Getting appropriate treatment and prolonging
life span may not always be the
goals of patients with chronic conditions.
To heart failure patients in Singapore, as
one study revealed, it was the challenge
of planning for end-of-life care arising
from the uncertainty in prognosis. The
study was published in Proceedings of
Singapore Healthcare recently.
While physical and psychological concerns
were also there, many patients
spoken to during focus group sessions
highlighted end-of-life care issues, particularly
in wanting to avoid undue prolongation
of their life. They were worried
about being a burden to their family
members by requiring extensive care,
spending family resources, or causing
As a result, patients often based care
decisions on what they believed would
be best for their family, said lead author
of the study, Assistant Professor
Chetna Malhotra, Lien Centre for Palliative
Care, Programme in Health Services
and Systems Research, Duke-NUS
Healthcare providers can help allay
these fears by not only discussing
treatment plans with patients and
their family members but also by initiating
Advanced Care Planning conversations.
Navigating the healthcare system
proved to be a challenge for these patients
too, according to the study. As
many of them were elderly with multiple
comorbidities, they faced difficulty in
juggling instructions and multiple medications,
as well as in deciding which advice
or treatment plan to prioritise.
"Instead of visiting multiple physicians,
it may be less complicated for
them to consult one physician who
is aware of all their conditions and is
able to advise them holistically.
The physician can be backed by tertiary
healthcare support should the need
arise," said Asst Prof Malhotra.
"Heart failure however can be a challenge
to manage as it is a rapidly developing
field," said study co-author
Adjunct Assistant Professor David Sim,
Senior Consultant, Department of Cardiology,
National Heart Centre Singapore (NHCS).
There are several useful clinical guidelines
such as the ones provided by
American Heart Association, European
Society of Cardiology and Ministry of
"These guidelines are very comprehensive.
Primary care physicians just
need to keep in mind that heart failure
is a chronic disease which needs a
multidisciplinary approach, and keep
up-to-date with the latest information,"
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