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Chinese perspective on end-of-life communication: a systematic review
  1. Jack K H Pun1,
  2. Ka Man Cheung2,
  3. James C H Chow2 and
  4. Wing Lok Chan3
  1. 1 Department of English, City University of Hong Kong, Kowloon, Hong Kong
  2. 2 Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
  3. 3 Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong
  1. Correspondence to Dr Jack K H Pun, Department of English, City University of Hong Kong, Kowloon, Hong Kong; jack.pun{at}


Background Palliative care providers serving Chinese patients lack a culture-specific model of communication, a strong evidence base for this and clear guidance on its application. Thus, providers find it challenging to address patients’ dignity, and determine their priorities and preferences for treatments and care, at the patients’ final stage of life.

Aim This study explores the culture-specific influences and current understanding of end-of-life (EOL) communication in the Chinese context.

Methods A qualitative systematic review of qualitative studies was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PsycINFO, PubMed and ERIC databases were searched for studies between January 1994 and July 2019, using keywords ‘end of life’, ‘terminal care’, ‘communication’ and ‘Chinese’. Included studies were appraised with Critical Appraisal Skills Programme criteria.

Results The search strategy yielded 982 entries and 13 studies were included. Six themes were identified in EOL communication in the Chinese context: (1) Chinese philosophies on the meaning of ‘good death’. (2) Negative attitudes towards communication on dying. (3) EOL communication as a taboo topic. (4) Clinician-centred approaches to treatment-decision making. (5) Family expectations being prioritised over patient self-autonomy in prognosis disclosure. (6) Care-providers expressing puzzlement over cultural preferences regarding EOL communication.

Conclusions The review detailed the complexity of EOL communication in the Chinese context, urging for a communication model distinct from Western-based practices. Future research could explore a validated communication framework that addresses the local culture, thus enabling an understanding of patients’ priorities and interpreting EOL encounters from a cross-cultural perspective.

  • end of life care
  • cancer
  • communication
  • terminal care

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  • Correction notice This article has been updated since it was first published. The article type has been changed to Systematic review.

  • Contributors JKHP contributed to the conception and design of the study. KMC and CHJC revised the study protocol. JKHP, KMC and CHJC contributed to the acquisition and analysis of data. WLC and JKHP evaluated the risk of bias of the included studies. JKHP and KMC interpreted the data. JKHP and KMC drafted the manuscript. All the authors critically revised the manuscript and gave the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.