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Challenges in the delivery of surgical care for head and neck cancer patients in the Hong Kong Special Administrative Region and China

Chan, Jason Y.K.a; Wong, Eddy W.Y.a; Xue, Lingbina; Liang, Fa Yab

Current Opinion in Otolaryngology & Head and Neck Surgery: June 2019 - Volume 27 - Issue 3 - p 203–206
doi: 10.1097/MOO.0000000000000535
DEVELOPING WORLD PERSPECTIVES IN OTOLARYNGOLOGY: Edited by Johannes J. Fagan
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Purpose of review This article aims to explore the ethical dilemmas faced by head and neck surgeons in the Hong Kong Special Administrative Region (HKSAR) and China in the provision of safe, oncological sound and timely care for head and neck cancer patients.

Recent findings There is no literature, in particular, in relation to the treatment of head and neck cancer patients and priority setting in head and neck surgery. However, through examining the healthcare provision and sociocultural backgrounds of the HKSAR and China, certain aspects, such as traditional Chinese medicine and medical guan xi (Seeking medical care for personal connections) have been shown to significantly influence the provision of care in China. Medical guan xi facilitates inequity and is problematic in developing a system based on justice, equity, nonmalfeasance and beneficence. In the HKSAR, resource limitations are related to the maldistribution of healthcare between the public and private sectors, resulting in significant time constraints for surgery and oncology care of patients. There is informal application of ethical frameworks for priority setting, however, these have neither been formally supported nor enforced from an administrative level that needs to be addressed.

Summary In the HKSAR, there needs to be a strengthening of an ethical framework for priority setting to adhere to justice for our patients and healthcare providers in treating head and neck cancer patients. In China, priority setting is largely set by sociocultural practices that are endemic, in particular, medical guan xi that is inequitable and needs to be addressed to improve the doctor–patient relationship.

aDepartment of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR

bDepartment of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

Correspondence to Jason Y.K. Chan, Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China. Tel: +852 3505 1879; fax: +852 2145 8876; e-mail: jasonchan@ent.cuhk.edu.hk

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