Esther Luo, MD
我最近有幸參加了與美華慈心關懷聯盟 (CACCC) 創辦人陳明慧 Sandy Chen Stokes、理事會共同會長 Gary Lee、物理治療師 Janet Lee 以及護理教育者 Nancy Chiang 一同前往中國，與世界健康基金會 Project HOPE 的 Linda Dong 合作，進行緩和療護及生命末期療護的培訓活動。
今年是首次在武漢舉行安寧療護醫師培訓師的培訓課程，也是第七屆護理培訓師的培訓課程。之後我們前往北京，並在當地舉辦了首屆安寧療護護理培訓師的培訓課程。在八天的培訓過程中，我們各自負責了數個與生命末期療護相關的主題教學。這是我第二年參加這項具有深遠意義的工作，再次能夠貢獻其中，讓我感到無比榮幸。
在中國，對於生命末期療護的關注正在明顯的增長，政府政策也積極支持其發展。我們注意到越來越多的護士渴望學習這一主題，同時也有更多的醫生希望參與其中。
在此次行程中，我觀察到中美在提供生命末期療護上的幾個顯著差異。其中一個重要的差異是在傳達嚴重疾病的壞消息時的溝通方式。在中國，醫生通常會先與家屬溝通，而不是直接告知病人。例如，當診斷出第四期癌症等嚴重病情時，許多人認為情緒上, 病人無法承受壞消息或糟糕的預後。這種觀念深植於傳統的孝道文化中，因此家屬往往選擇積極治療，即使這些治療可能並不符合病人的個人意願。另一個差異是有關舒適療護。在美國，在生命末期階段通常會放棄維持生命的治療，例如靜脈補液和營養。然而在中國，即便在安寧療護情況下，這些治療仍被視為舒適療護的一部分。
除了教學，我們還有機會參觀了北京的多家住院安寧病房，並參與了湖北癌症醫院的病人個案討論和醫院查房。在中國，安寧療護主要都在醫院進行，而不像美國多數是在病人家中進行。另外我還注意到，許多中國醫院設有中醫科，使用中藥和針灸作為症狀治療的一部分。我認為這是對西方治療方法中很好的輔助療法，能更全面地緩解病人的症狀。
這趟旅程中另一次難忘的經歷是參觀泰康的紀念公園和一家養老中心。該中心位於北京郊區，有超過3000名住戶。除了生活設施外，該中心還包括醫院、急診室、住院安寧療護單位，甚至還有為逝者準備的遺體防腐處理室。這種全程式的長者服務模式令人印象深刻，也提供了很多值得學習的地方。
最後，當地人的熱情好客與奉獻精神給我留下了深刻的印象。這是無法用言語完全表達的經歷，但卻深深地觸動了我們每一位成員的心。
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.