What is hospice palliative care?
Palliative care aims to provide active and holistic care to end-stage patients who do not respond to curative treatment in order to maintain the best quality of life for patients and their families. The professional medical team consists mainly of physicians, nurses, social workers, religious teachers, psychologists and volunteers, who deal with end-stage discomfort such as pain, asthma, dyspnea, insomnia, loss of appetite, nausea, vomiting, edema, constipation, diarrhea, fatigue, weakness, cough, pressure injuries, incontinence, and so on, through the overall assessment and various methods to manage discomfort and relieve pain and physical and psychological stress. The medical care team invites patients and their families to participate in the care program to enhance the dignity of the end life without regrets.
Characteristics and principles of hospice care:
- To affirm life and regard dying as a normal process, without urging or prolonging death.
- To attain relief from pain and other distressing symptoms.
- To integrate psychological and spiritual needs into medical care programs.
- To provide resources and support systems to help patients live as actively as possible until death.
- To assist patients and families to face the final stages of life and adapt to the process of bereavement.
In Taiwan, The NHI (National Health Insurance) system provides hospice services for the following illnesses:
- Terminal cancer
- Terminal motor neuron atrophy
- Senile and early age organic psychosis (dementia)
- Other terminal brain deterioration
- Heart failure
- Chronic obstructive pulmonary disease, not classified elsewhere
- Other lung diseases
- Chronic liver disease or liver cirrhosis
- Acute renal failure, unspecified
- Chronic renal failure and renal failure, unspecified
Common myths of hospice palliative care:
- Hospice palliative care is definitely not a place to wait for death.
- Hospice palliative care is definitely not a place for dying patients to be abandoned by doctors.
- Hospice palliative care is definitely not a place without any treatment.
- Hospice palliative care is definitely not a place where only morphine analgesics are given and the patient is groggy all day long.
- Hospice palliative care is definitely not a place to provide euthanasia.
- Hospice palliative care is definitely not a place where patients can never be discharged. Patients will be arranged discharged after their symptoms are stabilized.
Patient Right to Autonomy Act: (Implemented on January 6, 2019)
- Persons with full disposing capacity may make advance decisions, with relatives and a medical team consisting of physicians, nurses, psychologists, and social workers to communicate and discuss their wishes for hospice care, and make Advanced Care Planning (ACP). Under the five major clinical conditions: the patient is terminally ill, the patient is in an irreversible coma, the patient is in permanent vegetative state, the patient is suffering from severe dementia and other disease conditions, announced by the central competent authority, that shall meet all of the owing requirements that the conditions or sufferings are unbearable disease is incurable and that there are no other appropriate treatment options available given the medical standards at the time of the disease's occurrence. For example, cardiopulmonary resuscitation, life-prolonging machines or by tubing, blood transfusion or antibiotic therapy, etc. In addition, "artificial nutrition through a feeding tube" via naso-gastric tube, intravenous therapy, PEG (percutaneous endoscopic gastrostomy), etc. Through advanced medical decision agreed by the patients or family (advance directive, AD), you have the right to choose to accept or reject medical treatment. You can plan your medical care in advance, so that you can make end of life medical decisions and achieve the goal of dignity and respect. At any time, if you change your mind about your situation, you can modify the "'Advanced Medical Decision".
- The advanced medical decision is not activated immediately after signing, but after verifying with two specialists and two palliative medical teams, they will confirm if you meet the five clinical conditions, then the advanced medical decision will be implemented.
- The ''Advanced Care Planning Consultation Center" is located at the third of the First Clinic. To make an appointment, please go to the consultation center or call (02) 2875-7818.
- Fried, T. R., Zenoni, M., Iannone, L., O'Leary, J., & Fenton, B. T. (2017). Engagement in Advance Care Planning and Surrogates'Knowledge of Patients' Treatment Goals. Journal of the American Geriatrics Society. Retrieved From http://onlinelibrary.wiley.com/doi/10.1111/jgs.14858/pdf
- Hospice, U. K. (2019). What is hospice care. Retrieved March, 20, 2019. doi:10.7312/kuts91468-032
- Ma, J. C., Lin, P. X., Hsiao, C. Y., Su, M. S. Tseng, L. C. (2019). The Clinical Perspective on Death-Starting from Patient Autonomy Act and ACP. Leadership Nursing, 20(1), 16-27. http://doi.org/10.29494/LN.201903_20(1).0002
- Zwakman, M., van Delden, J. J., Caswell, G., Deliens, L., Ingravallo, F., Jabbarian, L. J., ... & Preston, N. J. (2020). Content analysis of Advance Directives completed by patients with advanced cancer as part of an Advance Care Planning intervention: insights gained from the ACTION trial. Supportive Care in Cancer, 28(3), 1513-1522. http://doi.org/10.1007/s00520-019-04956-1