Research On Hospice Palliative Care Utilization Among Chinese Older Adults

With the development of social economy and the continuous improvement of people's living standards,a "good death" is the common pursuit for the dignity and quality of life of the human.According to the global quality of death report published by the Economist Intelligence Unit in 2015,China ranked 71 st out of 80 countries and regions.In recent years,hospice palliative care(HPC)with the goal of improving the quality of life of the elderly at the end of their lives have become an important means of active aging and healthy aging,as well as an important part of the construction and deepening of old-age care services in various countries.In 2017,led by the National Health Commission,China began a pilot program to explore the development of HPC.However,the theoretical and empirical studies on the utilization of HPC in China are relatively inadequate.In this current study,with a combination of qualitative and quantitative research design and on the basis of the "Quality of Life Theory"," Maslow's Demand Hierarchy Theory ",and " Anderson Health Service Utilization Theoretical Model ",we analyzed the following three questions from an "HPC utilization" perspective: 1)the current status and characteristics of the development of HPC in China;2)what are the contents of HPC needs and the hierarchy characteristics;3)What elements influence the HPC utilization behaviors among older adults,and how HPC utilization behaviors affect the cost and quality of end of life.Based on the above three issues,this paper analyzes the existing problems and causes in the development and utilization of HPC in China.In view of the late start of modern hospice care services in China,this paper,focusing on research issues,summarizes relevant international experience supporting the use of hospice care services.Finally,based on the reality of our country,this paper puts forward some policy suggestions to promote the utilization and development of HPC.Based on the results of this study,The main findings and policy implications were:First,at present,China's HPC development lacks a complete policy system and uneven development in practice.On the one hand,there is a lack of systematic policies to promote the development of HPC.For instance: insufficient in policy basic research affects the combination of policy and practice;Only strength the provision of the services but ignore the demand for services caused an imbalance between supply and demand.On the other hand,the development of the HPC practice among different areas is unbalanced.The development and equity of HPC significantly influenced by economy,resources and population aging.Compared with big city and urban,the poor area and rural have bad access to HPC.Second,the needs of the elderly for the use of HPC include four aspects: "body,mind,society,spirit",but there are individual differences in the level of demand and satisfaction.The demand for the use of HPC at the physical level is mainly based on physiological needs,including pain control and symptom management;the psychological level of HPC covers the safety needs and love and belonging needs of the elderly at the end of life,including not wanting to be abandoned due to illness,or even being abandonment also includes maintaining close relationships with family members;the social level needs of HPC is mainly related to the respect and self-realization needs of the elderly at the end of life,that is,the elderly expect to be respected through behaviors such as organ donation,and achieve a higher level of inner value for life pursuit and understanding;the "spiritual needs" are the special needs of the dying elderly and are independent of Maslow's need level,which has confirmed the differences of needs between dying elderly and the general group and the needs of the dying stage and other stages of the life.This study also found that although the HPC needs among the elderly who are at the end-of-life are intrinsically consistent with Maslow's hierarchy of needs in terms of content and hierarchy,there are certain differences in the production and satisfaction order of the hierarchy of needs,mainly it is manifested that the generation and satisfaction of the use of HPC for the elderly do not completely follow the order of Maslow's hierarchy of needs from "low to high",and may generate multiple levels of demand at the same time.Therefore,in order to improve the quality of HPC,it is necessary and important to identify and assess the HPC needs and characteristics dynamically on the basis of dying elderly physical,mental and prospect survival time in practice.Third,at present,the survival status of the elderly at the end of life is worrying.From an individual perspective,the predisposing factors,enabling factors,and needs factors all have a significant impact on the behavior of the use of HPC.In terms of survival status,more than 70% of the elderly suffer from chronic diseases and major diseases before death,and extreme weakness such as bedridden and unconsciousness.Compared to choose an institution or community,more than 80% of the elderly mainly choose home-based HPC;and more than 90% of the elderly died at home.These above findings revealed that the burden of care for dying elderly mainly in the family.In terms of predisposing factors,the older,the higher the education level,the unmarried and non-agricultural elderly people were more likely to choose community-based or institutional-based HPC before they died;In terms of enabling factors,elderly with the low family economic state were more likely to choose institutional HPC before death,rather than at home;in terms of needs factors,elderly with chronic diseases such as high blood pressure or major diseases before death were more likely to choose community-based or institutional-based HPC than at home.The analysis results of the influencing factors showed that the HPC utilization behavior of the elderly affected and restricted by family care resources,regions,and physical conditions.Therefore,in order to enhance the HPC availability,during the development of HPC,attention should be paid to eliminating the unfavorable factors that affect the HPC utilization at the individual level,and to ensure that the elderly can freely choose and use various services including home-based,community-based,and institution-based HPC according to their needs and preferences.Fourth,the HPC utilization and its medical and care cost significantly affect the quality of end of life.From the cost perspective,the total cost of medical care generated by the use of community-based HPC was significantly higher than that of home-based,and the self-financed medical expenses of institutions are significantly lower than that of at home.From the perspective of the impact of the HPC use and its cost on the quality of end of life,the elderly who choose community-based HPC to have the least death pain,which showed that community HPC is more helpful to improving the quality of end of life,but should reduce cost;The higher the total medical cost before death,the more painful the death,indicating that excessive medical treatment or invalid rescue may reduce the quality of life.Therefore,we should focus on improving the quality of life at the end of life,fully consider the affordability of HPC,and issue support measures to a network of HPC use which including home HPC,community HPC,and institution HPC.Fifth,there are many elements have influence the effective HPC utilization among dying elderly.Considering the development of HPC is at the initial stage In China,we suggest the government may learn some useful experience from developed countries and issue support policies to improve the HPC quality and utilization effectiveness.Based on the "Anderson model of health service accessibility evaluation" framework,we suggest: at the policy level,the policy support system should be improved to ensure the accessibility of the HPC;at the service supply level,the service supply should be standardized to enhance the the availability of HPC services;at the social and cultural level,a good social atmosphere should be created to improve the acceptability of the use of HPC services;at the level of individual participation,individuals should be actively encouraged to participate in enhancing the effectiveness of the use of HPC.The innovation of this study lies in the following aspects: first,the innovation of the research perspective.Most of the existing researches focus on the aspect of HPC supply,and the research on the content of service supply is mainly about physical care.This study from the individual level perspective and takes "service utilization" as the entry point to extend the demand of hospice care service from the body level to multiple aspects of "body,mind,society and spirit".The second is the innovation of theoretical application.This paper combines "Maslow's hierarchy of needs theory" and "Anderson Health Service Utilization Theory" model to construct the analytical framework,and applied it for the firstly to study the utilization of HPC for the dying elderly,which broadens the scope and depth of theoretical application.Third,the innovation of research methods.In this study,the qualitative and quantitative research methods were introduced into the research on the utilization of HPC,which not only made up for the deficiencies of the existing literature in the application of methods,but also improved the interpretation of quantitative data analysis.Therefore,this study,to some extent,enriches and expands the perspective and theoretical application of HPC research,and has important academic value and practical significance for the theoretical research and practical development of HPC utilization for the elderly.