End-of-life care in urban areas of China: A survey of 60 oncology clinicians

Although cancer is a leading cause of death, little is known about cancer-related end-of-life care in China. We surveyed 60 Chinese oncology clinicians' practices and attitudes toward end-of-life care. Fewer than half reported available hospital-based hospice service, although most urban cancer patients die in the hospital. Most clinicians reported they felt competent to care for dying patients - more competent in controlling pain, constipation, nausea, and vomiting, but less competent in managing depression, anorexia, and dyspnea. Regarding disclosure, most believed that patients should know and want to know their diagnosis and stage, whereas families strongly resist informing patients. Unrealistic family expectations, fears of depressing patients, and physician reluctance to stop treatment were barriers to disclosing prognosis to patients, to ending anti-cancer therapy, and to starting palliative care. Results of the survey suggest specific training and research in symptom management that might improve end-of-life care for Chinese cancer patients.