| dc.description.abstract | Background
Since the concept of end of life care was first introduced in the late 80’s in Hong Kong
(Chan, 2002) and Taiwan (Glass et al, 2010), research interests examining the influence
of Chinese culture in respect of death, dying and end of life issues has gained popularity
(Bowman & Singer, 2001; Chan & Chow, 2006; Chen et al, 2014; Hsu et al, 2009; Mjelde-
Mossey & Chan, 2007; Tung, 2011; Zhou, 2016). However, there is a dearth of empirical
examination on the process of the establishment and development of the concept and
service of end of life care, within a socio-cultural Chinese environment. In the context of
Macao, there is only one study (Lo, 2002) describing the establishment of the inpatient
hospice, and to date, there is no empirical evidence on the establishment of end of life
care, nor on factors that influence the development of end of life care in the context of
Macao.
Aim
The aim of this case study was to develop a theoretical understanding of how the end of
life care was introduced, established and developed, and to examine the factors that had
shaped the end of life care in Macao.
Methods
A qualitative case study research approach (Stake, 1995) was conducted and the end of
life care in Macao was the case of this research. Data was collected through in-depth,
semi-structured interviews with the initiators (n=3) and developers (n=8), from three
different settings that provide and promote end of life care in Macao. Interviews were
digitally recorded and transcribed. Qualitative data analysis software, Nvivo 11, was used
to organise the data and facilitate analysis. All data was analysed based on the principle
of thematic analysis (Braun & Clarke, 2006).
Findings
Through thematic analysis, the emergence of end of life care in Macao can be
understood to some extent to have developed through a social movement formation.
Initiators with diverse backgrounds collectively conceptualised that the suffering of
people as experienced at the end of their lives in Macao was a social problem needed
to be changed, and they subsequently developed different approaches in pursuing for
change. This findings also revealed that the growth of end of life care has become
stagnant after the initial wave of establishment. The framing perspective (Snow &
Benford, 1988; Snow et al, 2014; Snow et al, 1986) was adopted in this research in aiding
the conceptualisation of end of life care in Macao as a social movement, and the
development of a theoretical understanding regarding the development of end of life care
in Macao.
This research identified three key conceptual perspectives elucidating the developmental
trajectory and factors contributing to the growth and then stagnation of end of life care in
Macao. These three conceptual perspectives were:
- The conceptualisation of the problem with dying: the suffering of people as
experienced at the end of their lives (the grievance in the context of the framing
perspective)
- The incoherent strategies developed by initiators in establishing end of life care (the
lack of internal frame cohesion)
- The variety of contextual and conceptual constraints that influenced the subsequent
development and then stagnation of end of life care (the lack of external frame
cohesion) within the context of Macao
The findings indicate the integration of these three conceptual perspectives has led to a
holistic, theoretical understanding of the development of end of life care in Macao
addressing the research aim and contributes to knowledge about end of life care. With
specific regard to the socio-cultural environment of Macao, the study has taken a unique
theoretical approach in developing understanding of the end of life care as a social
movement by way of the framing perspective. This thesis has proposed a new way to
examine the emergence of end of life care, which would facilitate the exploration of end
of life care development in other cultural contexts. | en |
