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With our ageing population and improved survival brought about by medical advancements, the number of people living with serious life-threatening illnesses is ever increasing. To help them maintain their quality of life while managing illness- or treatment-induced symptoms, it is important to ensure that supportive and palliative care is available in different phases of the serious illness trajectory.
Supportive care focuses on providing patients and families with the appropriate support to allay concerns relating to illness and make lifestyle changes to improve their quality of life while living with the illness.
This can be introduced as early as the point of diagnosis of a serious life-limiting illness, regardless of the stage of illness and treatment status.
Palliative care focuses on optimising quality of life through relieving symptoms and addressing psychosocial issues, preparing and supporting family and caregivers for the end of life, advance care planning (ACP) as well as bereavement support.
Currently, less than half of the seriously ill patient population in Singapore is introduced to specialist palliative care services and often at very late in their illness trajectory, for symptom management prior to death.
Some serious illnesses include:
A joint effort of shared care
While there is a need to increase access to supportive and palliative care, it is important to recognise the collective effort required to provide such care across the different care settings.
In acute hospitals, generalist supportive and palliative care can be provided by primary teams as part of their specialty care with sufficient training and guidance, before referring patients to palliative care specialists for complex care needs.
Generalist supportive and palliative care can also be provided in the primary care setting, to ensure patients with serious illnesses continue to live well in the community.
Established in April 2020, the SingHealth Duke-NUS Supportive & Palliative Care Centre (SDSPCC) brings together healthcare professionals of different expertise, dedicated to improving the quality of and access to supportive and palliative care for patients and their caregivers. It also fosters collaboration with community partners to achieve coordinated care and the best patient outcomes.
There are currently ten supportive and palliative care services across SingHealth institutions:
Inter-professional clinical care
Working in inter-professional clinical care teams consisting of doctors, nurses, medical social workers and other allied health professionals, SDSPCC provides different aspects of specialist palliative care in inpatient, outpatient and community settings.
Inter-department collaborations
Inter-department collaborations have been established by respective palliative care services to help clinicians from different specialties identify eligible patients earlier in their illness trajectory. Advice is also given to help primary teams provide generalist supportive and palliative care in their practice, prior to referral to palliative care specialists for patients with more complex palliative care needs.
Harmonisation of care
Dedicated to improving the quality of palliative care, SDSPCC is currently leading the harmonisation of the clinical assessment tools under the Palliative Care Outcomes Collaboration within SingHealth.
We aim to standardise palliative care clinical service quality indicators for cluster, national and international benchmarking.
As the supportive and palliative care needs of patients and caregivers vary in intensity over time, it is important that patients are rightly sited in different care settings based on their needs. The level of care provision increases along primary, acute, intermediate and long-term care settings.
Frequent visits to hospitals and the transition to step-down care are also pain points for patients with serious illnesses and their caregivers. SDSPCC is working to establish collaborations with community partners, including hospices and community hospitals, to facilitate smooth and seamless care transitions while ensuring consistent quality of care across different care settings.
Training programmes
Beyond central planning, SDSPCC works closely with the Lien Centre for Palliative Care (LCPC) and Singapore Hospice Council (SHC) to develop generalist supportive and palliative care training programmes for healthcare providers, students, community providers and the public, as well as to develop caregiver resources. For more information on generalist supportive and palliative care courses for general practitioners (GPs), please refer to Table 1.
Course
Course Description
Graduate Diploma in Palliative Medicine
10 months of part-time generalist training offered by the Division of Graduate Medical Studies, NUS Yong Loo Lin School of Medicine, aimed at training physicians who are interested in palliative care with the required competency and confidence to manage patients with palliative care needs in their respective care settings.
The course involves a mix of self-study, seminars with group discussions, group learning and six full-day attachments in various palliative care settings. Learners will also be assigned to a supervisor (specialist in palliative medicine).
Post-Graduate Course in Palliative Medicine (LCPC-SHC)
A 3-day course by LCPC and SHC on the principles and practice of palliative medicine for physicians across all settings. It aims to equip participants with generalist palliative care skills and knowledge for integration into their practice in the care for patients with life-limiting illnesses.
Renal Supportive Care Course (Interdisciplinary)
A 3-day online course conducted by LCPC to equip healthcare professionals caring for advanced chronic kidney disease patients with basic supportive care skills and knowledge to integrate into their practice.
