Palliative care in the Greater China region: a systematic review of needs, models and outcomes

Research output: Contribution to journalArticlepeer-review

Authors

Colleges, School and Institutes

External organisations

  • King's College London

Abstract

Context: There is rapidly increasing need for palliative care in Greater China because of rapidly aging populations. 

Objectives: This study aimed to systematically review and appraise evidence for palliative care needs, models of care, interventions, and outcomes in Greater China. 

Methods: Four databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) were searched, with hand searching of local journals and databases. Narrative synthesis was applied to the qualitative and quantitative evidence. 

Results: Nineteen qualitative studies and 47 quantitative studies were retained. With respect to care needs, nine themes were synthesized: pain control, reduced aggressive end-of-life care, truth telling, physical, emotional, and spiritual supports, and achieving preferred place of care/death. Informal caregivers expressed their needs for education and burden reduction. Health care professionals called for training and national policy support. Twenty-four studies evaluated interventions, mostly among patients with advanced cancer. Positive effects were suggested for improvements in quality of life, pain, anxiety and depression, readmission rate, and costs. Models of care evaluated were mostly specialist palliative care delivered in various settings (hospitals, residential care, and home). Outcome measures used were grouped into six categories of construct: quality of life, pain, physical assessment, psychospiritual assessment, quality of care, and implementation assessment. Limited rigorous randomized controlled trials are available to document intervention outcomes, and some problems (such as high attrition rates) reduced the strength of the evidence. 

Conclusion: Palliative care services within Greater China should pay more attention to management of nonmalignant disease and to integration into primary services. Policy support is key to establishing culturally appropriate person-centered services.

Bibliographic note

Funding Information: H. C. received funding from the Taipei City Hospital , Taipei, Taiwan (grant number: 106XDAA00208 ). P. G. and R. H. conceived the idea for the study. P. G. and H. C. developed the protocol and conducted the data extraction, synthesis, and quality assessments. H. C. wrote the first draft of the article. All authors contributed to the interpretation of findings and critical revision of the article. All authors approved the final version of the article for submission. The authors declare no conflicts of interest.

Details

Original languageEnglish
Pages (from-to)585-612
JournalJournal of Pain and Symptom Management
Volume61
Issue number3
Early online date8 Sep 2020
Publication statusPublished - Mar 2021

Keywords

  • Greater China, Palliative care needs, interventions, outcomes, systematic review