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A Global Perspective on Palliative CareThe future goals and Global opportunities for Hospice
  • By Constance Williams
  • Published 2016.12.08 10:59
  • Updated 2017.02.14 15:39
  • comments 0

The International Symposium on Hospice & Palliative Care Conference was held in DMC, Seoul on Wednesday December 7th with many prestigious doctors and professors from around the globe to discuss appropriate palliative care policies on supporting the health system.

The future plan is to transform the health system by integrating palliative care into national health system through a public health approach.

Palliativecare Conferences is a multidisciplinary approach to specialized medical for people with serious illnesses. It focuses on providing patients with relief from their symptoms, and pain along with physical and mental stress. The goal of this therapy is to improve quality for life for both the patient and the family. Another aim of this care is to help people who are dying have peace, comfort and dignity. The caregivers try to control pain and other symptoms so the patient can remain as alert and comfortable as possible.

“Palliative care focuses on the person, not the disease. Physical, practical, functional, social, emotional and spiritual needs for both patients and their families.” stated Professor Mhoira E.F. Leng in her opening speech about Palliative care future goals. “It will less focus on specific diseases; highlight more primary training, urging government to fund palliative care.”

Palliative care is crucial because it will be an essential contribution to global health. There are many countries around the world that do not have access to Palliative services; about less than 10% of the population. Lower-class countries for example India and Africa have many older people and children who have chronic mental and physical health. Poverty is a major key to the reason why prisoners, sex workers and substance users are not benefited in the Health system. The current challenges are non-communicable diseases such as chronic lung diseases, diabetes and cardiovascular diseases. All of these combined are rising fast among lower and middle-income countries.

Hospice and Palliative Care services in Australia

Ms Liz Callaghan, CEO of Palliative Care Australia started her speech by explaining that Australia has similar issues with the age demographic situation with South Korea which faces the problem of a rapidly aging population. In fact, the speed of aging in Korea is unprecedented in human history, 18 years to double aging population from 7 – 14% (least number of years), overtaking even Japan.

The leading cause of death in Australia is Coronary heart disease following Dementia and Alzheimer disease, compared to Korea which is Cancer. Palliative care in Australia is funded by both private companies and the government and patients request that the care is provided in the patient’s homes rather than in hospitals. Because of this, the program regularly asks patients where they would like to die. But death is often sudden and quick so the Palliative care provides a choice to have a right place at the right time with the right people.

How the Australian government invested in the Palliative Care program is to improve access to and the equality of palliative care: to provide research and drug trails, funding for research and education programs. Their strategy was made in 2010 and will be updated once more next year 2017. Their goal will be to try to make a framework where there can have a health system equally around Australia to make it available to all of their citizens.

Hospice and Palliative Care in Taiwan

The next presenter was Doctor Daniel Fu-Chang, Professor in the National Taiwan University College of Medicine who represented for Taiwan.

“The goal of the care is to help people who are dying have peace, comfort and dignity. The cost of dying is high. It ranges from 10,223 for sudden death, 36,652 for terminal illness such as Cancer and 39,937 for organ failure. 70% of the costs for terminal illnesses are due to hospitalizations. You need to have good policy, to train your staff with important education and implementation and Medicine availability.”

Taiwan’s quality of End-of-Life care is ranked number 14 in the world, the first in Asia. One of the main reasons why this is the case is community engagement; in particular to break down cultural taboos against discussing death has been a focus in Taiwan. They have introduced discussions of life and death into the education system from primary school through university and by changing the mindset of patients. But their flawed system is about healthcare spending, the capacity to deliver palliative care and shared decision making between the patient and families.

The Taiwan Hospice Organization called the act a major step forward as the act applies to the terminally ill, patients in a coma or vegetative state, and patients with advanced dementia or incurable diseases. The Patient Self-Determination Act was introduced to Taiwan in May of 2015. Under this, these patients have the right to accept or deny medical treatment, provided that they have signed a legal document called an advance healthcare directive. The Ministry of Health and Welfare pronounces that since the act aims to offer patients the opportunity to accept or deny medical care, medical institutions and doctors involved will not face criminal or administrative liability for their actions unless there is ill intent and there are major medical mistakes.

Currently in Taiwan, they are providing for Old age and early stage of organic psychopathic diseases, brain deterioration, chronic obstructive pulmonary diseases, acute renal failure, lung diseases, chronic liver diseases and heart failure. Among this, a program called ‘Truth-telling’ is about cancer disclosure to patients. This avoids futile medical care, ensures the dignity of the terminal ill, respect the rights of patients to know and their right to choose. The program organizes the training professional medical staff to enhance their skills of truth-telling. This allows the awareness of palliative care to increase with ‘Truth-telling’ as the first step.

The 4 essential components for Palliative Care development in Taiwan is Government, National Health Insurance, NGO and Academic Association. Dr. Daniel Fu-Chang stresses that the Government should provide policy and funded programs to hospitals and that Academic Association is important for communities it requires to change the cultures norms about death.

Hospice and Palliative Care in United States

Dr. David Hui from Texas, U.S.A, Professor at the MD Anderson Cancer Center Associated describes American Palliative care particularly for US Cancer Centers. They do provide home palliative care programs but patients must go back and forth to the hospital for treatments or when they are too weak. In the program, America categorizes their patients: Early disease (years-decades) Advanced disease (months-years) and Impending death (days-hours). Dr. David Hui believes that Palliative Care should begin earlier with inpatient programs because every patient life expectancy depends on their needs and the timing.

“American Hospice care is the patients understanding and agreeing to forego curative therapy. 2 physicians must declare the prognosis in 6 months if they can for their patients. Cancer is 37% while 63% are non-cancer such as heart disease, kidney disease, liver diseases, stroke and coma and HIV diseases.”

The challenges with Prognostication in America are that non-cancer diagnoses are highly inaccurate. The prediction of survival often overestimates and the eligibility criteria underestimate. Also, hospice referral can be delayed to 17 days. Cancer patients are good candidates if they have more than a year to live and have been diagnosed in 3 months.

Doctor David Hui believes that America specifically would like to improve the clinical structure and collaborate, improve the education to palliative care specialists and selecting the right policies.

In many cases, patients will benefit from specialized palliative care because many hospital-based integrated palliative care programs for patients with chronical diseases have been shown to improve symptom management and quality of life for patients and their families. In addition to helping with pain, other aims of care are improving the quality of end-of-life care for patients. With the future goals to develop Palliative care, countries can end extreme poverty and fight inequality throughout the health system.

connie@docdocdoc.co.kr

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