Examining the Gaps and Issues of End-of-Life Care among Older Population through the Lens of Socioecological Model—A Multi-Method Qualitative Study of Hong Kong

Roger Yat-Nork Chung, Dong Dong, Nancy Nam Sze Chau, Patsy Yuen-Kwan Chau, Eng Kiong Yeoh and Eliza Lai-Yi Wong
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Roger Yat-Nork Chung: School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
Dong Dong: School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
Nancy Nam Sze Chau: School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
Patsy Yuen-Kwan Chau: School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
Eng Kiong Yeoh: School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
Eliza Lai-Yi Wong: School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China

IJERPH, 2020, vol. 17, issue 14, 1-18

Abstract: End-of-life (EOL) care for terminal illness and life-limiting conditions is a sector in the health service spectrum that is drawing increased attention. Despite having the world’s longest life expectancy and an ever-escalating demand for long-term care, Hong Kong’s EOL care was underdeveloped. The current study aims to provide a holistic picture of gaps and issues to EOL care in Hong Kong. Data collection was conducted using a multi-method qualitative approach that included focus groups and in-depth interviews with key informants and stakeholders, and longitudinal case studies with patients and families. Deductive thematic analysis was used to examine service gaps in current EOL care through the lens of a socioecological model where gaps and issues in various nested, hierarchical levels of care as well as the relationships between these levels were studied in detail. Using the model, we identified gaps and issues of EOL care among older populations in Hong Kong at the policy, legal, community, institutional, as well as intrapersonal and interpersonal levels. These include but are not limited to a lack of overarching EOL care policy framework, ambiguity in the legal basis for mental incapacity, legislative barriers for advance directives, inadequate capacity, resources, and support in the community to administer EOL care, inadequate knowledge, training, and resources for EOL care in health and social care sectors, inadequate medical-social interface, general reluctance and fear of death and dying, as well as the cultural interpretation of filial piety that may lengthen the suffering of the dying patients. Findings highlight the multi-level gaps and issues of EOL care in a place where western and eastern culture meet, and shed light on how best to design more effective and comprehensive policy interventions that will likely have a more sustainable and instrumental impact on facilitating person-centered EOL care during the end of life.

Keywords: end-of-life care; palliative care; older persons; Hong Kong; Chinese (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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