The 2015 Quality of Death Index reflects that Hong Kong performs relatively poorly in palliative care, ranking 22nd worldwide. With approximately 45,000 deaths per year, there are only about 450 beds reserved for palliative care with an estimation of 300 beds being provided by public hospitals.
Home-based end-of-life care as an alternative?
With limited hospice beds and private rooms available for end-of-life (EOL) care, home-based EOL care has appeared as an alternative.
Home-based palliative care is built based on the intention of making care more centred on the needs and preferences of patients. It allows patients to receive treatment in the comfort of their own home and interact much more freely with their loved ones compared to in a hospital setting, enhancing quality of life and independence.
While oftentimes hospitals are said to be “the most horrible place to die” due to its lack of psychological support for patients, most Hong Kong citizens usually still choose not to live out their ending days at home.
Empowering doctors to serve dying patients at home
The current law states that dying at home requires a death certification from a doctor who has seen the patient within two weeks before death. If a death is deemed suspicious, a police report must be filed and autopsy probably conducted.
To avoid the toil imposed on family members, most patients choose not to receive home based palliative care. Also, some patients are concerned about the negative impact on the value of the property if death takes place at home.
Former health minister Mr Yeoh Eng-kiong urges more family doctors to work towards receiving authorisation to treat dying patients, including the certifying of death at home.
Autopsies are a tremendous source of fear and a burden for patients and family members, thus hindering the community’s acceptance towards home-based end-of-life care. Further education and promotion of home-based EOL care will require an amendment to the Coroners Ordinance on the types of death that require autopsies.
Unclear referral criteria for palliative care
It is common that palliative care referrals come late in the course of illness. As such, the government needs to implement comprehensive guidelines to facilitate the referral procedure.
In some cases, referral teams may be unclear of the referral criteria for non-cancer related illnesses such as chronic heart failure, respiratory disease and advanced renal failure. Late referral may jeopardise patients’ needs for palliative care which could have helped to improve quality of life or even better, prolong life.
Restricted concept of palliative care
Acute hospitals provide curative treatments and measures to patients. It is difficult to refer patients to a palliative team because it indicates a hopeless prognosis. As therapeutic outcomes in terminally ill patients are poor, recommendations by the palliative team may not be embraced.
Another reason is that EOL care is usually a time-consuming process is that referral teams often find it hard to cope with the workload. In this case, the effective communication between referral and palliative care teams plays a crucial role, as both sides will need to cooperate and maintain their shared responsibilities well for this to work.
Hong Kong is facing the challenge of an ageing population and is estimated to reach 70,000 deaths per year by 2035. MIMS
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