Palliative care has emerged as a crucial component of healthcare, particularly in the context of an aging population and the increasing prevalence of chronic and life-limiting illnesses. In the Philippines, however, access to palliative care remains significantly limited, especially in rural and underserved areas. This disparity is primarily driven by systemic challenges such as inadequate healthcare infrastructure, a shortage of trained professionals, and insufficient public awareness. While the inclusion of palliative care in the Universal Health Care (UHC) Act of 2019 (Republic Act No. 11223) reflects a progressive step toward addressing these needs, the implementation of comprehensive palliative services continues to face considerable hurdles. This paper advocated for the stronger integration of palliative care into primary health care systems at the barangay level, emphasizing the need to strengthen policy frameworks, ensure adequate resource allocation, and actively engage communities in this endeavor. Such efforts are essential to guaranteeing equitable, compassionate, and dignified care for all individuals, regardless of their stage of life or even socioeconomic status.

In palliative and hospice practice, health care professionals frequently faced ethical challenges related to end-of-life care. The complexities of patient care in the hospice and palliative care setting mandated a shift from healthcare professionals operating in “silo” to embracing an interprofessional team-based approach. However, ethical dilemmas and ethical conflicts within the interprofessional team and between the professional and patient family may arise, due to different perspectives about the patient's best interest. This paper utilized the Walker and Avant's (2011) concept analysis process in which the concept of interprofessional ethical reflective practice was developed. Adopting the analysis methodology from Walker and Avant (2011), this paper defined the concept and related concepts, attributes, antecedents, consequences, model case, borderline case and opposite case to describe the concept of interprofessional ethical reflective practice. The concept proposed a cyclical approach for interprofessional ethical reflective practice which includes three phases, pre-ethical situation reflection, intra-ethical situation reflection and post-ethical situation reflection. This concept allowed for the significance of interprofessional ethical reflective practice to become apparent, guiding healthcare professionals to navigate through ethical dilemmas with awareness, sensitivity, collaboration, and an attitude of commitment to upholding the ethical care principles in palliative and hospice care.

BACKGROUND

Palliative Care focuses on the needs of both the patient and their families, aiming to enhance their overall quality of life. It achieves this by anticipating, preventing, reducing, and treating suffering through comprehensive support across various aspects of life. This approach promotes patient autonomy, provides access to information, and encourages the freedom to make choices. Referring patients to Supportive and Palliative Care in a timely manner enhances their quality of life, improving symptom control, mood, and understanding of their illness. Additionally, it reduces distress for both the patient and their caregiver during the end-of-life period.

This study aimed to determine the proportion of late referrals among patients diagnosed with debilitating illnesses consulting at the Emergency Department of Batangas Medical Center from July to December 2022 and who needed Supportive and Palliative Care using the Palliative Care and Rapid Emergency Screening Tool, considering age, sex, and the specific diagnosis of the debilitating illness. Additionally, the timing of referrals for both discharged and admitted patients requiring Supportive and Palliative Care was described, with categories including those referred within one week, beyond one week, and those not referred at all.

This retrospective study was conducted via chart review of all patients with debilitating illnesses who visited the Emergency Department of Batangas Medical Center, admitted or discharged, from July 2022 to December 2022. Timing of referral to Supportive and Palliative Care was obtained from the admission charts and/or the SPC referral logbook. Frequency analysis specifically frequency tabulation was used to summarize data.

Between July and December 2022, 2,097 patients diagnosed with debilitating illnesses at the Emergency Department were identified. Only 2.52% of them received referrals to Supportive and Palliative Care, and among this group, more than half (38) were referred later than one week after diagnosis.

This study identified the need for comprehensive improvements in the referral process, emphasizing timely access to Supportive and Palliative Care for patients of all demographic facing debilitating illnesses. The call for systemic changes advocates for clear protocols and guidelines, reducing oversight and delays. The Palliative Care and Rapid Emergency Screening Tool can streamline referrals, while collaboration between healthcare providers and the palliative care team ensures a more efficient system. Strategies advocating for healthcare infrastructure improvement and awareness campaigns may be developed to facilitate timely referrals for patients across age and gender spectrums.

