Ministry to promote palliative care

It accepts recommendations on integrated system, training for caregivers, public education

By Salma Khalik, The Straits Times, 6 Jan 2012

MORE Singaporeans with terminal illnesses will in future get treatment designed to relieve their pain in their dying days. They will also be given more care and companionship.

This will come with the implementation of a country-wide strategy to deliver palliative care in a coordinated manner, instead of piecemeal as is the case now.

Health Minister Gan Kim Yong yesterday said his ministry had accepted the recommendations in the report on the National Strategy for Palliative Care prepared by the Lien Centre for Palliative Care.

In particular, the ministry will make palliative care a key part of each regional health system, and increase the number of people trained in it.

Each of Singapore's regional health groupings currently includes an acute hospital, community or convalescence hospital, nursing homes, polyclinics and general practitioners. These groupings will in future also have hospice services to provide palliative care.

'An integrated system for the delivery of palliative care will ensure that patients are cared for in an appropriate setting, and allow for seamless care as they move from one setting to another,' said Mr Gan at the opening of a new wing of Dover Park Hospice yesterday.

Palliative care will be part of the curriculum in medical schools, nursing schools, allied health schools, residency programmes, speciality training boards and postgraduate programmes.

The ministry will also promote research in the field and mount public-education drives to raise awareness of its benefits.

Palliative care is meant to raise the quality of life for patients with chronic life-threatening illness by preventing or minimising all aspects of their suffering.

For example, doctors might calibrate pain-killing drugs to ease a dying person's distress. Other care providers will help him live as actively as possible until he dies, or discuss his concerns about death. His family will also get help to look after him, and to cope with his death.

Palliative care was at first given to end-stage cancer patients in a lot of pain but has since been delivered as well to those with, for example, organ failure or neurological diseases.

As Singaporeans live longer, they are more likely to develop chronic diseases marked by pain that can be relieved through palliative care. This form of care can also be given to children with terminal illnesses.

The report estimates that by 2020, more than 10,000 people a year would need palliative care here, up from 8,000 in 2009.

In anticipation of this, the Health Ministry called for the report to be done last February. A team of 38 led by Associate Professor Pang Weng Sun, a senior consultant in geriatric medicine at the Khoo Teck Puat Hospital, took six months to put together and submit a 72-page report.

The Lien Centre for Palliative care is a collaboration between the Lien Foundation, a charitable organisation, and Duke-NUS Graduate Medical School to train palliative health-care professionals.

The team found that although the role of palliative care is recognised here, it is still being provided by independent groups operating in isolation, with no uniform standards and few links with other medical service providers. Palliative care has sometimes even been regarded as dispensable.

Mr Gan told The Straits Times that he has appointed Prof Pang to head a task force to study the recommendations and how to implement them.

The task force will look into integrating palliative care with curative medical treatment.

This means patients with terminal illnesses will get palliative care while being treated for their conditions, instead of having it kick in only when nothing more can be done to prevent the illness from getting worse.

The report noted that patients identified for palliative care at a late stage usually do not fare well, and often endure unnecessary hospitalisation.

It also pointed to the need to educate people on palliative care, given that many associate it with giving up hope and treatment.

Palliative care providers in the public and private sectors and voluntary welfare agencies also need to collaborate and coordinate their services.

Mr Gan noted that patients nearing the end often need intravenous antibiotics, blood transfusions and pain relief, and many are admitted - unnecessarily - to hospitals for these. Such transfers can be avoided with good palliative care in place.

Prof Pang said implementing the suggestions could take about five years.

He added that the greatest challenge is the need to 'slow down to understand and address the needs of patients and their families'.

'In busy health-care settings, it can be difficult for staff to set aside time to talk to patients and families, and manage their discomfort and concerns,' he said.

The most important goal, Prof Pang added, was 'delivering palliative care in a coordinated manner that ensures continuity of care across settings and over time'.

Dover Park Hospice adds 10 beds

By Melissa Pang, The Straits Times, 6 Jan 2012

PALLIATIVE care here has received a boost with the expansion of Dover Park Hospice.

The non-profit organisation, which admits about half of all palliative-care inpatients, now has 10 more beds, making it 50 in total.

It now also has the manpower and expertise to care for the terminally ill with more acute medical conditions.

Health Minister Gan Kim Yong, who was at the official opening of the hospice's new wing yesterday, commended the hospice for developing its capabilities to meet the changing profile of palliative-care patients here.

He noted that hospices traditionally cater to cancer patients, but there has been a growing demand for end-stage care by patients with non-cancerous conditions, such as end-stage organ failure.

End-of-life patients now also need more sub-acute care in the form of the administering of intravenous antibiotics and blood transfusions, procedures that would ordinarily require them to be readmitted to hospitals.

The addition of beds, upgrading of equipment, additional training of hospice caregivers and introduction of an integrated home palliative-care service have created a higher level of palliative care, Mr Gan said in his address.

Dover Park Hospice chairman Chey Chor Wai said the expansion was planned about four years ago in anticipation of the ageing population.

A task force made learning trips to leading hospices in San Diego, Perth and Hong Kong to gather information on the best practices in palliative care.

Talks were also initiated with the Ministry of Health, Mr Chey said in a speech.

Dover Park Hospice has cared for 7,500 terminally ill patients and their families since its opening in 1995.

It is open to all ages, races and income levels.

The eight hospice-care providers here offer three forms of palliative care - inpatient, day care and home care.

Besides the Dover Park Hospice, the Assisi Hospice, Bright Vision Hospital and St Joseph's Home & Hospice also offer inpatient care.

Home care and day care are available at the Assisi Hospice and HCA Hospice Care.

Metta Hospice Care, the Agape Methodist Hospice and the Singapore Cancer Society offer only home care, under which a nurse or doctor drops by the patient's home regularly.