DOI QR코드

DOI QR Code

Providing End-of-Life Care in the Community: What Are the Challenges in Malaysia?

  • Received : 2022.07.04
  • Accepted : 2022.08.23
  • Published : 2022.09.01

Abstract

A 72-year-old woman with metastatic lung cancer to bone and brain and with left external iliac vein thrombosis was under the care of a community palliative care provider. She experienced an acute pain crisis due to acute limb ischemia of the left lower limb. Goals-of-care discussions were held with the patient and her family; she prioritized symptom control and end-of-life care at home. The family and patient were aware of her short prognosis. Her complex pain was managed by the community palliative team, and her family was empowered to give subcutaneous injections. We illustrate a case showing the importance of community health services with palliative care support in providing symptom management and support to patient and family caregivers throughout the course of a life-limiting illness. It also highlights family caregivers' potential psychological distress in delivering subcutaneous injections in terminal care for a patient at home.

Keywords

Acknowledgement

We would like to thank the patient's family for the permission to publish this paper.

References

  1. Leong RLB. Palliative care in Malaysia: a decade of progress and going strong. J Pain Palliat Care Pharmacother 2003;17:77-85; discussion 87-9.
  2. National palliative care: policy and strategic plan 2019-2030. Chapter 3.3 [Internet]. Putrajaya: Medical Development Division, Ministry of Health, Malaysia; 2019 [cited on 2022 May 27]. Available from: https://www2.moh.gov.my/moh/resources/Polisi/BUKU_NATIONAL_PALLIATIVE_CARE_POLICY_AND_STRATEGY_PLAN_2019-2030.pdf.
  3. Sivalingam N, Lim RBL, Rampal L. Palliative care in Malaysia: the need to do much more. Med J Malaysia 2021;76:279-83.
  4. Yang SL, Woon YL, Teoh CCO, Leong CT, Lim RBL. Adult palliative care 2004-2030 population study: estimates and projections in Malaysia. BMJ Support Palliat Care 2022;12(e1):e129-e136. https://doi.org/10.1136/bmjspcare-2020-002283
  5. Palliative care needs assessment Malaysia 2016 [Internet]. Kuala Lumpur: Hospis Malaysia; 2016 [cited 2022 May 26]. Available from: https://www.hospismalaysia.org/wp-content/uploads/2016/10/Palliative-Care-Needs-Ass essment-Malaysia-2016.pdf.
  6. Wilson DM, Cohen J, Deliens L, Hewitt JA, Houttekier D. The preferred place of last days: results of a representative population-based public survey. J Palliat Med 2013;16:502-8. https://doi.org/10.1089/jpm.2012.0262
  7. World Health Organization. Integrating palliative care and symptom relief into primary health care: a WHO guide for planners, implementers and managers [Internet]. Geneva: World Health Organization; c2018 [cited 2022 May 27].Available from: https://apps.who.int/iris/handle/10665/274559.
  8. Furst P, Lundstrom S, Klepstad P, Strang P. Continuous subcutaneous infusion for pain control in dying patients: experiences from a tertiary palliative care center. BMC Palliative Care 2020;19:172. https://doi.org/10.1186/s12904-020-00681-3
  9. Thomas T, Barclay S. Continuous subcutaneous infusion in palliative care: a review of current practice. Int J PalliatNurs2015;21:60, 62-4.
  10. Healy S, Israel F, Charles MA, Reymond L. An educational package that supports laycarers to safely manage breakthrough subcutaneous injections for home-based palliative care patients: development and evaluation of a Service Quality Improvement. Palliat Med 2012;27:562-70.
  11. Anderson BA, Kralik D. Palliative care at home: carers and medication management. Palliat Support Care 2008;6:349-56. https://doi.org/10.1017/S1478951508000552
  12. Wilson E, Caswell G, Turner N, Pollock K. Managing medicines for patients dying at home: a review of family caregivers' experiences. J Pain Symptom Manage2018;56:962-74. https://doi.org/10.1016/j.jpainsymman.2018.08.019
  13. Community-based palliative care demonstration Model [Internet]. Routledge: National Hospice & Palliative Care Organization;2018 [cited 2022 May 28]. Available from: https://www.nhpco.org/wp-content/uploads/NHPCO_x_Coalition_CBPC_Demo.pdf.
  14. Gomes B, Higginson IJ, McCrone P. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2009(2):CD007760.
  15. Yosick L, Crook RE, Gatto M, Maxwell TL, Duncan I, Ahmed T, et al. Effects of a population health community-based palliative care program on cost and utilization. J Palliat Med 2019;22:1075-81. https://doi.org/10.1089/jpm.2018.0489