Perspective from Singapore

Koon, Ong Eng; Krishna, Lalit Kumar Radha

doi:10.1353/asb.2014.0038

Cited by 10 publications

(5 citation statements)

References 24 publications

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“…As an Asian society with a strong Confucian ethic, the principle of filial piety is one that is deeply entrenched. 18 As such, seeking the services of palliative care may be unthinkable as it may be perceived as “giving up” on therapy for one’s loved ones. 19 This may be coupled with inadequate or incorrect perceptions on what palliative care encompasses.…”

Section: Discussionmentioning

confidence: 99%

Initiating End-of-Life Care at the Emergency Department: An Observational Study

Chor

Wong

Ikbal

et al. 2019

Am J Hosp Palliat Care

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Objective: Terminally ill patients at their end-of-life (EOL) phase attending the emergency department (ED) may have complex and specialized care needs frequently overlooked by ED physicians. To tailor to the needs of this unique group, the ED in a tertiary hospital implemented an EOL pathway since 2014. The objective of our study is to describe the epidemiological characteristics, symptom burden and management of patients using a protocolized management care bundle. Methods: We conducted an observational study on the database of EOL patients over a 28-month period. Patients aged 21 years and above, who attended the ED and were managed according to these guidelines, were included. Clinical data were extracted from the hospital’s electronic medical records system. Results: Two hundred five patients were managed under the EOL pathway, with a slight male predominance (106/205, 51.7%) and a median age of 78 (interquartile range 69-87) years. The majority were chronically frail (42.0%) or diagnosed with cancer or other terminal illnesses (32.7%). The 3 most commonly experienced symptoms were drowsiness (66.3%), dyspnea (61.5%), and fever (29.7%). Through the protocolized management care bundle, 74.1% of patients with dyspnea and/or pain received opiates while 59.5% with copious secretions received hyoscine butylbromide for symptomatic relief. Conclusion: The institution of a protocolized care bundle is feasible and provides ED physicians with a guide in managing EOL patients. Though still suboptimal, considerable advances in EOL care at the ED have been achieved and may be further improved through continual education and enhancements in the care bundle.

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Section: Discussionmentioning

confidence: 99%

Initiating End-of-Life Care at the Emergency Department: An Observational Study

Chor

Wong

Ikbal

et al. 2019

Am J Hosp Palliat Care

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“…In Singapore' s predominantly ethnic Chinese society, the Confucian principles of filial piety remains pervasive. 19,20 Confucianism fosters social harmony and places great value on collectivism and the family. Elders are venerated and ancestor worship is practiced.…”

Section: Discussionmentioning

confidence: 99%

Perspectives of Singaporean patients and caregivers towards quality of life or quantity of life with disease-modifying treatment in the end-of-life setting

Sng

Lee

Tay

et al. 2016

Proceedings of Singapore Healthcare

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Background: Healthcare providers often struggle to balance the sometimes competing considerations of maximizing quality of life (QoL) and quantity of life with disease-modifying treatment (DMT). These decisions require in-depth dialog between all parties in order to understand the concerns and perspectives of the patient and caregiver in this period. Objectives: The objectives of this study were to explore Singaporean patients' and caregivers' attitudes towards QoL and DMT, and to examine the reasons behind their beliefs. Methods: Participants were given a video vignette of a family discussing how best to care for their mother who is recently diagnosed with cancer and were interviewed regarding their thoughts on QoL and DMT for a 70-year-old patient with stage IV metastatic cancer. Subjects/Setting: A total of 21 patients and caregivers were recruited from a tertiary oncology centre. Results: Both patients and caregivers show little support for pursuing QoL, despite the likely compromise to the patients' QoL. These participants believed that not pursuing DMT was tantamount to giving up and accepting death. Whilst patients did accept that in some circumstances a QoL approach would be acceptable, caregivers remained adamant upon a DMT approach. The perspectives of caregivers reflected the influence of the Confucian-inspired practice of filial piety. Conclusion: Local sociocultural beliefs and values continue to play a significant consideration in end-of-life decision-making. However, compliance with these beliefs have evolved, with greater consideration given to clinical and QoL factors.

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“…SEBA's constructivist approach [40][41][42][43][44][45][46] and relativist lens [47][48][49][50] acknowledge storytelling as a sociocultural construct [51,52] molded by six key elements [53]. One, individual characteristics, working styles, opportunities [54], motivations, attitudes, emotions [55], experience, skills, goals, historical, demographic [55,56], socio-cultural [57][58][59], ideological, contextual and psycho-emotional features (henceforth accounts). Two, clinical, academic, personal, research, professional, ethical, psychosocial, emotional, cultural, organizational, societal, legal, and educational spheres of the patient and the receiving physician and healthcare professional (henceforth contextual considerations) [60].…”

Section: Methodsmentioning

confidence: 99%

The role of patients’ stories in medicine: a systematic scoping review

Quah,

Chua,

Lin

et al. 2023

BMC Palliat Care

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Background Patients’ stories provide Palliative Care physicians with a glimpse into the former’s lives and their psycho-emotional, sociocultural, and contextual considerations. Yet, few physicians are trained to interpret and apply patients’ stories in their practice. Inherent variability in how stories are transmitted and interpreted raises questions over their potential effects on care. Amidst a dearth of accounts in Palliative Care, we map current use of patient stories to guide the training, assessment, and oversight of this ‘care influencing’ practice in medicine. Methods This systematic scoping review was guided by the Systematic Evidence-Based Approach (SEBA) to ensure a reproducible and structured approach. The themes and categories identified through the Split Approach’s concurrent and independent thematic and directed content analyses provided a comprehensive sketch of the included articles. The Jigsaw Perspective combined the themes and categories identified. The last stage of SEBA compared these results with two recent reviews of storytelling to ensure consistency of the domains created that guided the discussion. Results Ten thousand two hundred seven articles were reviewed, 963 full text articles were evaluated, and 199 articles were included. The four domains identified were study characteristics, benefits, approaches, and positive effects and concerns. Conclusion Stories support patient-centered, personalized, and holistic clinical care. However, variability in the stories, their interpretations and use in care decisions underscore the need for further study on the structuring, teaching, assessing, and delivery of this ‘care influencing’ practice.

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Perspective from Singapore

Cited by 10 publications

References 24 publications

Initiating End-of-Life Care at the Emergency Department: An Observational Study

Initiating End-of-Life Care at the Emergency Department: An Observational Study

Perspectives of Singaporean patients and caregivers towards quality of life or quantity of life with disease-modifying treatment in the end-of-life setting

The role of patients’ stories in medicine: a systematic scoping review

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