By Madonna R. Bacorro, MD, DFM, FPAFP, FPSHPM One of the greatest roadblocks a Palliative Sub-specialist encounters in the Philippines is the limited comprehension of the term’s “palliative” and “hospice” care. This is perhaps inevitable given that our culture does not allow you to give up even till the very end, no matter what.
This is why, 12 years ago, I began a Clinical fellowship in Supportive Hospice and Palliative Medicine at thePhilippine General Hospital, University of the Phillipines (UP-PGH) .
My curiosity first arose when I undertook a palliative care rotation within in the Department of Anesthesia, which initiated palliative care, at my alma mater – the UST Hospital.
Figure 1: The University of Santo Tomas (UST) Hospital where the Benavides Cancer Institute (BCI) is located.
It has been a long winding road since then.
Fast forwarding to the present; the pandemic meant Palliative care became a necessity. It showed its relevance in the need for strong communication skills, particularly when having to deliver bad news.
Being a Palliative Care specialist in the Philippines is an uphill struggle. You need to come up with novel ideas on how to introduce various elements of Palliative Care little by little, but, paradoxically, in a generous amount.
During the many challenges of the pandemic, when I frequently felt isolated and depressed, I found support from participating in the diverse six month International Fellowship in Palliative Care.
This is a programme run jointly by the Institute of Palliative Medicine Kerala, India – a WHO Collaborating Centre for Community Participation in Palliative Care and Long Term care; St Christopher’s Hospice in London; Sanjeevan Palliative Care, Puducherry, India; and the Bangabandhu Sheikh Mujib Medical University (BSMMU) in Bangladesh.
It has given me strength to initiate programs providing QOL provisions among palliative patients.
In the masterclass Harvard Medical School PGME’s Leadership in Medicine Southeast Asia, my one year participation as one of the partial scholars in 2023 led to the formulation of a capstone project entitled:
The Palliative Referral Framework in USTH.
Fig.2 Certificate Ceremony of Harvard’s Leadership in Medicine South East Asia, March 2023 for Batch 2023 HMS PGME LIM SEA Associate Alumni.
Its approval as the “QI Project : Improving the Patient-Centered Approach to Palliative Care through Strengthening Multidisciplinary Approach , Primary Care Utilization and Mobilization of Linkages in a Tertiary Hospital” now proved its relevance in holistic care approach.
About The Project:
The USTH Palliative Referral framework encompass’s
1)Primary Palliative Care—to address psychological, social, and spiritual domains of the “total pain” concept,
2)Multidisciplinary team approach—which should address the physical components of pain and the other distressing symptomatologies contributory , and
3)The Community Linkage—as an asset to the institutional provisions as this would address the practical struggles attributed to the debilitating condition .
The USTH MDT is now being composed of: BCI Head and Neck Oncology team, Tumor Board Clinics, ENT, Anesthesia Pain Management, Neurology and Psychiatry , Pediatrics , Internal Medicine, Palliative Subspecialty, Surgery , Rehab Medicine, and all other oncology teams.
In the process, I am also now permitted to practice my subspecialty of Palliative Medicine in the UST Hospital under Department of Family and Community Medicine.
The Universal Healthcare Law (RA 11223) in the Philippines initiated the public health awareness of the palliative discipline through primary care.
The concept of “total pain,” defined by Dame Cicely Saunders, as “suffering that encompasses all of the person’s physical, psychosocial, social, spiritual and practical struggles,” highlights the need for improving the provision of timely and holistic palliative care.
In summary , quality assurance measures in USTH palliative framework of effectiveness and efficiency prompted:
a) the formulation of a consistent multidisciplinary team in the BCI,
b) empowerment of the bio-psychosocial aspect of patient and family through the Primary Palliative Care, and
c) activation of compassionate community linkages.
The methodology consisted of basic protocols and institutional policies which were observed before the full implementation of such innovation. Certain buy-ins permeated the participation in the community level as well.
The total pilot of 20 patients established the incorporation of the primary palliative care in the tumor board meetings and multidisciplinary meetings ( MDM ).
In conclusion, consistency in proactive planning approaches by MDTs made the materialization of target deliverables possible.
As of this time, the innovative framework has been selected for presentation in the “poster abstract category” in the 29th World Congress of Parkinsons and other Related Disease in Lisbon, Portugal on May 19 to 22, 2024.
Publication in its counterpart prestigious journal would share the outcomes of the project globally and do its purpose of inspiring other institutions and groups which are undergoing the same challenges with implementation.
Most importantly: The continued progression of the palliative framework in the institution is a strong indicator of a milestone surpassed and conquered not only by the Department of Family and Community Medicine but the whole USTH Institution as well.
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About the author:
Madonna R. Bacorro is a Family Medicine Specialist and Palliative Medicine Subspecialist in the Philippines, who had a qualification recently in Harvard Medical School PGME LIM:SEA. She is the UST Hospital Co-Head of Family Health Care Program (including Geriatrics and Palliative Care ). She sits as one of the board members of The National Hospice and Palliative Council of the Philippines or Hospice Philippines, and is the outgoing appointed Chair of the Informatics Committee of Philippine Society of Hospice and Palliative Medicine.
References:
1) Lecture notes from online Harvard LIM: SEA Masterclass (2022-2023)
2) DOH. (2021), Manual of Operations, Procedures, and Standards, National Palliative and Hospice Care Program. Manila, Philippines: Department of Health
3) Richmond C. Dame Cicely Saunders. BMJ. 2005 Jul 23;331(7510):238. PMCID: PMC1179787.
4) David Clark, Ph.D., Nicole Baur, Ph.D., et al Mapping Levels of Palliative Care Development in 198 Countries: The Situation in 2017, Journal of Pain and Symptom Management
5)Lecture notes from Academic Fellowship masterclass, Palliative Care, Institute of Palliative Medicine, Kozhikode (WHO Collaborating Centre for Community Participation in Palliative Care and Long Term Care) & St.Christopher’s Hospice, UK et al; 021, 2022)
6) Quality Improvement Project Introducing A Reflective – Education Model Optimizing Palliative Care Delivery: A Multidisciplinary and Primary Care Integration Model By Madonna R. Bacorro, M.D., 1 M.T.G. Bautista, M.D., 2 M. Mejia, M.D., 3 J. Diaz, M.D., 4 W. Bacorro, M.D., 5 M.C.A. Maranion, M.D., 6 M. M. Valencia, M.D., 7 A. Fernando, M.D., 8 M.P.R. Pasicolan, MD 9.
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