Speech by Dr Amy Khor, Minister of State (Health) at the Lien Centre for Palliative Care Conference, 17 October 2012

Professor Ranga Krishnan, Dean, Duke-NUS Graduate Medical School

Associate Professor Angelique Chan, Director (Research), Lien Centre for Palliative Care

Distinguished Guests

Ladies and Gentlemen

Introduction

            A very good morning to one and all.  I am happy to be here today at this inaugural Lien Centre for Palliative Care Conference. I would like to extend a warm welcome to all participants, especially our foreign delegates and speakers. Thank you for participating in this conference and sharing your insights in palliative care research.

2.         One of the key recommendations of the national strategy for palliative care is to promote research in this area to guide clinical practice and service delivery. I am heartened that the Lien Centre has responded to this call and has initiated this conference as a platform to advance research and share best practices in palliative care.

Importance of Research in Palliative Care

3.         High quality research underpins all aspects of healthcare. Good research evidence on therapeutic interventions and care processes is essential to improve clinical care and service delivery. From a broader systems-perspective, research on the cost-effectiveness of treatment options is also important to ensure the sustainability of the care services provided.

4.         Despite the growing importance of palliative care, there is general recognition of the relative lack of research on the provision of care for the dying. This is in part due to the difficulties in conducting research studies involving a vulnerable population and the potential burden that the process might bring to the patient and the family.

5.         Yet, high-quality research is urgently needed on palliative care in general and especially on palliative care for older people, given our rapidly ageing population and increasing prevalence of chronic debilitating conditions. Because of its multi-faceted nature, it is important that we develop a robust evidence base for the various dimensions of palliative care, including symptom control, palliative care for non-cancer illnesses and psychosocial care.

6.         In tandem with this, we will also need to translate good research into strategies for health care programmes, service delivery, as well as workforce training and education.

7.         I understand that the Lien Centre for Palliative Care is looking into consolidating existing evidence on palliative care interventions to enhance the delivery of palliative care in Singapore. I also learnt from their researchers that there is good evidence for palliative care interventions, some of which I will share with you in the following sections of my speech.

(A)       Effectiveness of Coordination of Care

8.         Patients with life-limiting illnesses often require multiple interventions provided by different health professionals over the course of their illnesses. As patients transit across settings, it is often easy to be lost in the system, resulting in fragmented care and unplanned admissions to the hospital. Coordination of care across settings is therefore critical to ensure that the patient receives appropriate and timely care in line with his or her needs and preferences. 

9.         Research suggests that coordinated care improves patient outcomes in terms of better symptom control, self-rated health and satisfaction with general healthcare. In many instances, this coordination is facilitated by a health care professional who proactively identifies all the care needs of the patient, and facilitates referrals to the relevant supporting services such as home nursing and personal care assistance.

10.       Coordination of care can be enhanced by putting in place the relevant systems to organise and integrate care. For example, I recently visited Edmonton in Canada and was impressed by the strong collaboration that existed across different healthcare settings involved in the delivery of palliative care, including the hospitals, long term care institutions, hospice home care providers and the primary care physicians. Under this integrated service model, all palliative care services in the Edmonton region utilise a common set of symptom assessment tools and a single medical recording system to facilitate smooth transfer of patients across settings, which optimizes the continuity of care.

(B)       Effectiveness of Programmes for Informal Caregivers

11.       Besides coordinated care, a common wish of many terminally ill patients is to be able to spend the last days of life at home, in the company of their loved ones. This is possible only if the family caregivers have the requisite skills and knowledge to cope with the complex needs of the patient at home. While there are existing resources to support caregiving, research suggests that more can be done to minimize caregiver burnout and improve their quality of life. This is important as caregiver health and well-being can impact their ability to provide care.

12.       Clinicians generally agree on the value of providing information in empowering caregivers and reducing the burden of caregiving. Information on the disease, anticipated disease progression, symptoms and side effects has been reported to be useful in giving caregivers a sense of control and reducing feelings of uncertainty and helplessness. Greater research in this area will be useful to better support caregivers and allow more terminally-ill patients to be cared for at home for as long as possible.

(C)       Effectiveness of Advance Care Planning (ACP)

13.       There has also been a growing body of research on the effectiveness of Advance Care Planning, or ACP. ACP is a systematic process whereby individuals actively plan for their future treatment preferences, in consultation with their family and healthcare providers. Through ACP, patients reflect on their goals, values and beliefs and express their care wishes in areas like the degree of medical intervention during medical crisis and preferred site of care.

14.       Research has shown that ACPs improve the quality of patient-clinician communication and enhance the patient’s understanding of his or her own condition and future treatment options. The end of life care wishes of terminally-ill patients with ACPs were also much more likely to be known and respected compared to patients without ACPs. In addition, research has also shown that patients with ACPs exhibited higher congruence with their surrogates in terms of their end of life care wishes. Families of patients with documented ACPs also reported having lesser anxiety, depression and stress.

Encouraging Palliative Care Research

15.       As mentioned earlier in my speech, while there is a growing interest in palliative care research in recent years, there are still gaps in our knowledge in palliative care. At the international level, we will need more research on palliative care interventions to determine how effective and feasible they are, in the context of cultural differences, patient preferences and health care systems across countries. This conference is a huge step in this direction.

Conclusion

16.       In closing, I encourage you to be steadfast in your efforts to engage in further research to improve the care of patients at the end of life.  As our society ages, there will be many more elderly and terminally ill people who will need our care and support at the end of life. Therefore, the importance of what you do can only grow.

17.       On this note, I congratulate the Lien Centre for Palliative Care for organising this conference and wish all of you a pleasant and enjoyable time at this conference. Thank you.

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