Patient s dilemma. Hospice Care. Benefits of Palliative Care? The reflections and the development of palliative care service a physician s perspective

Transcription

1 0th HK Palliative Care Symposium The reflections and the development of palliative care service a physician s perspective Dr KS Chan Haven of Hope Hospital 0th Hong Kong Palliative Care symposium 203 Benefits of Palliative Care?. Improve quality of life of patient and family 2. Reduce overall health care costs 3. Increase survival! (Morrison RS, 20) (Temel JS, 200) 97 An advanced cancer patient: seek a place with highest chance to receive palliative care Patient s dilemma Korea (95) Japan (973) Hong Kong (982) Singapore (985) Taiwan (990)

2 An advanced cancer patient: seek a place with highest chance to receive palliative care An advanced disease patient ask: what is my chance of receiving palliative care under HA- 5. Korea : 8-0% (20) 4. Japan : 24 % (200) 3. Taiwan : 39 % (200) 2. Hong Kong : 8% (HAHO: 202). Singapore : 72% (2004-5) Liver failure End stage Renal failure COPD Congestive heart failure Cancer An advanced disease patient ask: what is my chance of receiving palliative care under HA-.Cancer 8% 2.End stage Renal failure 3% 3.COPD ~5 % 4.Congestive heart failure < 5% 5.Liver failure < % Development of Hospice Palliative Care in Hong Kong Development of Palliative Care in HK 2

3 l l l l l l l l l l l l l l l l l l l l l l l l l l / l l 200 l / l l 200 l Pioneered in Our Lady of Maryknoll Hospital l l l l l l l l l l l l l l l l l l l l l l l l l l / l l 200 l st Home care team By SPHC NGO: Society for the Promotion of (SPHC) Pioneered in Our Lady of Maryknoll Hospital First independent Hospice: Bradbury Hospice Courtesy of BBH, HHH, NLH, OLMH, RH, SPHC, UCH. Build up palliative care values & philosophy 2. Build up palliative care knowledge & skill 3. Build up palliative care team 4. Promote palliative care referral 2 0 l l l l l l l l l l l l l l l l l l l l l l l l l l / l l 200 l Palliative Medicine as a Specialty Hong Kong Society of Palliative Medicine Hong Kong Hospice Nurses Association Post graduate hospice nursing course by HA 3

4 . Palliative care become part of health care system 2. Establish palliative care model of care 3. Establish audit 4. Professional establishment of palliative medicine & palliative nursing 5. Life & death education 2 l l l / l l l l l l l l l l l l l l l l l l l l l l l l l l 0 Donation with matched HA funding 5 Non-cancer Palliative care. Further expansion of service 2. Research 3. Promote palliative care to non-cancer diseases 4. Promote Advance Care Planning Reflections What have we achieved? our doings- Patient journey % of cancer deaths received PC Services in HA T T2 T3 T4 Curative Disease Modifying Palliative Disease Intervention and Disease Progression Bereavement EOL HA overall 8.3% (202-3 Review) HA overall 59.% ( Review) Outpatient Day Care Home Care % % 3% 79% 9% 72% % 59% 49% 47% 3% 2% 73% 3% Review Review Inpatient Consultative Non PC admission PC admission * Statistically significant at 5% level. Courtesy of HAHO 4

5 25 WHO Public Health Model for Palliative Care Stjernsward J, 2007 MSDC HA Palliative Care Services Policy Target to cover cancer patients MSDC Specialist-led services Clinical Audit MSDC Cluster-based provision of services DM Integrated PC services for cancer patient 3-digit Forum PC services for patients with endstage organ failure 3-digit Forum Enhance PC psychosocial services Comparing cancer & Non cancer Deaths in HK Lau KS et al, JSPM 200 Non Cancer (n=5) Cancer (n=83) P value No. of ICU admissions 0.22 (0.8) 0.04 (0.3) No. of ward admissions 3.70 (2.7) 3.23 (2.2) Duration of hospital stay in days 40.9 (3.0) 28.5 (2.0) No. of SOPD attendance 3.30 (3.3) 3.0 (2.9) 0.22 No. of VMO visits 0.8 (2.0) 0. (0.8) Received palliative care.5% 79% COC (Palliative Care) CC (Palliative Care) Courtesy of HAHO Non-cancer patients have more ICU admissions, more ward admissions & longer hospital stay Significantly less non-cancer patients received palliative care CMC Renal Palliative Care program Retrospective review Retrospective analysis of patients died after RPC program N=22 % % Symptoms Prevalence documented in last 2 weeks Significant physical symptoms during EOL where PC team can help to palliate 5.8% 48.2% 44.2% 38.% 3.0% 2.5% Courtesy of Dr Doris Tse & CMC Psychological symptoms is not common Experience of palliative care Availability Quality Transition to palliative care % 9.0% 7.7% 4.0% 0.9% 0.4% 0 Dyspnoea Fatigue Edema Pain Anorexia Cough Nausea & Bowel confusion Fever insomnia depression anxiety vomiting problems 5

6 USA : 44.% of all deaths under Hospice Need an overall Palliative Care policy for Hong Kong SAR? Training & Professionalism SPHC (from mid 80s) Palliative Nursing (995) Professional Societies Palliative Medicine subspecialty : HKCP (998), HKCR (200) Diploma course : CUHK EOL, HKU Oncology & PC Research Clinical teams, CUHK, HKU, Poly U Research of PC in HK- Pubmed ~ 70 articles Symptom & QOL Drugs Symptom cluster, ESRF QOL Prognosis Good death Care & care system Nurse-patient relationship Home care Advance directive, ACP EOL in elderly EOL care pathway Ethics Psychological & grief Psychological outcome Psychological well-being scale Bereavement Existential & spiritual Dignity Hope Spirituality Meaning of Life intervention Existential distress Euthanasia Agency for Healthcare Research & Quality, Evidence Report Oct 202 Agency for Health care Research & Quality Evidence Report Oct 202 Summary :. Palliative care has became part of public health care system : cover majority of advanced cancer & some non-cancer patients 2. Palliative Medicine has integrated in main stream medicine, with its science & retains its characteristics

7 The future of Palliative Care? Palliative Care in 20 years time? Will Palliative Care be medicalized? Symptomatologist? Our Doing versus our Being Personal reflections Our Doing Our Being The Being of Palliative Care Worker Service Outcomes Professionalism Research Our competence? Our inner quality? Historical root of hospice palliative care worker Research findings & reflection The Being of Palliative Care Worker The Being of Palliative Care Worker Historical root of hospice palliative care worker BEFORE RELIEF : Encounter : I-Thou versus I-It Worth of an individual Suffering Compassion: Con passio Historical root of hospice palliative care worker Research findings & reflection EOL research : Low score of Existential distress : Research on - Dignity Hope Spirituality Meaning of Life intervention Existential distress Euthanasia 7

8 The Being of Palliative Care Worker Life touches life, life influences life In touch with suffering Remain vulnerable Transcend finiteness Transcend temporality Remain hopeful Instill faith, hope & love The Being of Palliative Care worker A Wounded Healer Thank you Acknowledgement : SPHC, HAHO, PC units CC (PC) members HKSPM members PM Subcom members Staff of PC units Staff of collaborating Universities Local & International supporters Donors Patients & their families Our family 8