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Cultural Approaches to Pediatric Palliative Care in Central Massachusetts: Chinese

This subject guide is a collaborative project with the Children's Medical Center Pediatric Palliative Care Team, the Lamar Soutter Library, and Interpreter Services.




General Cultural Information:

The term “Chinese” can refer to any of the 56 different ethnic groups recognized by the People’s Republic of China but it is most commonly used to describe the Han Chinese. The Han Chinese constitutes 95% of the nation's population and is also the largest ethnic group in the world. Although the other 55 ethnic groups (5% of the population mostly spread throughout the western region and along the borders of the country) live in China, most do not consider themselves as Chinese. The three largest minority groups are the Tibetians, the Uighurs, and the Mongolians. Each ethnic group has its own unique culture.  

Although there is a standardized written form of the Chinese language, spoken Chinese is divided into seven major dialect groups (all of which are tonal and analytic). The major dialects are: Mandarin (which is the standardized form of spoken Chinese and the official language of the People’s Republic of China and the Republic of China – Taiwan), Wu, Yue, Min, Xiang, Hakka, and Gan. Most of these dialects are mutually unintelligible from one another.   

Family Structure: 

The Chinese culture emphasizes loyalty to family and devotion to traditions and puts less emphasis on individual feelings. The Chinese family structure has undergone great changes in the recent years. Traditionally, the Chinese family consists of at least three generations living in the same house as it is expected that children will take care of their elderly parents. Modern Chinese families, especially those in the United States, are similar to the American nuclear family. The father is the head of the family but the mother is usually responsible for care of the household, including health and medical issues. The grandparents are usually the caretakers for the children. The whole family engages usually in discussions that involve healthcare decisions and education. 

Traditional Chinese families adhere to a patriarchal ideology, follow the patrilineal rule of descent, are patrilocal, have familialistic value orientations, and endorse traditional gender role preferences.  In the traditional Chinese culture it is important for the family to have a son. A son brings honor to his parents, and eternity is passed on through sons. Today, girls as well as boys are valued. Women now do many kinds of work outside the home. Many young households share in the shopping, housecleaning, cooking, and caring for the children to show that they believe the sexes are equal. Some of the older generations may still show slight hope for a grandson or great-grandson and disappointment if the outcome is a granddaughter, but in the end they love and value each with equality. However, equality between the sexes is more widely accepted in the cities than in the countryside.

Relationships have become more democratic as parents no longer expect their children to show unquestioning obedience; however, most Chinese parents today, although much more lenient and reasonable, still are strict and expect a good deal of respect. As for marriage, young people today generally choose their own marriage partners on the basis of shared interests and mutual attraction. However, parents still play a role in arranging some marriages, especially in rural areas. Any couple today would at least consult their parents about such a major decision.  

Religious Practice: 

Chinese religious practice is often characterized by pluralism and is deeply influenced by Confucianism thought that each culture should carry on its own ethnic religion. Many Han Chinese people practice a mix Chinese folk religion and Taoism but Buddhism, Christianity, Catholicism, and Islam are also commonly practiced, especially among the other ethnic groups.  

Food in Daily Life: 

Rice and flour are two main staples in Chinese cuisine. Chinese people also drink tea with their meals and snacks. Traditionally a meal consists of rice and vegetables but meat and animal products are becoming increasingly common. The diet also depends largely on the region. 

Communication Style:

The communication style depends largely on the relation of the social status between the speaker and the listener. There is a tendency to refer to matters indirectly. Patients may nod, smile, and/or say “yes” or “ya” to acknowledge he/she heard you, rather than that he/she understands or approves. Patients may be reluctant to say “no” to a doctor or health care provider because it may be considered disrespectful or cause disharmony. Respect is shown to authority figures by giving a gentle bow and avoiding eye contact. Nonverbal cues like smiling are an important part of communication.

Chinese do not talk much about emotions. It is considered unhealthy. You will hear a Chinese say, "I think…." rather than "I feel…", because you cannot help how you feel. Chinese also highly value emotional self-control and appear stoic. They desire to keep emotions in control when asked about upsetting subject matters.

Please refer to the link below for detailed communication style of Chinese.   

Concepts of Health and Wellness: 

Most Chinese actually are very comfortable with duality between western and traditional Chinese health beliefs. Health may be viewed as finding harmony between complementary energies such as cold and hot, dark and light. These forces are called yin and yang. Traditional Chinese medicine is largely based on the concept that everything is made of an energy called “qi” and that the human body consists of complex subsystems of energy and matter. The hypothesis is that illness is caused by external and/or internal factors that disrupt the body’s natural processes. Many Chinese people use herbal medicine for their general health but they also embrace Western medicine. They may use foods, herbs and drink hot liquids to restore yin/yang balance. They will use traditional Chinese remedies as an initial approach for healing, especially during the early stages of illness. Many patients will believe that western medicine is too strong and may not take the full dose or complete the course of treatment. They may cut the dose in half or stop taking the medicine whether he/she feels better or not. There are many cultural and traditional beliefs that influence decisions about health care treatment. For example, preference to retain full complement of body parts (eg., uterus, gall bladder, etc.) may lead to avoidance of surgery. 

