Preparing for a dignified and restful departure is never easy, especially for family members. To better facilitate the patient’s final exit, healthcare specialists are pushing for more training on advance care planning (ACP).

"It can be difficult as a health professional to probe this conversation, but it is so important. You need to gauge whether the patient is prepared to talk about it, and to know how to go about it," said Beth Salleras, a nurse who is attending ACP training in Australia.

Often, it is the latter that makes the nurse hesitant in bringing up the discussion.

Recognising the lack of training in this aspect, associate professor Josephine Clayton, a specialist physician in palliative medicine, and her team have collaborated with HammondCare, a healthcare provider in Australia to develop a training program to equip nurses with skills and insights into end-of-life care.

"If there is a plan in place for how that person will be looked after ahead of time -- as opposed to when they are in the face of a confronting condition or illness -- the process is made much easier," Clayton said.

Malaysia steps up efforts to promote holistic care

In Malaysia, efforts are being made to ensure that holistic care is not compromised. Hospis Malaysia, the largest palliative care service provider in Malaysia since 1992, runs yearly workshops for nurses, addressing topics like patient assessment, communication, palliative care ethics and the entire spectrum of holistic care.

In a 2013 study published in the British Medical Journal (BMJ), researchers found that 75% of Malaysian nurses surveyed had good knowledge of end-of-life care but 57% had poor perception of end-of-life care. The study suggests further directives in the training of nurses in ACP and enhancing its value.

But Dr Richard Lim Boon Leong, a pioneer in palliative care in Malaysia says that now the sector is growing to serve those with non-cancerous life-limiting conditions.

“Sometimes, doctors are reluctant to consider palliative care for their patients because they think it means giving up,” says Dr Lim, who is also the national advisor on palliative medicine at the Health Ministry and head of the Palliative Care Unit at Hospital Selayang.

“To me, the biggest misconception is that palliative care is what we do when there is nothing else to be done, that it is only focused on care for the dying.

“Many people also think that palliative care is merely about hand-holding or counselling, and do not understand that it is an active field of medicine that applies interventions requiring knowledge and skills.”

He stresses that palliative care does not mean “nothing will be done”, and it certainly does not mean the clinicians nor the family are “giving up”.

“If I could get one message out, it would be that rather than focusing on death and dying, palliative care is really about helping people live their lives in the best way possible till the very end,” stressed Dr Lim.

Death remains a taboo to Singaporeans

In Singapore which is home to diverse cultures, most people are reluctant to talk about death. Yet, it still warrants attention as end-of-life discussions pave the way for families and patients to plan their final exit.

“There’s a bit of a cultural thing. At the same time, it’s also a very emotional thing. Talking about it gives a sad feeling and I don’t want to go there,” said Singapore Hospice Council chairwoman Angel Lee.

The concept of advance care planning is gaining increasing relevance in Singapore, and pilot programmes and training are being geared up to ensure a more meaningful final process.

Recognising that ACP is in tandem with the ageing population, the Ministry of Health has rolled out initiatives to raise awareness and provide training to healthcare professionals.

According to official statistics, 61% of its population end up dying in the hospital, and these people would want to die with their wishes fulfilled.

Ms Sim, a veteran clinician with more than 12 years in palliative care at Khoo Teck Puat Hospital (KTPH), once had a patient who desired to see her daughter get married. Assessing that the patient had limited time, she and the hospital staff arranged for the marriage to be brought forward and to be conducted in the hospital’s Lily Room, a special haven where the terminally ill can live their last moments peacefully. The patient passed on a few days after witnessing the wedding.

By encouraging open and early communication among patients in their last lap, the subject of dying may not be so frightening but instead, more empowering. MIMS

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