Developing an Appropriate Model of Palliative Care for Mainland China

: Exploring the Application of Alternative Medicine in the Shanghai Model

Abstract

In the context of mainland China, policy related to palliative care has a close relationship with social care, with the support of World Health Organization (WHO) guideline and evidence from developed countries with high-quality palliative care services. Shanghai is the only pilot city in mainland China. The Shanghai model of palliative care provides a full spectrum of palliative care, whereby GPs and community health service centres play important roles. However, medical studies dominate the research of the Shanghai model of palliative care. There is no study depicting the Shanghai model from the perspective of social science, although the Shanghai model aims to build a community-based and social-based model. This study aims to depict the Shanghai model from the perspective of social science. This study combines grounded theory and ethnography to cope with the absence of previous evidence. The 24 participants of this study are from 6 community health service centres and one 3A hospital in Shanghai.

The Shanghai model of palliative care is a pilot project aims to build a national palliative care model, which caters to the requirements of the new medical reform in mainland China. Under this background, the central government is the policy maker of the Shanghai model, while Shanghai’s municipal government is the primary designer, organiser, leader of the Shanghai model. In order to cover and satisfy more service-users, Traditional Chinese Medicine (TCM) is advocated by policy in the Shanghai model. This study argues that GPs in the Shanghai model perceive their work as less than ideal because of their understanding of the ideal palliative care model. In addition, they believe that the Shanghai model cannot be promoted nationwide. The application of TCM in palliative care is part of their work. The hospital-led palliative care model, characterized by sufficient medical resources and high specialization, is an ideal palliative care model from the view of GPs, but it has been criticised academically by social science research. Under this background, the Shanghai model has been paying attention to some Traditional Chinese Medicine methods or treatments with clear operating instructions. For example, Chinese medicine appropriate technology and Traditional Chinese medical ingredient soup has been brought into focus, while the psychosocial and spiritual care of TCM is ignored in the Shanghai model because it is hard to quantify TCM’s psychosocial and spiritual care in the current Chinese health insurance system.

This study questions those previous studies that argue traditional Chinese culture and its less developed economy are the main reasons for a less developed palliative care in mainland China. This study concludes that the imitation palliative care which is the imaginary western model of palliative care limits the development of palliative care in the context of mainland China. Imitation palliative care is constructed as a ‘luxury’ belonging to Western developed countries by many Chinese including both service-providers and service-users. Although policymakers design the Shanghai model as a community-based and social-based model, both service-providers and service-users cannot understand and fully benefit from the Shanghai model. Policy with clear clarification and a supportive Chinese health insurance system can help the Shanghai model become a successful model to be promoted nationally.

Date of Award	27 Mar 2024
Original language	English
Awarding Institution	University of Bath
Supervisor	John Troyer (Supervisor) & Louise Brown (Supervisor)