Lien Foundation gives $3.93m to TTSH, NUH to extend early palliative care to ICU patients who need it
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The Neuroscience Intensive Care Unit ward at Tan Tock Seng Hospital. Lien Foundation is pumping in $3.93 million into an initiative it calls A Kinder ICU.
ST PHOTO: AZMI ATHNI
SINGAPORE – Tan Tock Seng Hospital (TTSH) and National University Hospital (NUH) have launched a new initiative to integrate palliative care into standard ICU care, with the support of Lien Foundation.
Enabling intensive care unit (ICU) teams to provide general palliative care will ensure that critically ill patients receive earlier symptom relief and psychological support to ease their suffering in the ICU as they receive life-sustaining treatment.
Palliative care aims to improve the quality of life of patients and their families who are facing challenges associated with a life-threatening illness.
Singapore has 96 palliative care specialists in total – far too few to meet increasing needs in ICU settings. There are just four such specialists at NUH, and 14 at TTSH.
Lien Foundation, which has been investing in programmes that integrate palliative care across medical specialities and settings, is pumping $3.93 million into this initiative, which it calls A Kinder ICU.
Under the initiative, the hospitals will train about 800 ICU staff – mostly nurses, along with doctors, therapists and social workers – in palliative care over the next four years. Nurses will be empowered to proactively identify non-verbal cues and manage patient discomfort promptly, for instance.
The initiative is expected to benefit more than 7,600 ICU patients at both hospitals.
Palliative care is often delivered only in the final days of life by specialists but this programme will bring the care upstream. ICU staff will be trained to carry out not just physical symptom assessment and management and transition of care after ICU, but also to provide psychosocial support for patients and families, and professional caregiver well-being.
Under A Kinder ICU, all ICU patients will be assessed for palliative care needs, including for symptoms such as pain, breathlessness and confusion, and timely interventions will be done to address distressing symptoms. Screening for psychosocial needs will take place within 48 hours of admission, with appropriate referral to medical social workers. Furthermore, ICU doctors will consider specialist palliative care referrals within 72 hours of ICU admission.
A Kinder ICU will also help to increase the art and music therapy referrals at TTSH’s ICU and introduce these therapies to NUH’s ICU so that music and art therapists can bring these services to the bedside.
TTSH has supported over 2,500 ICU patients since establishing Singapore’s first ICU-palliative care programme 12 years ago. About one in four dying patients in its ICU receives palliative care, said Assistant Professor Neo Han Yee, senior consultant and head of the palliative medicine department.
NUH’s ICU was keen to offer its patients better support and sent several nurses over to TTSH in 2023 to learn some best practices in this area.
Palliative care specialists can sit down with families to figure out what the patient would really want, helping them navigate the guilt and confusion of difficult life-support decisions.
Madam Seng Swee Keow, 54, said she appreciated this greatly when her father was admitted to the ICU in TTSH following a major stroke in August 2025. A sprightly 82-year-old, her father, Mr Seng Boon Kee, had fainted at the neighbourhood coffee shop he cycled to every morning. In the ICU, he was dependent on a ventilator, and was unable to speak or open his eyes.
“He had bleeding in the brain. They told us that even if he were to wake up, he would no longer be independent. But we were expecting him to wake up and still hoped that he could continue to live his life like before, as much as possible,” Madam Seng said.
In the ICU, the palliative care doctor helped the family achieve a moment of clarity by asking if Mr Seng would want to live with ventilator support. Knowing he would not want this, Madam Seng, with her two siblings and mother then decided with the medical team to withdraw life support the following day.
They also ventured a request, unsure if it could be met. As Buddhists, it was important to them that they performed eight hours of uninterrupted prayer after Mr Seng’s death – a rite that the ICU environment could not accommodate.
Madam Seng Swee Keow (left) speaking to Ms Fionna Yow, an advanced practice nurse for palliative medicine, at Tan Tock Seng Hospital on May 5.
ST PHOTO: AZMI ATHNI
However, the ICU and palliative care teams worked with a hospice partner to arrange a transfer that would honour this request. Mr Seng was then moved to a room in Dover Park Hospice, which is connected to the main TTSH building via a sky bridge. This was the first time the teams withdrew life support in a community setting outside the ICU.
Prof Neo said that by the end of A Kinder ICU, they want to ensure that all dying patients in the ICU will receive some form of palliative care. This is aligned with the global shift to assimilate palliative care earlier in ICU settings.
