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Research

Research Themes

End Organ Diseases

Palliative care uses a holistic approach to improve the quality of life of patients with life-limiting illnesses. Research in palliative care is mostly focused on cancer patients and they have been shown to improve patient and caregiver satisfaction, quality of life, symptom burden and healthcare utilisation.

Patients with end organ diseases also experience high symptom burden which adversely affects their quality of life. Preliminary findings show that palliative care benefits patients with end organ diseases by supporting them and their caregivers. However, access to palliative care for this patient group is still limited due to challenges in prognostication.

Further study is required to help us better prognosticate so that patients may receive more timely referrals for palliative care. Additional studies will also provide more evidence and insights into the specific benefits of palliative care for this patient group.

Models of Care

A model of care broadly underscores the organisation of healthcare services and its delivery. It delineates the framework, the underlying principles, the core components of care delivery and the structure of implementation.

Due to the multi-faceted nature of end-of-life care, a wide range of services is required to holistically support patients with life-limiting illnesses as well as their families. The model of care used to deliver these services can affect the quality of care.

Against the backdrop of a rapidly ageing population and increase in the number of people living with multiple chronic conditions, the development of an adaptable model of end-of-life care is required to meet these changing complex needs. Models have to be dynamic in order to respond to changing demographic demands, adapt to structural and policy changes in the health system, and sensitively consider socioeconomic and cultural contexts.

Further research is required to evaluate the effectiveness of newly developed and implemented care models. We welcome well-designed studies that analyse and demonstrate the effectiveness of various palliative care models.

Community Palliative Care

Provision of palliative care in the community such as home care increases the probability of home deaths, fulfilling the wishes of individuals who want to die at home. Community palliative care can potentially reduce healthcare utilisation. It has also been found to increase family and patient satisfaction and provide support to families to continue care at home. Similarly, systematic reviews on palliative day care centres show that patients feel positive about the experience of attending day care through experiencing a renewed sense of meaning and purpose.

We welcome more studies to demonstrate community palliative care’s clinical effectiveness and its effect on patient and caregiver well-being. Despite the increasing demand for community palliative care services in response to an ageing population, there exists few high-quality research on the aspects of palliative care that can best support patients and their families in the community.

Caregiver Needs

Family caregivers provide unpaid care and support to family members or friends who have terminal illnesses. Caring for a loved one at the end-of-life can be challenging and complex as they deal with issues such as symptom management, cognitive decline, functional dependency, anticipatory grief and ultimately bereavement when the loved one passes on.

Supporting caregivers is an important component of palliative care as it can be extremely stressful mentally, physically and emotionally to care for someone with a life-limiting condition. They may also burn out if care has to be provided over a prolonged period of time.

The needs of patients are commonly studied and have received more attention than those of family caregivers. Additionally, current palliative care services are geared towards supporting caregivers of individuals living with cancer.

The challenges of an ageing population include an increase in the number of people with end organ diseases and chronic conditions. There is also the risk of suffering from multiple co-morbidities, which makes end-of-life care more challenging and complex. There is a pertinent need to adapt and modify existing services to assist caregivers of individuals with non-malignant illnesses who have needs that are different from caregivers of cancer patients.

Ethical Issues in End-of-Life Care

Advancements in medical sciences have reshaped the circumstances surrounding death. Its intervention at the time of death may sustain the lives of patients. However, for patients with life-limiting illnesses, these interventions may prolong the suffering and dying process instead of bring healing and recovery.

Sustaining the life of a patient without meaningful existence raises various ethical issues such as treatment futility and non-beneficence. Technical advances in the care of terminal patients have created ethical challenges for physicians, patients, and families at the end-of-life.

We welcome research that investigates existing practices and frameworks, while exploring and proposing new and viable models, frameworks and methods in reframing/reclaiming/repositioning the moral discourse in palliative medicine and care.

Education

Palliative care education of healthcare professionals is a key component of their training. Many are ill-equipped to deal with issues concerning death and dying. Some also feel inadequate  with providing end-of-life care.