Table 1 Generalist supportive and palliative care courses for doctors in SingaporeCompetency frameworks
SDSPCC has also developed competency frameworks for nurses and medical social workers to enhance their skills and competencies within the palliative care fraternity, which will be shared with the Ministry of Health to aid development of national competency frameworks in palliative care.
Existing training programmes available are also mapped to performance expectations to facilitate the development of individuals within the competency framework.
Public education
In public education, the National Cancer Centre Singapore (NCCS) and Singapore General Hospital (SGH) have provided supportive survivorship care education to SingHealth Polyclinics, SingHealth Community Nursing, as well as volunteers and community social workers in selected social service agencies (e.g., Breast Cancer Foundation, SPD, SG Enable and Singapore Cancer Society).
NCCS also conducts an annual Supportive and Survivorship Care Symposium targeting healthcare professionals, patients and caregivers to share the latest updates on cancer supportive care.
SDSPCC aims to train more healthcare professionals in research, encourage cross-institution collaboration, embrace innovation and experiment with new models of care.
There are plans to develop a SingHealth Palliative Care Registry – a database that can be used to address service development, quality improvement and research objectives. The registry will eventually be linked to data available in the hospices and home care services in the community, to track the patient journey from hospital to community and monitor care outcomes.
The team is exploring the possibility of providing ‘precision medicine’ in the field of supportive and palliative care to achieve more efficient and effective models of care. This involves identifying individualised patient needs through data in electronic health records or patient-reported outcome measures, and matching them with the specific support required to meet those needs.
Domains of care
Some inter-department collaborations within SingHealth
For referral to palliative care services, please contact the respective institutions:Singapore General Hospital: 6326 6060Changi General Hospital: 6788 3003Sengkang General Hospital 6930 6000KK Women’s and Children’s Hospital: 6692 2984National Cancer Centre Singapore 6436 8288National Heart Centre Singapore 6704 2222National Neuroscience Institute 6330 6363GPs who would like to collaborate with the SingHealth Duke-NUS Supportive & Palliative Care Centre, please email to sdspcc@singhealth.com.sg.
Head 1. Clin Asst Prof Patricia Neo Senior Consultant, Division of Supportive & Palliative Care, NCCS
Deputy Head (Clinical Services/Education) 2. Clin Asst Prof Alethea Yee Senior Consultant, Division of Supportive & Palliative Care, NCCS; Clinical Director, Assisi Hospice; Director of Education, Lien Centre for Palliative Care, Duke-NUS Medical School
Deputy Head (Research) 3. Prof Eric Finkelstein Executive Director, Lien Centre for Palliative Care, Duke-NUS Medical School; Professor, Health Services and Systems Research, Duke-NUS Medical School
Strategic Advisor, Community Partnership 4. Ms Irene Chan Director, Office of Patient Experience, KKH
Director, Clinical Services 5. Clin Asst Prof Shirlynn Ho Senior Consultant, Division of Supportive & Palliative Care, NCCS
Director, Community Partnership 6. Dr Lee Guozhang Consultant, Internal Medicine Supportive and Palliative Care Service, Department of Internal Medicine, SGH
Director, Education 7. Clin Asst Prof Peh Tan Ying Senior Consultant, Division of Supportive & Palliative Care, NCCS; Head (Medical), Assisi Hospice Director, Research 8. Asst Prof Grace Yang Senior Consultant, Division of Supportive & Palliative Care, NCCS; Assistant Professor, Lien Centre for Palliative Care, Duke-NUS Medical School
Programme Director (Medical), Clinical Services 9. Dr Komal Tewani Senior Consultant, Department of Gynaecological Oncology, KKH; Head, Women’s Palliative Care Service, KKH
Programme Director (Allied Health), Clinical Services 10. Assoc Prof Lita Chew Group Director, Group Allied Health, SingHealth
Programme Director (Nursing), Clinical Services 11. Ms Wong Yoke Ping Senior Nurse Manager, Specialty Nursing, CGH
Co-Director, Community Partnership 12. Clin Asst Prof Loo Yuxian Head of Service & Consultant, Post-Acute and Continuing Care, SCH@OCH
Co-Director, Education 13. Mr Andy Sim Principal Medical Social Worker (Educator), Medical Social Services, SGH
Co-Director, Research 14. Dr Ling Xu Yi Principal Clinical Pharmacist, Pharmacy, KKH
Singapore Hospice Council
Lien Centre for Palliative Care
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