According to Chinese medicine, the passage of the seasons and changes in the weather can have an influence on the human body. Those having the most pronounced effect are wind, cold, heat, moisture, dryness, and internal heat. Excessive or extraordinary changes in the weather harm the body, and are referred to as the "six external disease-causing factors". In addition, if mood changes within the individual, such as happiness, anger, worry, pensiveness, grief, fear, and surprise are too extreme, they will also harm the health. These emotions are called the "seven emotions". In Chinese medicine, the six external disease-causing factors, interacting with the seven emotions, form the theoretical foundation of disease pathology. These theoretical two models along with the "theory of latent phenomena" are used to analyze the patient's illness, and diagnose the exact nature of the patient's overall physical and psychological loss of balance. Based on this analysis, the doctor can prescribe a method to correct the imbalance. Chinese medicine focuses on the person, not just the illness. In Chinese medical thinking, illness is only one manifestation of an imbalance that exists in the entire person. 

The accumulation of experience strengthened the Chinese understanding of natural phenomena and increased the applications of natural principles in Chinese medicine. The same principles  are also applied to assess the patient's living environment, life rhythms, food preferences, personal relationships, and language and gestures. This attainment of equilibrium in the body's flow of energy is the ultimate guiding principle of Chinese medical treatment. 

In addition to the prescription of medicines, acupuncture is another frequently used tool of treatment in Chinese medicine. Ch'i or energy flows through the body via the system of main and collateral channels of the body. At certain points along these channels, acupuncture needles may be inserted to adjust imbalances in the flow of ch'i and concentrate the body's self-healing powers in the necessary areas. In 1980, the World Health Organization released a list of 43 types of pathologies, which can be effectively treated with acupuncture. 

A Chinese pharmacy looks extremely different from a typical Western pharmacy. On shelves and in tidy drawers are animal, plant, and mineral products, each with a particular purpose. Among the assortment of medicines are amber to relax the nerves, peach pits and safflower to improve blood circulation, Chinese ephedra (mahuang) to induce perspiration, and ginseng to strengthen cardiac function.
Today, many compounds used in modern medicine for treatment of cancer and other diseases originate from the traditional Chinese medical pharmacopeia.

Concept of Death: 

There are two kinds of endings: a happy ending and sad endings. A good ending is a 5-blossoms death. The five blossoms stand for things that you want to happen in your life: marriage, having a son, being respected, having a grandson that loves you, and dying in your sleep after a long life. The funerals for a happy ending are attended by lots of people who touch the body for good luck and bring their own food as there is the belief that eating will bring good luck. Christian funerals in China are more similar to American funerals, but there is much singing of Christian songs. 

A sad ending is the death of parents without a son, or loss of an only son because there will be no eternity in that family. Suicide or death from an accident is considered a bad ending, especially if the body is mutilated. In suicide, the soul has been taken from the body at the wrong time. People keep a distance from the body if there has been a bad ending. A person who died from suicide must be buried separately from other ancestors. 

After a funeral, the Chinese believe that burning paper will provide material goods for the dead. Family members purchase paper replicas of money, a house, cattle, and a car, write the name of the deceased so the correct person receives the items when they burn them.Beliefs about death and afterlife are more influenced by philosophy than religion in China.  

The first son remains in mourning for 72 days. For six months after the funeral the son cannot wear the color red or get married.  Chinese celebrate a Memorial Day on April 5th each year when families get together to clean the gravesites and place flowers at the graves. 

Local Community Information:

Central Mass Chinese Language School

Asian American Civic Association
        Translation & Interpreter Services are provided to individual clients as to outside organizations which contact AACA's Chinatown Multi-Service Center to translate documents and information into Chinese, Vietnamese and Cambodian.

Boston Chinatown Neighborhood Center   
        617 635-5129

Greater Boston Chinese Golden Age Center  
         800 410-5288
Additional Locations: 3 sites in Boston area & 4 outreach sites in Brookline, Cambridge, Malden & South Shore area.
617 357-0226

Chinese Community Health Resource Center

Asian Nation: Asian American History, Demographics, & Issues       



1.     Culture and Nursing Care, A Pocket Guide, J.G. Lipson, S.L. Sibble, P.A. Minarik, 1997, pp. 280-290.

2.     Explaining Illness Research, Theory, and Strategies, Whaley, Bryan B., Lawrence Erlbaum Associates, 2000, pp. 283-297.

3.     Culture Clues and End-of-Life Care Sheets: Culture Clues™ is a project of the Staff Development Workgroup, Patient and Family Education Committee Contact: 206-598-7498

4.    Windows on Asia. Asian Studies Center. Michigan State University