Esther Luo, MD
我最近有幸参加了与美华慈心关怀联盟 (CACCC) 创办人陈明慧 Sandy Chen Stokes、理事会共同会长 Gary Lee、物理治疗师 Janet Lee 以及护理教育者 Nancy Chiang 一同前往中国，与世界健康基金会 Project HOPE 的 Linda Dong 合作，进行缓和疗护及生命末期疗护的培训活动。
今年是首次在武汉举行安宁疗护医师培训师的培训课程，也是第七届护理培训师的培训课程。之后我们前往北京，并在当地举办了首届安宁疗护护理培训师的培训课程。在八天的培训过程中，我们各自负责了数个与生命末期疗护相关的主题教学。这是我第二年参加这项具有深远意义的工作，再次能够贡献其中，让我感到无比荣幸。
在中国，对于生命末期疗护的关注正在明显的增长，政府政策也积极支持其发展。我们注意到越来越多的护士渴望学习这一主题，同时也有更多的医生希望参与其中。
在此次行程中，我观察到中美在提供生命末期疗护上的几个显著差异。其中一个重要的差异是在传达严重疾病的坏消息时的沟通方式。在中国，医生通常会先与家属沟通，而不是直接告知病人。例如，当诊断出第四期癌症等严重病情时，许多人认为情绪上, 病人无法承受坏消息或糟糕的预后。这种观念深植于传统的孝道文化中，因此家属往往选择积极治疗，即使这些治疗可能并不符合病人的个人意愿。另一个差异是有关舒适疗护。在美国，在生命末期阶段通常会放弃维持生命的治疗，例如静脉补液和营养。然而在中国，即便在安宁疗护情况下，这些治疗仍被视为舒适疗护的一部分。
除了教学，我们还有机会参观了北京的多家住院安宁病房，并参与了湖北癌症医院的病人个案讨论和医院查房。在中国，安宁疗护主要都在医院进行，而不像美国多数是在病人家中进行。另外我还注意到，许多中国医院设有中医科，使用中药和针灸作为症状治疗的一部分。我认为这是对西方治疗方法中很好的辅助疗法，能更全面地缓解病人的症状。
这趟旅程中另一次难忘的经历是参观泰康的纪念公园和一家养老中心。该中心位于北京郊区，有超过3000名住户。除了生活设施外，该中心还包括医院、急诊室、住院安宁疗护单位，甚至还有为逝者准备的遗体防腐处理室。这种全程式的长者服务模式令人印象深刻，也提供了很多值得学习的地方。
最后，当地人的热情好客与奉献精神给我留下了深刻的印象。这是无法用言语完全表达的经历，但却深深地触动了我们每一位成员的心。
This year marked the inaugural physician train the trainer end-of-life training and the 7th annual nurses train-the-trainer end-of-life training in Wuhan. We then traveled to Beijing, where we held inaugural nurses train-the-trainer end-of-life training. Over eight days, we each had the privilege to teach several topics related to end-of-life care. It was my second year participating in this impactful work, and I felt honored to contribute once again.
There is clearly a growing interest in end-of-life care in China, with government policies actively encouraging its development. We’ve noticed more nurses eager to learn about this topic, and a growing number of physicians wanting to become more involved.
During the trip, I observed several key differences in how end-of-life care is delivered in China compared to the U.S. One significant difference lies in the communication process when delivering bad news about serious illnesses. It is common for doctors to speak with family members, rather than the patient, when disclosing a serious diagnosis, such as Stage IV cancer. Many believe that patients cannot handle bad news or a poor prognosis emotionally. This belief, rooted in traditional filial piety, often leads families to pursue aggressive treatments—even when it may not align with the patient’s individual wishes. Another key difference relates to the concept of comfort care. In the U.S., we often forgo life-sustaining treatments, like IV hydration and nutrition, at the end of life. However, in China, these treatments are still considered part of comfort care, even in hospice settings.
In addition to teaching, we had the opportunity to visit several inpatient hospice units in Beijing and participated in patient case discussions and hospital rounds at Hubei’s cancer hospital. In China, hospice is mainly delivered in the hospital setting rather than at patient’s homes as seen in the US. Another difference I noticed was that many hospitals in China will have a traditional Chinese unit where Chinese herbs and acupuncture are used as part of symptoms treatment. I think this is a great compliment to the Western treatments offered to patients in addressing symptoms.
Another memorable part of our trip was visiting Taikang’s memorial parks and a senior care center. Located on the outskirts of Beijing, the senior care center houses over 3,000 residents. In addition to living facilities, the center also includes a hospital, an emergency room, an inpatient palliative care unit, and even an embalming room for deceased patients. This end-to-end service model for seniors is fascinating and offers much to learn from.
Lastly, the hospitality and dedication of the people we met left a lasting impression. It’s an experience that words alone can’t capture but one that profoundly touched us all.