Taking Better Care of the Dying

Integrating Care in the hospital, hospice and

home

Dr Loh Ee Chin

Palliative medicine physician

University Malaya

The ideal care model

Essential values in integrated C.A.R.E

•C Communication

•A Attitude

•R Responsibility

• E Education

Public health actions to improve palliative care in Germany:

Results of a three-round Delphi study

• The action ranked highest was "close collaboration between specialist palliative care services, general practitioners and community nursing services"

• Health Policy. 2012 Apr 27.

The dilemma of dying

• Ah Ching

• Advanced leukaemia

• Bilateral pleural effusion

Patient’s concern

• What if my symptoms are not control?

• Who can visit me at home?

• How often can hospice come?

• Is it free?

• My mum does not know------

Mother’s concern

• I am only a housewife

• What if she is in pain again?

• How to take care if she is

not eating much?

Concerns from hospice

• Can we off the pigtail for pleural effusion?

• What if patient cannot be manage at home?

• Send to emergency or direct to PCU

Concerns from hospital.

• Availability of beds

• Needs for regular suction of the pigtail

• Patient’s distress, wish to go home

Shared decision making

Strategy for integrated care

Strategy for integrated care

• Patient focus

• Shared resources

• Shared training and education

• Collaboration

• Inter-team meeting and discussion

Quotes from uncle Lim