1、Role of Culture in Palliative Care: Family MeetingPingfen Tang professor of NursingKunming Medical UniversityWHO emphasize that the family is the basic unit of end-of-life care1，family deathbed is very popular in some developing countries2which the long-term palliative care is mainly provided by the
2、 family31戴红霞，殷磊姑息护理新型的护理方式护士进修杂志，（）：2何婉珠，黄素枰，林利荣，等居家晚期患者临终关怀护理的探讨现代医院，（）：3 Spillman B C , Pezzin L E.Potential and active family caregivers : changing networks and the “ sandwich generation” J .Milbank Q , 2000 , 78(3):347-374 Palliative care could be defined as any relative, friend or partner who h
3、as a significant relationship with and provides various forms of support to a person with incurable illness 1. Family member may experience a considerable burden when caring for a person with complex and serious conditions, which could affect their health and wellbeing negatively 2.1. Hudson P, Payn
4、e S. Family caregivers and palliative care: current status and agenda for the future. J Palliat Med. 2011;14(7):8649.2. Kohler N, Perner A, Anders D, Brahler E, Papsdorf K, Gotze H. Family caregivers of palliative cancer patients: health-related quality of life and care-related burden. Psychother Ps
5、ychosom Med Psychol. 2012;62(5):15762.Individual Family &Social Support NetworkSystems for Health Care DeliveryCultural CommunicationExpectation Decision PlanningGrief Elain Wittenbery, Betty Ferrell Textbook of Palliative care Patient-centered communication and palliative care Elain Wittenbery, Bet
6、ty Ferrell Textbook of Palliative care Patient-CenteredCommunication&Palliative CareBeliefs, values,attitudes, preferences,goals, and emotionsBeliefs,values,attitudes,preferences,goals, andemotionsBeliefs, values,attitudes,preferences,goals, andemotionsPatient Family Health care term Individual Fact
7、orsAgeGenderIllnessGenePsychosocial CultureReligious Family FactorsStructureFunctionRelationship Environment Social NetworksCommunityHealth care DeliveryIndividual OutcomesMorbidityMortalityQuality of LifeFamily OutcomesLifestyleSatisfactionQuality of lifeEnvironment ConvenientEfficient Full service
8、sIndividual Margaret el., 2006Individual -FamilyManagement Model FamilyCultural play an important role in Palliative Care in China“Raise children to the elderly endowment and death”，and it always has been emphasized Chinas “filial piety”，The elderly are willing to in their own homes, accompanied by
9、children through the final stages of life.Men xianwuHospice careTianjin：Tianjin science and technology publishing house：Chinese traditional culture about Filial Piety Filial Piety is the younger generation handling the relationship with the elders in the family should have moral quality and must abi
10、de by the code of conductShi Lihua point out that 90% of the elderly are more likely to choose to die at home，cared by their family member 1. 40% - 80% of the dying patients in the developed countries choose died at home，because home is the most place can make them feel comfortable and safe place 2-
11、3。1 Lihua ShiUnder the background of research of Chinas ageing hospice career development strategy JChinese medical ethics，2009。22（4）：82-832Stajdhar KI。 Davies B。 Variations in and factors influencing family member decisions for palliative home care J. Plliative Med，2005，9（1）：21-323 Yong-xing shi. A
12、ged care of hospital service Situation and policy research of Shanghai。 M Shanghai Fudan University press., 2008 :74-75 .Psychological Problems for Family Members in Palliative CareAnxietyPessimisticDespair Davis MP, Gutgsell T, Gamier P. What is the difference between palliative care and hospice ca
13、re? J. Cleve Clin J Med, 2015, 82(9):569-571.Family Goals for End-of-Life Care Patient is pain-free. Patient is clean. Patient is able to be with loved ones. Environment is beautiful, peaceful. There is a comfortable place to lie down. Lights are gentle. The patients wishes are respected. Medication
14、 is available to manage pain.Gwyther LP, Altilio T, Blacker S, Christ G, Csikai EL, Hooyman N.Social work competencies in palliative and end-of-life care. J Soc Work End Life Palliat Care. 2005;7:87120.Family MeetingSupporting Medical TermFamily Members CooperationContent of Family MeetingEncourage
15、family emotion and desireDiscuss the treatment & care planDetermine the decision makersTell to family the patients last timeRhondali W, Dev R, Barbaret C, et al. Family Conferences in Palliative Care: A Survey of Health Care Providers in FranceJ .J Pain Symptom Manage,2014,48(6):1117-1124 Yennura J
16、S, Dev R, Lockey M, et al. Characteristics of Family Conferences in a Palliative Care Unit at a ComprehensiveCancer Center J .J Palliat Med, 2008,11(9):1208-1211.Preparation Family MeetingGoalsEnvironmentParticipantsRelationshipInformationCognitiveAgreementSummaryNursePhysicianPsychological consulta
17、ntSocial work/volunteersFamily membersReligious group(if need)InformationChen, Zhao Shi,Zhu. A family meeting communicate the treatment for ICU terminate dying s satisfaction analysis J Chinese hospital management.2011,31（3）:53-55.IllnessInformationDiagnosisTreatmentFamily RelationshipSocial Support
18、ingReligious Culture Meeting skillsUsing scientific communication skills such as the SPIKES and ABCDE Models and timely transfer the “bad news“ to family members.McFarlane J, Riggins J, Smith T J. SPIKES: A Six-Step Protocol for Delivering Bad News About the Cost of Medical Care J . J Clin Oncol, 20
19、08, 26(25):4200-4204.SPIKES WALTER F. BAILE, 2000ABCDE Rabow MW, Mcphee,1999 Breaking Bad News Mode Arrange for some privacy Involve significant others& Sit down Make connection and establish rapport with the patient Manage time constraints and interruptionsS: Setting Determine what the patient know
20、s about the medical or what is suspected. “Before you tell, ask.”, Listen to the patients level of comprehension Accept denial but do not confront at this stageP: Perception of condition/ seriousness Ask patient if wishes to know the medical and/or treatment Accept patients right not to know Offer t
21、o answer questions later if s/he wishesI: Invitation from patient to give information Consider educational level, socio-cultural background, current emotional Give information in small chunks, warn the patient bout to give bad news Check whether the patient understood what you said & Respond reactio
22、ns Give any positive aspects firstK: Knowledge give medical factor Prepare to give an empathetic response: 1. Identify emotion expressed by the patient (sadness, silence, shock etc.) 2. Identify cause/source of emotion 3. Give the patient time express his or her feelingsE: Explore emotions & sympath
23、ize Patients who have a clear plan for the future are less likely to feel anxious and uncertain-so clarify their understanding Close the interviewStrategy & summary ABCDE Mode Advance PreparationBuild Environment/ RelationshipCommunicate WellDeal with Patient & Family Reactions Encourage and Validate Emotions Rabow MW, Mcphee SJ, Beyond Breaking the bad news: How to help patients that suffer West J Med 1999;171:261 Cases discussCase 1 Case 2
