Raising palliative care standards in Malaysia

Categories: Care.

The more people know and understand what palliative care is, the more those in need will benefit from it.

Population ageing and the increasing incidence of non-communicable, life-limiting diseases such as cancer, organ failure, or certain degenerative neurological diseases, is bringing about significant challenges to the way most health care services operate.

Modern healthcare systems tend to focus on cure and treatment to reverse a disease rather than on the individual patients’ preferences, needs or values.

Person-centred care

When someone is diagnosed with a life-limiting illness and is told that their condition is irreversible, often, apart from physical symptoms that they may be suffering, they and the people around them will experience emotional anxiety and psychosocial issues.

If these issues are not addressed in totality, they will affect the well-being and quality of life of the person accessing care.

Research shows that care centred around the person, and clinical decisions guided by what they consider as important often achieves better outcomes.

Palliative care addresses the physical, emotional, psycho-social aspects of their life. It aims to improve the quality of life of the person accessing care and to facilitate a support system for family members to help them cope with their loved one’s illness.

This is found to be currently still lacking in our healthcare services and is attributed largely to the approach taught in medical schools.  

The palliative care approach

The palliative care approach challenges the boundaries of medicine. 

“Is palliative medicine a medical sub-specialty or simply an approach to care that should be adopted by all healthcare professionals?” asks Dr Ednin Hamzah, Medical Director of Hospis Malaysia.

Palliative care asks us about the fundamentals of how we care for our loved one and begs the question of the clinicians: ‘should you treat the patient the same way as you would treat your loved one?’ 

“Shouldn’t all healthcare providers then practise the palliative care approach as a core part of their practice?” adds Dr Hamzah.

Integrating palliative care into healthcare education and training

The palliative care approach should be a core skill of every clinician at the hospital and community level. It should also be a mandatory part of curricula for not only nursing and medical schools but also to all allied healthcare professionals such as physiotherapists and psychologists.

In Malaysia, awareness of the benefits of palliative care is low, few patients are referred to palliative care, and often, referrals are late in the course of the illness.

Most healthcare providers are unaware of or have misconceptions about the concept of palliative care.

Palliative care in Malaysia

In a 2015 Economist Intelligence Unit report, Malaysia is placed 38th out of 80 countries in a report ranking end of life care across the world. The top three countries were the UK, Australia and New Zealand.

The report revealed that there were only seven palliative care experts in Malaysia. This shortage of experts is further worsened by the fact that most medical schools in the country do not offer compulsory courses in palliative care, resulting in a limited understanding of the topic within the medical community.

For the few medical schools that do offer palliative care training, exposure to the subject is limited to just a few days out of their entire undergraduate teaching.

Most nursing postgraduates do not receive any exposure to palliative care. “There is simply not enough exposure. The principle of palliative care is an approach that all healthcare professionals need to be aware of and practise when attending to a patient,” says palliative care doctor, Dr Aaron Hiew.

Hospis Malaysia palliative care training

Hospis Malaysia is a charitable organisation that provides community palliative care. It is currently the only organisation conducting regular palliative care courses nationally through a series of structured workshops.

These are conducted in collaboration with the Asia Pacific Hospice and Palliative Care Network (APHN).

The workshops carry the endorsement of professional colleagues from the region (through the APHN). Also, most medical schools looking to include palliative care teachings in their curriculum will invite Hospis Malaysia’s doctors to facilitate these lectures. However, there is still a lack of an officially-prescribed palliative care training curriculum in the country.

The need for national standards in palliative care

Consequently, there is no officially-prescribed minimum standards required of our palliative care service providers.  

Issues faced by most patients such as adequate pain and symptom management, nutrition, communication or emotional well-being are central to improving someone’s quality of life.

If you or your loved one had a serious illness, what type of care would you want to receive from your healthcare professionals? Would you want them to focus on the person with the illness, or just on the illness? Do you know if they have been trained to do that?

Hospis Malaysia supports standardisation in palliative care throughout Malaysia.

To find out more about palliative care and to pledge your support towards standardisation in palliative care nationwide, visit the Hospis Malaysia website.

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