Palliative care is a relatively young care practice in Singapore. Despite being first recognised as an official medical subspecialty in 2006, there has been remarkable progress in making palliative care accessible and affordable to Singaporeans. Patients and families can now receive palliative treatment at all government acute care hospitals, a large number of community hospitals, day-care hospices and at home from private palliative care specialists. Patients can also tap into MediShield Life, MediSave, or apply for MediFund and other subsidies for their palliative care needs.
As the population ages, the need for palliative care is expected to increase. Yet, research revealed that public awareness of palliative care in Singapore is one of the hurdles to receiving adequate palliative care. In our earlier blog article, we covered the basics of palliative care and how it helps with various conditions and stages of illnesses. In this article, we are sharing practical knowledge on what palliative care is and what it is not; where, when and how to get the right palliative care in Singapore, through an interview with Dr. Michael Chong – an experienced palliative care doctor.
Dr. Michael Chong is the founder and principal doctor of Livewell Medical Clinic, an established family practice GP clinic in Singapore. With intensive medical experience at Raffles Medical as a Physician Leader for the A&E and at HCA Hospice as a palliative care physician, Dr. Chong is well-versed in the palliative care field. Livewell Medical Clinic and Ninkatec are now collaborating to provide home care, palliative care, and elderly care for patients who need care at home.
Interviewer: What is Palliative Care?
Dr. Chong: Firstly, it is a care approach involving a team of medical practitioners which can be extended to include volunteers, not just one doctor or one nurse or one caregiver. Its goal is not only to improve the quality of life of the patient but also that of the patient’s family who deal with an array of problems related to the patient’s illness. The most common problem palliative care addresses for the patient is treatment and management of pain. But there are also many other physical, psychological and spiritual issues that can be prevented and relieved through palliative care.
Secondly, palliative care is broader than hospice care or end-of-life care. It is true that the need for palliative care service increases as life-threatening illnesses progress to terminal stage, and that palliative care medicine has been developed from hospice care practice. But it is not true that it is only needed for patients with terminal illnesses and approaching end of life. Palliative care can be beneficial for the well-being of patients and their families at every stage of illness; for children, adults as well as elderlies; in hospital as well as at home.
Interviewer: What are the Benefits of Palliative Care?
Dr. Chong: Palliative care is not to prolong the patient’s life. The main benefit of palliative treatment is to improve the quality of life. This is already proven. It also aids in the reduction of stress among family members and caregivers. Another objective of palliative care is to help prevent symptoms and complications.
With the main goal of improving patient’s quality of life, palliative care is highly patient-centered. Palliative care team always makes a careful assessment to ensure the benefits the patient receives from palliative treatment outweighs the burden, through collaborative discussion with the patient and family to find out what their care goals are and how best to achieve them in a reasonable way.
Interviewer: Why is Palliative Care Needed in Addition to Standard Treatments?
Dr. Chong: Palliative care is necessary in addition to standard treatments for 2 main reasons. The first reason is flexibility and timeliness in symptom and discomfort management. Let me take the example of cancer. A cancer patient who receives standard care such as chemotherapy or radiotherapy may develop symptoms unexpectedly. To see their oncologist, the patient needs to make an appointment which might not be immediate. By the time of the appointment, symptoms may have gotten worse. However, with palliative care, the patient can get access to a health specialist within an hour’s notice. The symptoms can be assessed and managed quickly at their home and prevented from worsening. In short, we co-manage the patient with the doctor-in-charge.
The second main reason is facilitating care at home. Some patients prefer to be treated at home, some might not want to go to hospital at all cost. For this group of patients, palliative care service can be conveniently provided at home. The doctor or palliative care specialist will come once or twice a week to assess the patient’s condition and adjust their prescription.
Interviewer: What are the Different Palliative Care Solutions for Different Conditions?
Dr. Chong: Palliative care solutions are highly patient-centered. As such, there are different palliative treatments for different patients, depending on their conditions, stage of illnesses, and their care goals. Palliative care can be provided for patients with serious conditions such as cancer, heart disease, liver disease, kidney disease. It can also be offered to the frail elderly who have chewing difficulty to mitigate the risk of malnutrition, or the elderly who are bedridden or suffering from strokes to provide sympathetic or acute treatment.
For each patient, we will first evaluate the patient’s condition and discuss care goals with the patient and family. Only necessary palliation is provided according to their wishes. For patients with pneumonia or an acute infection, for example, we have basic treatment such as antibiotics and other medications. For patients with advanced cancer, as another example, we can provide painkillers if they’re in pain, medicine if they’re constipated (a common cancer symptom), and recommend oxygen therapy if they are feeling breathless. (Learn more details about palliative care for cancer in our other blog post here.)
Apart from that, we assist patients with any advice or support they need such as recommendations for daily activity support equipment for the patients or home care services. We can also conduct an assessment to determine whether they are eligible for government subsidies to help with their financial burden, or refer them to other social care services. If counselling is needed, counsellor from the palliative team is available.
Interviewer: What’s your Advice for Patients and Families with regards to Palliative Care?
Dr.Chong: Firstly, the patients need to understand and come to terms with underlying conditions. Secondly, know what they want; whether they want to be treated at home or treated in hospice or receive palliative care in the hospital. If you feel overwhelmed and uncertain what palliative treatment to get, it’s advisable to talk to the doctor in charge or a palliative care specialist.
Ninkatec and Livewell Clinic provide palliative care at home for patients with various underlying conditions. With our remote monitoring technology and extensive palliative care experience, you can be assured you and your loved ones are palliated with the highest quality and attention. Feel free to drop us a message or chat with our care team for any palliative care related questions.