Fieldwork - In-depth Look into Palliative Care in Hong Kong - Essay Example

Palliative care and Outcomes in Hongkong Fieldwork Summary: An Indepth Look into Palliative Care in Hong Kong INTRODUCTION Hong Kong hospitals have improved in the giving of palliative care to their patients over the last two decades. This change or development is geared towards improving the quality of life for patients who are chronically ill. Palliative care which has been introduced in the 1960's, deals with the improvement of the quality of life of patients and their families when faced with terminal illnesses such as cancer. It is the strengthening of support for families and the patient during the time of illness while exploring ways and means to help cure illnesses (Chan, 2001). The interaction between patients and health care workers are also examined in giving palliative care. While providing much needed support to the patient and the family in order for them to cope with the emotional stress associated with being critically ill, it has also been found that nurses and health care staff assigned to intensive care units that deal with end of life situations deal with more stress than nurses assigned to other wards (Kostopoulou & Katsouyanni, 2006). During my visit to the Queen Elizabeth Hospital in Hong Kong, I observed the palliative care given to patients in their oncology ward. This a mixed ward where they give care to both geriatric and pediatric patients with cancer. As an observer, I was able to see the developments made in giving palliation and what needs to be improved still. PALLIATIVE CARE SERVICES IN HONG KONG Queen Elizabeth Hospital is one of the many hospitals in Hong Kong that provides palliative care to their patients in the oncology ward. The services that they offer include providing possible placement and hospice care for patients. In providing palliative care, the patient and their families are given support for quality of life by preventing and providing relief from emotional, spiritual and physiological impacts of chronic illnesses such as cancer. One of the main objectives of giving palliative care to patients with cancer is the utilization of support groups such as the family and the community in order to provide care. Cancer not only affects the elderly, it also affects children and even infants. The giving of palliative care may differ a bit in giving care to different age groups. Such as with pediatric palliative care that deals with children with the idea that children with chronic illnesses may not survive to become adults (Liben, Papadatou, & Wolfe, 2007). Education and psychosocial support is also given to patients and their families. In educating families, it is giving them options with clinical trials that can help with the prognosis of their illnesses. The psychosocial aspect helps patients and their families deal with the emotional and psychological stresses associated with being chronically ill (Chan, 2001). Culturally speaking, Chinese people find it a privilege to spend the last moments of their loved ones. This is slowly changing with the advancement of medicine and the constraints of living spaces in Hong Kong. Most deaths happen in the ICU or hospices and this has a significant impact especially on the elderly who seek palliative care. Even health care workers are aware of this human factor and may sometimes allow patients who are admitted to hospices to go home for a few days. This home leave improves the psychological and emotional aspect of the patient, but in most cases is brought back to the hospice or hospital (Ngai, Yuen, & Wong, 2006). CONCEPTS BEHIND PALLIATIVE CARE IN CLINICAL ONCOLOGY Palliative care has a significant role when dealing with patients who are chronically ill. The scope of care does not only extend to the patient, but to the family of the patient as well who together with the patient deal with the stresses and emotional burdens of being ill. Palliative care also gives importance on the role of health care workers in giving appropriate psychosocial support and exploring other clinical studies that can help in the prognosis of illnesses. The health care workers also provide means of improving the quality of life of the patient and possible preparation for end of life (Tse Man Wah, 2007). One of the main concepts in giving palliative care in clinical oncology is to improve the quality of life of the patient. This means discussing options of care and medication to the patient and giving the patient and their families the options of making decisions on what type of care they will get. This family and patient discussion also makes them prepared for the possibility of shifting palliation to end of life especially if the patient is terminally ill (Chan, 2001). Part of palliation is informing the patient and their families of their disease. Patients who are more aware of their condition can make changes in their lifestyle in order to improve their quality of life and possibly help in the prognosis of their illnesses by adopting healthier lifestyles (Kostopoulou & Katsouyanni, 2006). FAMILY EXPERIENCES ON PALLIATIVE CARE Chinese people are known to have close knit family ties. This has been evident on their culture and the giving of importance to the ceremonies for the