Deng, Wenna, Fan, Siyi, Diaz, Brett A., Steinberg, Leah, Ying, Irene, Leiter, Richard E., and Jia, Zhimeng
1. Describe unique barriers that Chinese North American patients with advanced cancer face in expressing emotions and discussing future planning. 2. Identify empathic opportunities (ie, topics associated with emotional expression) during care planning discussions with Chinese North American patients. Recognizing emotions in intercultural contexts represents a core competency in palliative care. Yet, a paucity of literature describes the types, patterns, and contexts of patient-expressed emotions during high-stakes conversations with patients from linguistically marginalized communities. We sought to address this gap by analyzing the emotional content during care planning conversations with Chinese patients with advanced cancer and their caregivers. We conducted a secondary analysis of 22 semistructured interviews of Chinese patients (n=20) with metastatic cancer and their caregivers (n=8) recruited at one American comprehensive cancer centre. Informed by the Empathic Communication Coding System and existing literature, we conducted template analysis to code the transcripts for patients' and caregivers' expressed emotions. We also thematically analyzed the patterns and contexts in which emotions arose. Participants were middle-aged (55.6±13.5 years), born in China (89.3%), 60.7% female, 85.7% partnered/married, and 89.3% college educated. Most of the interviews were conducted with patients alone (72.7%). Happiness was the most prevalent emotion (62%) followed by gratitude (43%), fear (43%), sadness (38%), anger (14%), surprise (14%), and humour (5%). When a caregiver was present, the interviews trended toward lower frequency of emotional expression. Regarding intensity, only one instance (anger) was categorized as most severe. Regarding context, emotions were only expressed in discussions about the past or present. Specifically, participants expressed positive emotions when discussing clinician attributes, symptom relief, and immigration to North America. Participants expressed negative emotions when discussing burdensome symptoms, diagnostic journey, the COVID-19 pandemic, and experiences with linguistic or cultural discordance. Emotional expression during high-stakes care planning conversations with Chinese patients and caregivers may be infrequent and grounded in social, topical, and temporal context. Future work is necessary to understand how clinicians could best respond to distressing emotions during naturally occurring palliative care conversations with Chinese patients and their caregivers. [ABSTRACT FROM AUTHOR]