End-of-life care preferences of chinese adults vary based on whether they have children

November 01, 2018

Chinese adults who have children prefer to receive end-of-life care from family members at home, while those who lost their only child prefer to be cared for in hospice or palliative care institutions, finds a new study led by an international team of researchers and published in the November issue of The Journal of Palliative Medicine. Income, property ownership, and support from friends also influenced individuals' end-of-life care preferences.

"Childlessness greatly influences adults' end-of-life care preferences, as children play an important role in traditional Chinese family-based end-of-life care," said Bei Wu, PhD, Dean's Professor in Global Health at NYU Rory Meyers College of Nursing and co-director of NYU Aging Incubator. She is the study's senior author.

Filial piety, or respect for one's parents, is a core value in traditional Chinese culture, and children play a critical role in caring for aging parents and providing end-of-life care. End-of-life care is the support and medical care provided during the days, weeks, or months leading up to one's death.

China's one-child policy has led to a unique situation in caring for aging parents. As of 2010, one million Chinese parents had lost their only child, a number projected to grow to 11.8 million in 2050. Chinese adults who lose their only child are particularly disadvantaged when it comes to family-based end-of-life care.

In Western society, the end-of-life care model relies less on family members, instead using hospice and palliative care institutions and professional health care providers to provide support, reduce pain, and improve comfort. Hospice and palliative care systems are underdeveloped in China and face many structural and cultural challenges, including traditional views toward death, limited public funding, and a shortage of end-of-life care professionals at all levels.

In this study, Wu and her colleagues used data from a survey of 1,400 older adults in Shanghai to explore their end-of-life care preferences. The majority (1,200) were adults aged 60 years and older; the researchers also surveyed 200 adults aged 45 years and older who lost their only child. Participants were coded as having children who live with them, having children who do not live with them, or having lost their only child.

The researchers asked participants to share how they would want to be cared for at the end of their lives: by family, by visiting health care professionals, or in a specialized hospice or palliative care institutions.

They also measured factors related to end-of-life care, including sociodemographic characteristics such as gender, age, marital status, education, income, and property ownership; whether they have a support network of relatives and friends; health status, including chronic diseases, recent hospitalizations, mental health, and limitations in performing daily tasks; and whether they have health insurance.

The researchers found that adults who lost their only child prefer end-of-life care provided by a specialized hospice or palliative care institution (58 percent), while adults with children prefer family care at home (47 percent for adults whose children do not live with them and 49 percent for those whose children live with them).

Additional analyses show that adults with higher incomes and property tend to opt for family care at home. Conversely, those with a supportive network of friends prefer end-of-life care provided by visiting health care professionals or in end-of-life care institutions over family care at home. Health status was not associated with end-of-life care preferences; nor were other demographic factors (age, gender, marital status, and education).

"Our findings demonstrate a need to develop hospice and palliative care in China, both at-home care and care in hospitals and other clinical settings. Health care professionals and policymakers should recognize the particular preferences of those who have lost their only child and should develop tailored care accordingly," said Wu, who is also the director of research for the Hartford Institute of Geriatric Nursing at NYU Meyers.
-end-
This study is published in the November issue of the Journal of Palliative Medicine and appeared online ahead of print in July 2018.

In addition to Wu, study authors include Yan Liang and Hong Liang of Fudan University in China, and Jing Wang and Hanzhang Xu of Duke University. The study was partially supported by the Shanghai Municipal Yangpu District Commission of Health and Family Planning.

About NYU Rory Meyers College of Nursing (@NYUNursing)

NYU Rory Meyers College of Nursing is a global leader in nursing and health. Founded in 1932, the College offers BS, MS, DNP, and PhD degree programs providing the educational foundation to prepare the next generation of nursing leaders and researchers. NYU Meyers has three programs ranked in the top 10 by U.S. News & World Report and is among the top 10 nursing schools receiving NIH funding, thanks to its research mission and commitment to innovative approaches to healthcare worldwide.

New York University

Related Palliative Care Articles from Brightsurf:

Palliative care needed across China for everyone who needs it -- study
Palliative care should extend across China and pay more attention to managing non-malignant disease -- integrated within the country's healthcare system and available to everyone who needs it, according to a new study.

New palliative care model shown to reduce costs without compromising on quality of care
Findings from a large-scale clinical trial testing a new palliative care model have shown to be lower cost, viewed positively by patients and their carers while showing no difference in patient-reported outcomes when compared with standard care.

Palliative Care in emergency departments during COVID-19 pandemic
The clinical characteristics and outcomes of patients who received intervention by a COVID-19 palliative care response team are examined in this case series.

Palliative care for patients with cancer in COVID-19 era
The considerations and challenges affecting the palliative care specialty and delivery of palliative care in the COVID-19 era, as well as potential solutions, are discussed in this Viewpoint.

To face coronavirus disease 2019, surgeons must embrace palliative care
This Viewpoint describes the relevance of a palliative care approach to surgery during the coronavirus disease 2019 pandemic.

Call for palliative care to be adapted for severely ill Covid-19 patients
Emergency-style palliative care needs to implemented to meet the needs of Covid-19 patients who wouldn't benefit from a ventilator say researchers.

A COVID-19 palliative care pandemic plan: An essential tool
Palliative care physicians have created a coronavirus disease 2019 (COVID-19) palliative care plan as an essential tool to provide care and help manage scare resources during the pandemic.

MAiD is not driven by socioeconomic vulnerability or poor access to palliative care
A new study of people who received medical assistance in dying (MAiD) in Ontario found that about three-quarters were cared for by palliative care practitioners at the time of their request for MAiD, and MAiD recipients were younger, wealthier and more likely to be married than the general population at time of death.

Palliative vs. standard care for Parkinson's disease
This randomized clinical trial that included 210 patients with Parkinson's disease and related disorders and 175 caregivers examined whether outpatient palliative care was associated with better patient or caregiver outcomes compared with standard care.

Palliative care in hospitals linked to decrease in use of ICU; treatment intensity
A new study shows that implementing hospital-based palliative care services in New York State reduces treatment intensity at the end of life for hospitalized patients.

Read More: Palliative Care News and Palliative Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.