Friday 19 October 2012

End-of-life care survey top wish: Being free from pain

People also prefer to die at home than to prolong life for another year
By Salma Khalik, The Straits Times, 18 Oct 2012

A SURVEY of more than 500 people here has found that they value being able to die at home more than an extra year of life.

But right at the top of their list is being free from pain, the findings of a survey by the Duke-NUS Graduate Medical School and Lien Centre for Palliative Care showed.

They were willing to pay $24,000 a year to relieve severe pain, but only $9,100 to prolong life for another 12 months.

In presenting the findings at a Lien Centre for Palliative Care conference yesterday, Dr Chetna Malhotra, an assistant professor at the centre, said what people value has implications on where government subsidies should go.

She asked: "Does it make sense for the Government to pay for expensive therapies to extend life?"

Based on the findings, she said "subsidies for end-of-life treatments may not be a good use of scarce resources". "Pain management is at least as critical as prospects for extending life when deciding treatment options."

Similarly, Dr Malhotra suggested that "facilitating home deaths should be an important aspect of end-of-life care".

For one in five people surveyed, all above the age of 50, cost was the most important factor in determining their choice of end-of-life treatment.

But she also cautioned that the people surveyed, who are healthy individuals, might not truly know what they will want when they are actually facing death.

If that is so, people might be under-insuring themselves and not putting aside enough in Medisave.

Associate Professor Eric Finkelstein of Duke-NUS, who was part of the team involved in the survey, said the idea was to get a handle on what people want.

"They want a pain-free end of life, they don't want to be a burden, and extending life at a high cost is not something they place a high value on," he noted.

Associate Professor Angelique Chan, interim executive director of the Lien Centre, said in her welcome address that evidence shows that as people here live longer, they spend more years being sick.

She told the 120 participants that many who are over 80 suffer from cancer, heart disease, dementia and end-stage organ failure, so it is important to know what they want and manage pain optimally.

Opening the two-day conference at the Grand Copthorne Waterfront Hotel, Minister of State for Health Amy Khor called for more high-quality research on end-of-life care, given the country's rapidly ageing population and the increasing prevalence of chronic debilitating conditions.

She, too, spoke of how most terminally ill patients want to spend the last days of their lives at home, in the company of loved ones. She said: "This is possible only if the family caregivers have the requisite skills and knowledge to cope with the complex needs of the patient at home."

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