Most health professionals feel unprepared to give palliative care, survey finds

More are becoming aware of the importance of this field.
More are becoming aware of the importance of this field.PHOTO: ST FILE

SINGAPORE - Most healthcare professionals here feel unprepared to provide palliative care for patients with life-threatening illnesses, a survey released on Friday (March 26) showed.

But more are becoming aware of the importance of this field, which focuses on relieving pain and improving quality of life for the seriously ill or dying.

The Singapore Hospice Council survey of 2,326 healthcare professionals revealed that only about four in 10 received training in palliative care either at medical school, at nursing school or while studying social work.

Of those who had been trained, 58 per cent of doctors, 45 per cent of nurses and 60 per cent of allied health professionals felt it was not enough to prepare them to support patients with life-threatening illnesses.

Around six in 10 doctors and nurses who took part in the online survey between August and October said they were aware of hospice and palliative care, a 20 per cent increase since 2014.

Dr Patricia Neo, who chairs the Singapore Hospice Council, said palliative care is a relatively young field in Singapore. It was not established as a medical sub-speciality until 2006.

"Many healthcare workers may not be exposed to palliative care in their undergraduate years and are hence unfamiliar with the work that we do," Dr Neo said.

"With the increasingly ageing population and increase in palliative care needs, it is necessary to raise awareness and equip all healthcare workers with enough general palliative care knowledge to better serve patients and families."

Those who took part in the survey, released at the council's 25th anniversary award ceremony, comprise doctors, nurses and allied healthcare professionals such as medical social workers, therapists and pharmacists. About half work in acute care hospitals, while the rest are from community hospitals, polyclinics, private clinics, nursing homes and other places of care.

While those from the hospices regularly see patients nearing their end of lives, most healthcare workers do not.

"Much work remains to be done in improving familiarity and training in palliative care, and in facilitating advance care planning," said Dr Neo.

The Singapore Hospice Council said the increase in awareness since 2014 could be due to its public education programmes to raise awareness about end-of-life care.

The survey also found that healthcare professionals want more training in communicating sensitively with patients and their families, providing information about pain and symptom management, assessing psychological issues, recognising patients who need palliative care and understanding ethical dilemmas at the end of life.

Dr Chong Poh Heng, vice-chairman of the Singapore Hospice Council, said of the training provided in schools: "Modules might have aimed to create awareness rather than build competency. Practical or skill-based training (such as role-playing or clinical attachment) that targets anticipated responsibilities could bridge the gap."

The council plans to develop a training framework that will be customised for healthcare staff who need either general or specialised palliative care knowledge.

Practical and skill-based training modules are being planned in collaboration with institutions and other social service agencies.

The survey also found that 44 per cent of the healthcare staff have not prepared for matters relating to their own death, such as making a will, planning their care in advance or thinking about giving a loved one lasting power of attorney. More than 15 per cent of those surveyed said they did not plan to make any of these preparations.

"Without being convinced themselves, they would find it hard to influence their patients to make plans and improve their end-of-life experience," said Dr Chong.

On-the-job training must not be overlooked, said Associate Professor Cynthia Goh, a senior consultant in the division of supportive and palliative care at the National Cancer Centre Singapore.

"There are many difficult conversations that doctors and nurses need to have with patients and their families when things are not going well, when the treatment is not working or the patient is deteriorating despite the best efforts.

"Watching a skillful senior colleague do it is good, but in the end the skill is acquired by practising."


(From left) Associate Professor Cynthia Goh, senior consultant at the Division of Supportive and Palliative Care in the National Cancer Centre Singapore, receives an award from President Halimah Yacob with the Council's honorary secretary, Dr Wu Huei Yaw, looking on. PHOTO: SINGAPORE HOSPICE COUNCIL

Prof Goh, who formerly chaired the Singapore Hospice Council, was one of 36 award recipients at its silver jubilee ceremony at the Shangri-La Hotel, which was attended by President Halimah Yacob.

Awards were given to its pioneers and member organisations such as the public hospitals for their contributions to the hospice movement.

The council will be hosting a charity show on Saturday (March 27), where it hopes to raise $500,000, its largest fund-raising target so far.

The money will be used to sponsor new programmes, boost training and improve the palliative care landscape in Singapore. As of Friday,  less than $125,000 had been raised.

Madam Halimah said in a Facebook post that she was glad the council had "evolved over the years with a vision to continue providing quality palliative care for all".