Palliative care is a service dedicated to relieve symptoms of life-limiting diseases. In the past, palliative care was more specific to cancer diseases. Nowadays, however, it also includes end-stage organ failure, neurodegenerative diseases, and other chronic life-threatening diseases.

Malaysia has yet to develop a specialised palliative care unit in all state hospitals. Despite this, basic palliative care services such as symptom management, counselling and good nursing care are provided in all state hospitals.

A specialised palliative care unit will deal with more complex and technical disease processes. This often involves patients with life-threatening diseases as well as significant disease-related morbidity. This unit will also be led by a specialist with proper training and knowledge, just like any other medical subspecialty.

The history of palliative care in Malaysia

Palliative care is still considered a new field, as compared to other medical subspecialties in Malaysia. A palliative care unit had been developed in the mid-1990s in Malaysia; however, the Ministry of Health (MOH) had only recognised it as a subspecialty of medicine in 2005.

The first palliative unit care was established in Queen Elizabeth Hospital in Sabah in 1995. However, the field itself was further developed in Selayang Hospital in Selangor.

Currently, NGOs such as Hospice Malaysia and the National Cancer Society of Malaysia are the main forces in catering for community-based palliative care. Up to 2015, 25 hospice NGOs had provided this service without charge.

Demand for palliative care likely to rise

The MOH aims to establish palliative care units for inpatient and outpatient clinics, community care services, consultative care services and day care services. These services will integrate palliative care in Malaysian healthcare in a more efficient and holistic manner.

However, up until 2015, only 29 government hospitals had palliative care units, with three palliative care specialists out of 99 government hospitals.Four out of 10 Malaysians are estimated to need palliative care at the end of their lives. Additionally, 60% of these individuals are suffering from non-cancerous illnesses.

The non-cancerous diseases include cardiovascular diseases, chronic obstructive airway disease (COPD), HIV/AIDS, diabetes mellitus, kidney diseases, liver cirrhosis, Parkinson’s and Alzheimer’s. This number clearly reflects a community demand for well-established palliative care services.

Malaysia is also estimated to need 60 palliative care specialists. This goes in accordance with the ratio of one specialist per 500,000, as Malaysian’s total population is 30 million.

However, an ideal ratio would be one specialist per 200,000 citizens. According to 2015 data, Malaysia has only 17 specialists, with 10 of them still in training.

Strategic planning required to reach out to public

Despite the demand for palliative care services, there are also a large group of Malaysians who are unfamiliar with it. Several are also uncertain of what this service will provide.

Hence, strategic planning is needed not only to address this issue on a public level, but also to improve the quality of palliative care services. Additionally, if the capacity to provide such services is increased, the demand for it may be adequately met in the future. MIMS

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