dead such as funerals and honoring ancestors. In Katz's three inter-related principles on end-of-life care, the first principle is to provide dignity to the dying patient. The second is to provide familiarization to the surrounding of the dying patient. This can be familiar faces or sometimes the home itself. The last is to provide pain management in order for patients not to suffer in their last hours (Ngai, et al., 2006). Many families and patients viewed cancer as a stigma and may have no access to care due to socioeconomic factors. Palliative care twenty years ago was delivered only by health care practitioners who had sufficient training about it in Hong Kong. This has changed and has improved the relationship between patients and health care practitioners over the last two decades (Chan, 2001). A NURSE'S ROLE IN PROVIDING PALLIATIVE CARE With the principles of palliative care and end of life care, nurses play a critical role in providing these to families and their patients. Statistically speaking, a large percentage of cancer patients are those aged 64 and up. This means that aside from having cancer, there is a high risk of patients having pre-existing conditions such as diabetes and hypertension. There are some studies that show that fifty percent of the elderly population with cancer suffers from chronic pain (Lo & Woo, 2000). But cancer is not isolated to the elderly alone. People of all ages can suffer from cancer, even children. One of the general barriers when it comes to providing palliative care is the issue of avoidance among hospital staff. This avoidance stems from cultural aspects and lack of training in this kind of care services. In developing countries, adding to this barrier is the added cost of possible longer stay in the hospital or medication. ANALYSIS ON PALLIATIVE CARE AND WHAT NEEDS TO BE IMPROVED There is still room for improvement when it comes to the giving of palliative care. This kind of care and holistic approach to diseases is not constrained to cancer patients alone. There are many chronic illnesses where the disease becomes progressive to the point where the palliation shifts to end of life care (Lo & Woo, 2000). One of the changes that need to be done in terms of giving palliative care is educating patients and their families that there is such care services that are available to them. When patients are diagnosed with chronic illnesses such as cancer, the thought process sometimes shift almost immediately to end of life care. Some patients and families do not realize that even when diagnosed with cancer there has been many medical breakthroughs that can have their cancer placed into remission, and if not at least improve their quality of life so that they can still live as normal as possible even with cancer (Tse Man Wah, 2007). In terms of providing access to palliative care, Government should provide such services to marginalized sectors of the community. One set back that has always surfaced when analyzing the giving of palliative care is the cost and accessibility of such care services. CONCLUSION In spite of the improvements made in palliative care worldwide and in Hong Kong, there is still much that needs to be done. In a study made by the International Observatory on End of Life Care the ratio of services for palliative care to population is not enough. This also contributes to the crude deaths from patients who have no access or not received palliative care. This means that the integration of palliative care into the basic health services in the country needs to be improved (Wright, Wood, Lynch, & Clark, 2006, p. 32). Cost and accessibility is the main factors in terms of improvement and integration of palliative care to hospitals in developing countries. Hong Kong is among the countries listed that need to integrate this type of care to their basic services. The training of staff, especially nurses who have direct interaction with patients and their families also need to be improved. The training includes symptom assessment and control, dialogues with family members and resolving conflicts and emotions that may arise from such dialogues (Tse Man Wah, 2007). References Kostopoulou, V., & Katsouyanni, K. (2006, February). The truth-telling issue and changes in lifestyle in patients with cancer. Global Medical Ethics, 32, 693-697. Chan, F. (2001, June). Psychosocial oncology and palliative care in Hong Kong: the first decade. Hong Kong Medical Journal, 7(2), 216-217. Tse Man Wah, D. (2007, December). Palliative care in intensive care. HKSPM Newsletter, 12, 11-15. Liben, S., Papadatou, D., & Wolfe, J. (2007, August 16). Paediatric palliative care: challenges and emerging ideas. The Lancet, 10(1016), 1-13. Retrieved September 28, 2009, from http://www.thelancet.com Wright, M., Wood, J., Lynch, T., & Clark, D. (2006). Mapping levels of palliative care development: a global view. Lancaster, United Kingdom: National Hospice and Palliative Care Organization. Ngai, K., Yuen, J., & Wong, C. (2006, December). Promoting quality end-of-life care: an elderly woman with visual impairment. Asian Journal of Gerontology & Geriatrics, 1(3), 171-174. Lo, R., & Woo, J. (2000, January). Palliative care in the elderly. Journal of the Hong Kong Geriatrics Society, 10(1), 16-24. Read More