BACKGROUND

Th Philippines has faced challenges in quality end-of-life care and ranks poorly on the 2015 Quality of Death Index. This study explores the perceptions of a good death among patients, caregivers, and bereaved family members within the Palliative and Hospice Care Program of Ospital ng Makati.

The research aimed to offer insights into the factors that influence end-of-life care preferences in the Philippine context.

The study involved 38 participants – patients, caregivers, and bereaved family members. It adapted and modified the Good Death Inventory, a validated scale with 47 questions covering 18 domains related to end-of-life care.

Results show significant differences in perceptions of a good death among patients, caregivers, and bereaved family members. Maintaining hope and pleasure, having control over the future, and a good relationship with medical staff were identified as top priorities while dying in a favorite place was of lower importance. Caregivers and bereaved members valued patient autonomy, with higher importance placed on being respected as an individual and feeling that one’s life is worth living. Additionally, spiritual comfort was more significant for caregivers and bereaved family members. The study highlights the importance of understanding distinct preferences in the context of end-of-life care. The findings also call for longer data collection periods, larger sample sizes, and potential qualitative research methods.

By addressing these nuances, healthcare providers can better improve end-of-life care, ensuring that patients and their families experience a more positive and meaningful transition at this crucial stage of life.

BACKGROUND

Rolling out palliative pain management had been challenging in the wards due to the hesitancy of nurses in carrying out opioid administration. Studies and daily practices in the hospital show that lack of knowledge, fear of handling opioids and low confidence are some of the barriers in managing palliative care patients efficiently. Through coaching and appropriate training, nursing knowledge, and confidence level in patient care are bolstered.

This study determined the effect of physician’s coaching in addressing hesitancy in opioid administration among QMMC nurses involved in palliative care.

This action research study utilized convergent parallel, mixed methods design with 28 ward nurses handling palliative care referrals. Participants were randomly assigned in the control (lecture only) and intervention (lecture with coaching) groups. Both groups answered a self-administered questionnaire and underwent interviews pre- and post-interventions. The intervention group had additional coaching prior to post-test and final interview.

Baseline characteristics were similar. The control (lecture only) and intervention (lecture with coaching) groups showed a significant difference in improved practices (p < 0.01) and increase in knowledge (p < 0.00) post-interventions. Qualitative analysis of post-intervention responses indicated increased confidence, reduced doubts, and a better understanding of opioid administration.

It is critical to remove the barriers to opioid administration in order to expand patients’ access to effective drugs. Increased knowledge and understanding resulted in a confident and informed attitude towards opioid administration. Continuing education with coaching can effectively minimize nurses’ hesitation to administer opioids.

Background: Palliative care is an approach which improves the quality of life of patients and their families facing life-threatening illness, through the prevention, assessment and treatment of pain and other physical, psychosocial and spiritual problems. The Palliative and Hospice Care Act was enacted to improve quality of life of terminally- ill patient, however, the readiness of general practitioner to participate in palliative care is still a critical issues. Objectives: This study aimed to identify factors affecting provision of palliative care, as perceived by primary care physicians in Ilocos Norte. Methods: The study is a descriptive-comparative research utilizing the purposive sampling technique in selecting the participants. It used a structured survey questionnaire in google form and was sent through email. For participants having difficulty with online platform, printed questionnaire was distributed. Data gathered was entered and analyzed using Microsoft Excel. Specifically, mean, standard deviation was used for descriptive statistics and spearman correlation for inferential statistics was utilized. Results As to the knowledge of the primary care physicians, this study showed that they are knowledgeable as to the definition and objectives of palliative care. The study able to assess factors affecting the provision of palliative care in five (5) domains. Among the domains it was noted that national, regional and local healthcare networking and healthcare team are perceived challenges in provision of palliative care among the primary care physicians of Ilocos Norte.
Palliative Care ; Physicians, Primary Care

