The Palliative Care Committee of the hospital organized the conference, and the rapid growth of end of life care is a testament to the enthusiasm for palliative care in this country of 65 million people.
It is only 11 years since Maharaj Nakorn Chiang Mai hospital initiated its first policy for palliative care. The policy has required palliative care-trained nurses in each ward, and doctors trained in palliative care for each specialty.
An on-site temple provides spiritual care and support. Social workers and volunteers – including monks and people from other faith denominations – are also trained in palliative care. Palliative care training is included in religious instruction.
The palliative care committee delivers both teaching and direct care, and this has been underpinned by a commitment to research and tools to measure and improve care.
First, the team led on the Thai validation of the Palliative Performance Scale (PPS), which allows classification of patients by function. This classification has informed a local model of palliative care that provides guidelines on patient management according to their PPS score. This has been published in the academic literature (E.g.: Chewaskulyong et al., 2012).
Second the Family Assessment of Treatment at End of Life Care (FATE) was translated into Thai, and the validation is complete.
Third, at the conference this week, data were presented on the Thai Palliative Outcome Scale (POS). POS is used for palliative cancer patients in the hospital, and POS training has been delivered at around 20 provincial hospitals across Thailand.
POS training manuals have been locally developed for those who cannot attend training. The data presented at the conference demonstrated that the cancer patients receiving palliative care at Maharaj Nakorn Chiang Mai hospital self-report improvements in all domains. The data on validation of POS in Thai showed it to be a valid and reliable measure.
The concept of palliative care is readily accepted in Thailand. The Ministry of Health’s Healthcare Accreditation Institute national hospital accreditation document stipulates that palliative and end of life care, and assessment of palliative care-related problems such as pain and symptoms, is mandatory.
The conference focused on the selection and use of outcome tools. The meeting has stimulated the clinical teams to now move from their current cancer palliative care populations into non-cancer groups, and also how to use POS to inform and monitor patients’ needs and outcomes.
Ladarat Sapinun, Advance Practice Nurse in elderly lung cancer, said: “POS can help me know about the needs and problems of the patients, but more than that, only a small proportion of our patients tell us about their problems in detail and POS stimulates them to open up to us.
“Sometimes we don’t know how to open up a conversation with a patient and POS helps us to ask ten questions that then help the patient talk to us. I also use the POS data to provide the Government’s Hospital Accreditation review of our hospital’s palliative care team to prove the outcomes of our service.”
Dr Richard Harding is Reader in Palliative Care at the Cicely Saunders Institute, King’s College London. He played a key leadership role in developing the African POS, now widely used across clinical care and research in sub-Saharan Africa.