Palliative Medicine Understanding the resources: smooth transitions and appropriate care
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1 College of Physicians Medicine Review Course 2011 Palliative Medicine Understanding the resources: smooth transitions and appropriate care Clin A/P Pang Weng Sun Geriatrician, KTPH
2 End of Life Trajectories
3 Resources I need help with the care and placement of my patient I want some resources on palliative medicine I want some training in palliative medicine
4 Historical milestones 1985: St Joseph s Home set aside beds for hospice care 1987: Singapore Cancer Society starts Hospice Care Group to provide home care 1988: Assisi Home and Hospice 1989: Hospice Care Association HCA Hospice Care 1992: Dover Park Hospice (opened in 1995) 1995: Singapore Hospice Council 1996: Hospital based palliative care services 2008: NUS-Duke Lien Centre for Palliative Care 2011: National Strategy for Palliative Care
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6 PALLIATIVE CARE SERVICES Community based services Hospital based Singapore Hospice Council services Agape Methodist Hospice AH Assisi Home and Hospice CGH Bright Vision Hospital KKH Dover Park Hospice KTPH HCA Hospice Care NCC/SGH Metta Hospice Care St Joseph s Home & Hospice NUH Singapore Cancer Society TTSH
7 When you need help with palliative care Know what s available in your institution Palliative Care Unit, Palliative Care Service or Palliative Care Nurse Assistance with symptom control and advice on appropriate placement Consider placement Estimate prognosis Determine availability and capability of caregiver(s) Extent of symptoms and likelihood of progression and type of care needed Do not forget to consider patient s preferences
8 Distribution of service providers
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11 Charges (community hospice services) Subsidies based on means testing Medisave for inpatient hospice Hospice day care: nominal fee Home care: free, donations optional
12 About Project CARE Project CARE Care at the End of Life for Residents in Homes for the Elderly A 3 year pilot project / program started in 5/2009 between TTSH and 7 voluntary welfare organization-based Nursing Homes
13 About Project CARE - What s involved in ACP- PCP discussion? Use of Respecting Choices Framework, an Advance Care Planning progam 1 st created in La Crosse, Wisconsin, USA Certain ACP discussion type indicated for patients with terminal conditions or staying in nursing homes Discussion summarized into Physician Orders for Life Sustaining Treatment (POLST) Customize and localized to local environment Use of Respecting Choices Framework Summarize discussion and document into a Preferred Care Plan (PCP) Form
14 Advance Care Planning provides the opportunity for patients to make choices about future personal plans ensures that care received matches patient s goals and values gives patients and families peace of mind that patients wishes are made known and will be acted upon when the need arises also guides families and medical team when making decisions on behalf of patients
15 Palliative Medicine in Mainstream Medicine Professional Evolution of palliative medicine as a specialty Practice Incorporating/ restoring principles of palliative medicine/care into mainstream clinical practice
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20 Specialist Training Palliative Medicine A subspecialty of Internal Medicine, Geriatric Medicine, Family Medicine, Oncology
21 The future A national palliative care organization Service development, Standards of care Co-ordinate education and training across clusters Regional palliative care clusters Regional hospitals Palliative care units Palliative care in general wards, emergency units, ICU/HDs Community Community hospitals Hospices Nursing homes Home hospice care Day care
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