New guidelines for palliative care

PHOTO: New guidelines for palliative care

SINGAPORE - New national guidelines on end-of-life care will ensure doctors identify in advance patients who need such care, as well as caregivers who are at risk of severe grief.

The new standards, expected to be unveiled at the end of the month, will spell out clearly what hospices, hospitals and other providers are required to do in areas from coordinating care to bereavement support and the use of pain-relieving drugs.

The guidelines come after the Health Ministry accepted recommendations from a broader report called the National Strategy for Palliative Care in 2012, which looked at how to deliver such care in a more coordinated manner.

The Ministry of Health (MOH) told The Straits Times it has recently received the guidelines from a subgroup under the team tasked to implement the national strategy.

ST understands that MOH is looking into funding the roll-out of the guidelines and possibly making them enforceable by awarding licences only to those who comply with them.

"The national guidelines articulate what is required for high-quality palliative care across the entire health-care sector," said an MOH spokesman. He said that more details will be shared at the Singapore Palliative Care Conference 2014 at the end of the month.

It is estimated that by 2020, more than 10,000 people a year would need palliative care, up from 8,000 in 2009.

The new standards will hopefully "provide guidance in the delivery of high-quality care for the terminally ill, minimise gaps in service, improve the quality of training as well as ensure support for those in the field", said Dr Angel Lee, chairman of the subgroup, in the report of the guidelines.

ST had obtained a copy of it.

Dr R. Akhileswaran, chairman of the Singapore Hospice Council, said what this means is that end-of-life patients should receive the care that they need, be they in hospitals, nursing homes or hospices or using home hospice services.

"The guidelines will differ for different settings and will also be based on the palliative care expertise expected and available in that setting. Patients can be moved across settings depending on their needs," he said.

This is crucial because the team behind the national strategy found that palliative care is still being provided by independent groups operating in isolation, with no uniform standards and few links with other medical service providers.

The guidelines provide clearly defined benchmarks in 13 areas, including a system to identify people who are likely to die within the next 12 months. Patients identified at a late stage usually do not fare well and often endure unnecessary hospitalisation.

It also called for screening for caregivers and families so that those at risk of severe grief can be referred to support services.

However, experts say the guidelines will have bite only if there are penalties for not following them or incentives for adhering to them.

"I hope it will not be punitive, so my preference will be giving incentives such as providing more funding if people comply," said Dr Wu Huei Yaw, medical director of Dover Park Hospice.

This article was first published on June 15, 2014. Get a copy of The Straits Times or go to for more stories.