Palliative care (also known as end of life care) is a specialised approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life threatening illnesses. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, emotional, psychological or spiritual.

Addressing the suffering of the terminally ill involves taking care of issues beyond physical symptoms. Palliative care uses a holistic care approach to support patients and includes addressing practical needs at different stages, providing long-term care services and curative treatment support to manage complex conditions as the illness progresses and providing bereavement support in the final days.

Palliative specialists offer healthcare team services and emotional support to help patients live as actively as possible until end of life.

The World Health Organisation estimates each year, an estimated 40 million people are in need of palliative care services after they receive inpatient care treatment.

Early delivery of palliative care reduces unnecessary hospital admissions and the use of health services.

Palliative care is required for a wide range of diseases. The majority of adults in need of palliative care have chronic diseases such as cardiovascular diseases (38.5%), cancer (34%), chronic respiratory diseases (10.3%), AIDS (5.7%), and diabetes (4.6%). Many other conditions may require palliative care & hospice care, including treatment for kidney failure, chronic liver disease, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological disease, dementia, congenital anomalies, and drug-resistant tuberculosis.

Pain and difficulty in breathing are two of the most frequent and serious symptoms experienced by patients in need of palliative care. For example, 80% of patients with AIDS or cancer, and 67% of patients with cardiovascular disease or chronic obstructive pulmonary disease will experience moderate to severe pain at the end of their lives.

The Singapore Hospice Council seeks to improve public understanding of palliative care in Singapore. Its vision of quality palliative care brings comfort and healing through:

• Pain & symptom control

• Financial counselling

• Emotional support

• Grief and bereavement care

• Counselling

• Caregiver training for loved one

• Facilitating conversations to achieve patient care goals

• Guidance for family complex decision making & planning

A multidisciplinary healthcare team, consisting of doctors, nurses, social workers, therapists, counsellors, and trained volunteers, will deliver the services.

According to the Singapore Hospice Council, palliative care services may be provided in own homes, in nursing homes, hospices, specialist clinics, general and community hospitals, catering to every patient’s needs. Services provided include home palliative care services, day care, inpatient hospice care and consultative services.

Death remains a taboo topic for the patient and loved one. The Singapore Hospice Council hopes to change the way society views death and dying through its campaign of Live Well Leave Well.

In 2021, Singapore ranked number 23 in the global Quality of Death and Dying index. The Lien Centre for Palliative Care at Duke-NUS Medical School, commissioned by the Lien Foundation, has produced the Cross Country Comparison of Expert Assessments of the Quality of Death and Dying 2021. This effort systematically ranks and grades 79 countries representing 81% of the world’s population, on the quality of palliative care based on input from experts within each of the included countries.

Palliative Care Singapore team from Home Instead

Home Instead believes in an integrated approach to home palliative care that addresses physical and emotional care needs and assists the patient in medical condition and symptom management. Home Instead combines non-specialist and specialist care in a team approach through a Care Plan that is established for each client’s care.

Home Instead palliative care teams are home care specialists who work together with the patients, loved ones, doctors and nurses. They provide an extra layer of support when the patient needs it most. In addition to treating symptoms and stress and supporting patients and families, the palliative care team communicates with all of the patient’s doctors so that everyone is on the same page. They support the patient and loved one every step of the way.

This palliative care team approach includes:

• Professional care team with Home Instead nurses and Care Pros personally matched with patients

• Tailored specialised home care to match specific palliative care needs of patients according to medical or terminal condition (such as cancer) and symptoms including pain and difficulty breathing

• Strong companionship from Home Instead Care Pros alongside family caregivers

• Dedicated palliative care services for patients (from occasional visits to 24/7 home care)

• Telephone support provided by Home Instead Care Pros

• The comfort that professional caregivers can help with whatever is needed around the house.

• Specific specialized services such as nursing care, hospice care and therapy as needed.

Home Instead Palliative Care Approach to Cancer

Home Instead Palliative Care Pros treat the symptoms and stress of illnesses such as cancer. They work in close partnership with the patient’s oncologist (cancer doctor). Any person, of any age, with any type or stage of cancer can benefit from palliative care—and the earlier, the better.

They understand that both the disease—and the treatments for it—can cause suffering. Cancer symptoms might include pain, nausea, vomiting, fatigue, anxiety, depression, constipation, diarrhea, confusion or shortness of breath. The palliative care team not only specializes in relieving the symptoms and stress of cancer, but they can also help with other situations, such as feeling overwhelmed by complicated medical information, or confusion and worry about making important treatment decisions.

Home Instead Palliative Care Pros have both the time and the expertise to interpret the complex medical information the patient receives from the oncologist. They can help the patient understand what it all means.

They specialize in dealing with the full range of cancer symptoms and ensure the patient can enjoy quality of life. They will help the patient figure out what information is needed to make an appropriate treatment choice. They will help the patient sort out immediate concerns—like worrying about how chemotherapy or radiation might make the patient feel, or what impact surgery may have, or if the patient will lose hair, or what will happen if the patient ends treatment. And they will help the patient with the bigger-picture things, like deciding what it is the patient values most in life or weighing the effects of a given treatment against those of the disease itself.

And, the best news is that studies show that people receiving palliative care may live longer.

Home Instead Palliative Care Approach to Kidney Failure

The challenges of kidney disease and kidney failure can be profound.

Home Instead Palliative Care Pros partner with the patients, families, kidney doctor (nephrologist) and other health professionals to provide pain and symptom management, communication, coordination of care, and family caregiver support.

Managing symptoms is a big part of palliative care. Working closely with the kidney doctor, the Home Instead Palliative Care Pros will help control symptoms through medicines and other therapies.

The team will also help the patient make critical decisions about treatment options, including the one treatment offered to nearly every patient with advancing kidney disease: dialysis.

The team will help match goals to treatment choices. They will help patients understand and decide what dialysis might add to quality of life. And they will help balance that against any drawbacks.

They can also help the patients decide when treatment might be more of a burden than a benefit. Whatever the treatment choice, the palliative care team will work side-by-side with the nephrologist and/or transplant team to support patients.

Patients who need a kidney transplant turn to palliative care before, during and after surgery. Getting a transplant has its own risks and rewards so it has to be examined carefully before choosing it as a treatment option.

The team will always look at the whole person and the whole picture. They are there to enhance quality of life as patients live with kidney disease.

According to a WHO survey relating to noncommunicable diseases conducted among 194 Member States in 2019: funding for palliative care was available in 68% of countries and only 40% of countries reported that the services reached at least half of patients in need.

Other barriers to palliative care include:

• lack of awareness among policy-makers, health professionals and the public about what palliative care is, and the benefits it can offer patients and health systems;

• cultural and social barriers, such as beliefs about death and dying;

• common misconception about palliative care, such as that it is only for patients with cancer, or for the last weeks of life; and

• misconceptions that improving access to opioid analgesia will lead to increased substance abuse.