the technology, and the main thing is I healed this patient, this disease.” (T 04)
- “If she doesn’t want to live, then she will not go to the hospital.” (T 03)
- “A lot of people in this country think, they just come to a hospital, they have to get the good result.” (T 24)
Home as part of the ideal idea of dying - I: „And what about other death related symptoms […]. Are they present in education? “– P: „Actually not […]. Because most patients, they want to go home. They know, that’s incurable, they are going to die, they won’t die here at the hospital. “(T 04)
Culture of truth telling
→ Information disclosure as precondition to PC
→ ambivalent judgement
- “But whether or not, whether to receive the palliative treatment or not is decided by comprehensive reasons, like economic status. […] And psychology status. How his ability to tolerate or accept the truth.” (T 16)
- I: „Do you talk with patients about death? Or with families about death? And dying?” – P: “But for the patient, we usually don’t directly talking this. […] Most, I will want give the patients hopes.” (T 20)
- “In my opinion, I think the patient should know the truth of their disease.” (T 22)
- “So, in China, we don’t want to talk, in your life, we don’t to talk about the death […] But it’s a real life. We must face it.” (T 23)