Palliative care was only incorporated into the undergraduate medical curriculum in recent years. It exposes students to the medical sub-specialty, improves attitudes towards caring for patients with life-limiting illnesses, and provides them with the appropriate frameworks and methodologies in the management of palliative care patients.

However, the nascent undergraduate curriculum has limitations in its practical application. Continued education in post graduate palliative care thus helps to renew and advance the capacities and competencies of practicing physicians.

Developing insights into the effectiveness of new and existing training programmes will help academics and curriculum developers keep up to date with the relevant practical and pedagogical aspects of palliative care education.

2nd PalC Research Grant

The 2nd PalC Research Grant is open for application from 2nd December 2019 to 11th February 2020.

The project topics should preferably fall within the research themes illustrated above.

Strong preference will be given to projects that address palliative care in advanced dementia and end organ diseases and have long-term impact and implications. All the three partner institutions of PalC, i.e. NHG, LKCMedicine and Dover Park Hospice, must be featured in the grant application form.

Projects with great significance, are original and innovative, have scientific/clinical/economic potential and have plans for future funding will be considered favourably. Projects will be reviewed based on their feasibility, appropriateness and the rigour of the proposed methodology and approach. The research team should also have the required qualifications, experience and competency to carry out the project and bring it to fruition.

Each proposal can be funded up to a maximum of $50,000 for 2 years.

Please download and refer to Annex 1 of the PalC Research Grant Application form for the list of fundable and non-fundable items. The completed form should be emailed to research@palc.org.sg

Appendix 1 – PalC Grant Application Form 2019

Please also mail the hard copy of the original completed application form to the PalC Research office at the following address by 11th February 2020:

The Palliative Care Centre for Excellence in Research and Education (PalC)

c/o Dover Park Hospice
10 Jalan Tan Tock Seng
Singapore 308436
Attn: Research

Late submissions will not be considered.

If you require additional information or have any queries, please refer to the list of
Frequently Asked Questions or email research@palc.org.sg

We look forward to receiving your applications.

1st PalC Research Grant

We would like to congratulate the following recipients of the inaugural PalC Research Grant.

Name of awardee: Adj Asst Prof Neo Han Yee
Designation: Deputy Head and Senior Consultant
Institution: Tan Tock Seng Hospital
Title of study: Evaluating Clinical Benefits and Healthcare Utility Impact of a Novel Palliative Rehabilitation Service for Patients with Chronic Breathlessness– The Integrated Care for Advanced REspiratory Disorders (ICARE) Program
Theme of study: End organ diseases, models of care
Study team members: Asst Prof Sanjay Haresh Chotirmall (LKCMed and TARIPH), Dr Ong Wah Ying (DPH), Dr Lee Liang Tee (RCH and TTSH), Dr Ho Si Yin (TTSH) and Dr Xu Huiying (TTSH)

Name of awardee: Dr Goh Wen Yang
Designation: Associate Consultant
Institution: Tan Tock Seng Hospital
Title of study: Geriatric Oncology SuPportive clinic for ELderly (The GOSPEL study)
Theme of study: Models of care
Study team members: A/Prof Konstandina Griva (LKCMed), Dr Allyn Hum (DPH), Dr Teo Hui Lin (TTSH), Dr Francis Ho (TTSH), Dr Neo Han Yee (TTSH), Dr Mervyn Koh (TTSH) and Dr Lim Ming Yann (TTSH)

Name of awardee: Dr Tessa Koh Li-Yen
Designation: Resident Physician
Institution: Tan Tock Seng Hospital
Title of study: Movie Reflection for Junior Doctors working in Palliative Care Units
Theme of study: Education
Study team members: Dr Andy Ho (LKCMed), Dr Chia T-Yunn (DPH), Dr Tricia Yung (TTSH), Dr Chia Siew Chin (TTSH), Dr Mervyn Koh (TTSH) and Assoc Prof Wong Teck Yee (TTSH)

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