Huiwen Zhai1,2, Christopher Lavender1, Cong Li3, Haotan Wu2, Ni Gong4, Yu Cheng5,6. 1. Office of Research Management and Education Administration, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, China. 2. School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, 510275, Guangdong, China. 3. Department of Colorectal Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine , Guangzhou, 510060, Guangdong, China. 4. School of Nursing, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China. 5. School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, 510275, Guangdong, China. chengyu@mail.sysu.edu.cn. 6. Department of Medical Humanities, the Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, 518107, Guangdong, China. chengyu@mail.sysu.edu.cn.
Abstract
PURPOSE: Patient-centered care (PCC) and shared decision-making (SDM) is advised within the English medical literature for its positive impact. The benefits of such approaches are said to foster increased trust, patient decision satisfaction, and even better outcomes. Looking at a Chinese cancer hospital, this research sought to understand how surgical decision-making was made among colorectal cancer patients. METHODS: Observations (n = 36) and semi-structured interviews (n = 24) were conducted with patients and family members. RESULTS: In the observations, 69.4% of the participating families made the decision to undergo surgery at the end of the consultation. In the interviews, three main themes emerged in regard to the characteristics in the family decision-making model, and they included three structural elements: the patient's sick role, family functional structure, and control of information. CONCLUSION: This study showed that the Chinese decision-making model is different from the western SDM model. In the Chinese context, family members dominated the decision-making process which raised concerns around informed consent. This may benefit patients insofar as receiving timely treatment in the short term but at the same time may be at the expense of limiting patient's autonomy. The promotion of a new model or a model encompassing family-centered care values may be more appropriate in clinical practice in China that can address the issues around informed consent.
PURPOSE:Patient-centered care (PCC) and shared decision-making (SDM) is advised within the English medical literature for its positive impact. The benefits of such approaches are said to foster increased trust, patient decision satisfaction, and even better outcomes. Looking at a Chinese cancer hospital, this research sought to understand how surgical decision-making was made among colorectal cancerpatients. METHODS: Observations (n = 36) and semi-structured interviews (n = 24) were conducted with patients and family members. RESULTS: In the observations, 69.4% of the participating families made the decision to undergo surgery at the end of the consultation. In the interviews, three main themes emerged in regard to the characteristics in the family decision-making model, and they included three structural elements: the patient's sick role, family functional structure, and control of information. CONCLUSION: This study showed that the Chinese decision-making model is different from the western SDM model. In the Chinese context, family members dominated the decision-making process which raised concerns around informed consent. This may benefit patients insofar as receiving timely treatment in the short term but at the same time may be at the expense of limiting patient's autonomy. The promotion of a new model or a model encompassing family-centered care values may be more appropriate in clinical practice in China that can address the issues around informed consent.
Entities:
Keywords:
China; Cultural issues; Family; Shared decision-making
Authors: Heather L Kane; Michael T Halpern; Linda B Squiers; Katherine A Treiman; Lauren A McCormack Journal: CA Cancer J Clin Date: 2014-09-08 Impact factor: 508.702