INTRODUCTION: Acute malignant large bowel obstruction (MBO) occurs in 8%-15% of colorectal cancer patients. Self-expandable metal stents (SEMS) have progressed from a palliative modality to use as bridge to surgery (BTS). We aimed to assess the safety and efficacy of SEMS for MBO in our institution. METHODS: The data of patients undergoing SEMS insertion for MBO were reviewed. Technical success was defined as successful SEMS deployment across tumour without complications. Clinical success was defined as colonic decompression without requiring further surgical intervention. Rates of complications, median time to surgery, types of surgery and rates of recurrence were studied. RESULTS: Seventy-nine patients underwent emergent SEMS placement from September 2013 to February 2020. Their mean age was 68.8 ± 13.8 years and 43 (54%) patients were male. Mean tumour length was 4.2 cm ± 2.2 cm; 89.9% of malignant strictures were located distal to the splenic flexure. Technical and clinical success was 94.9% and 98.7%, respectively. Perforation occurred in 5.1% of patients, with none having stent migration or bleeding. Fifty (63.3%) patients underwent SEMS insertion as BTS. Median time to surgery was 20 (range 6-57) days. Most (82%) patients underwent minimally invasive surgery. Primary anastomosis rate was 98%. Thirty-nine patients had follow-up beyond 1-year posttreatment (median 34 months). Local recurrence and distant metastasis were observed in 4 (10.3%) and 5 (12.8%) patients, respectively. CONCLUSION Insertion of SEMS for acute MBO has high success rates and a good safety profile. Most patients in this audit underwent minimally invasive surgery and primary anastomosis after successful BTS.
Humans ; Male ; Middle Aged ; Aged ; Aged, 80 and over ; Female ; Colorectal Neoplasms/pathology* ; Singapore ; Tertiary Care Centers ; Stents/adverse effects* ; Intestinal Obstruction/etiology* ; Treatment Outcome ; Retrospective Studies ; Palliative Care

Objective To analyze the changes of death status of the inpatients in Peking Union Medical College Hospital before and after the development of palliative care.Methods All the death cases of Peking Union Medical College Hospital in 2013 (384 cases) and 2019 (244 cases) were included in this study,and the general information of the patients and the details of diagnosis and treatment before death were collected.Results The departments of intensive care,emergency,and respiratory diseases and the international medical services had highest number of deaths in both 2013 and 2019,with the cumulative constituent ratios of 67.7% and 62.7%,respectively.The number of clinical departments that involved or implemented palliative care increased from 7 in 2013 to 14 in 2019.The number of patients who died in 2019 and exposed to palliative care increased (P<0.001) compared with that in 2013,and increasing patients received humanistic care (P<0.001).Compared with 2013,2019 witnessed reducing patients receiving vasoactive drugs (P=0.006),cardiopulmonary resuscitation (P=0.002),endotracheal intubation (P=0.002),invasive mechanical ventilation (P<0.001),and invasive operation (P<0.001) before death in 2019.Conclusion The concept and practice of palliative care have significantly reduced the proportion of terminal patients receiving traumatic treatment.
Humans ; Palliative Care ; Hospitals ; Retrospective Studies

Integrative palliative care is the early intervention of palliative medicine for the patients with serious illness,jointly providing care with the patients' primary care team.By literature review and real-life experience study,we conclude that the integrative palliative care can make effective use of existing healthcare resources and provide the original treatment team with palliative medical technical support,thereby improving the patients' quality of life.The healthcare institutions need to choose an appropriate care model on the basis of evaluating its own strengths and weaknesses.The palliative care team needs to establish a long-term and sustainable relationship with each department in the hospital to provide patients with a safer and more effective medical experience.
Humans ; Palliative Care ; Quality of Life ; Hospitals

Since end-stage renal disease leads to a variety of problems such as disability,reduced quality of life,and mental and psychological disorders,it has become a serious public health problem around the globe.Renal palliative care integrates palliative care philosophy in the care for patients with end-stage renal disease.As a planned,comprehensive,patient-centered care,renal palliative care focuses on the patient's symptoms and needs,aiming to reduce the suffering throughout the course of the disease,including but not limited to end-of-life care.This study reports the palliative care practice for a patient on maintenance dialysis in the Blood Purification Center of Peking Union Medical College Hospital and reviews the present situation of palliative care in end-stage renal disease.
Humans ; Palliative Care/psychology* ; Quality of Life ; Kidney Failure, Chronic/therapy* ; Terminal Care/psychology* ; Renal Dialysis/psychology*