SINGAPORE: While almost all doctors and nurses consider hospice palliative care important for those with life-threatening illnesses, a number of them feel that medical professionals do not know enough about this approach to care-giving, a survey commissioned by the Lien Foundation revealed.
The report on the findings of the survey, released on Wednesday (June 18), showed that 95 per cent of doctors and 94 per cent of nurses surveyed considered hospice palliative care important for the terminally-ill, while 98 per cent of doctors and 95 per cent of nurses want such care to be made readily available.
Hospice palliative care is a holistic approach to caring for patients going through the last stages of their lives, by meeting their needs - physical, emotional, psychosocial and social - to alleviate suffering and maximise the quality of life for patients and their loved ones.
The report suggested the following areas of action for the local healthcare community and policy-makers to consider:
Enhancing basic medical and nursing education as well as continuing professional training to increase the skills and knowledge of hospice palliative care of doctors and nurses Equipping all doctors and nurses with the skills of how to talk about death and dying with their supports Incorporating palliative care principles in all healthcare settings, and fostering a culture and environment that supports better end-of-life care
The Lien Foundation commissioned Blackbox Research to conduct the survey, polling more than 200 doctors and 400 nurses on their views on death and dying. The survey was conducted from February to April this year.
INSUFFICIENT TRAINING, MANPOWER
The survey found that 74 per cent of doctors and 46 per cent of nurses felt medical professionals do not know enough about hospice palliative care. Among those with frequent contact with terminally-ill patients, about half - 44 per cent of doctors and 59 per cent of nurses - said they were familiar with hospice palliative care.
"This suggests a gap in the knowledge needed to support patients in end-of-life matters," the Lien Foundation said in the report.
One possible reason could be the lack of education in palliative care. According to the survey, 62 per cent of doctors and 38 per cent of nurses said basic medical or nursing education was not enough to prepare them to support patients with life-threatening illnesses.
"The focus during my time in medical school was all about management options first, and palliation was taught or considered as the last resort when all else failed," said an unnamed doctor polled in the survey.
"I feel that from the outset, the preparation of our doctors is sorely lacking in preparing doctors for end-of-life issues, as we are taught to avoid and not embrace it, and then we see that death is more the norm than the exception when we enter into the workforce."
Beyond insufficient training, other areas the respondents identified as weaknesses in this area of care in Singapore's healthcare system are shortage of trained manpower, lack of information on hospice palliative care, limited hospice facilities and the issue of cost, according to the report.
Said another unnamed doctor: "(There is) insufficient training of health professionals; clear pathways for patients who would not benefit from care in an acute hospital so these patients go direct to a care facility which could handle end-of-life care with backing/ guidance from MOH.
"We need expansion of the palliative care workforce - nurses, allied health and doctor and integration of palliative care in geriatrics training, family medicine training, medical school and residency training."
MORE TRAINING IN THE PIPELINE
There are plans afoot to enhance the training of healthcare professionals in this area of care. The National University of Singapore's School of Medicine, for instance, will expand its training in palliative medicine.
Associate Professor Yeo Khay Guan, Dean of Yong Loo Lin School of Medicine at NUS, said: "Currently, undergraduate students at the NUS School of Medicine receive training in palliative care from the third year of studies. We plan to expand and enhance the training in palliative medicine from the third to the fifth year of studies, in a variety of practice settings including hospices, home care and in hospitals."
At Nanyang Technological University's Lee Kong Chian School of Medicine, medical students will receive hospice palliative care training in their fourth year of studies, while Duke-NUS Graduate Medical School provides one-day exposure and training in hospice palliative care for students, according to the report.