Development of a novel integrated palliative oncology model of care for cancer inpatients
For cancer patients, an unplanned hospital admission is often an indicator of poor prognosis and represents a need for palliative care input. However, only a minority of these patients are referred to a palliative care team. Early palliative care alongside standard oncology care has been shown to confer benefit in the outpatient setting. The aim of this study is to explore whether a resource-efficient model of early palliative care improves patient quality of life and reduces resource utilisation in the acute hospital setting.
In collaboration with the Division of Medical Oncology, we piloted a new model of integrated palliative care and oncology care for cancer inpatients. We are now planning for a larger scale trial of this model of health service delivery.
Empirical study on End of Life ethics issues
With the goal of addressing the dearth of clinical studies in ethical issues, the Division of Palliative Medicine has set out to study a wide array of ethics issues relevant to the Singapore healthcare setting. Amongst these are the very first studies on the evolving concept of personhood amongst terminally ill patients and its impact upon care determinations of palliative care patients and the impact of filial piety on end of life decision making in Singapore.
It is envisaged that data from these studies will not only improve care provision within the local setting but also lead the way to holistic care within the region. Other areas of study include decision making at the end of life and conceptions of food and feeding at the end of life.
Cancer patients in the adolescent and young adult (AYA) age group (15 – 39 years old)
AYA cancer patients face a multitude of complex problems and current services that can meet the needs of AYA cancer patients are still in early stages of development.
We plan to determine what the specific needs of AYA cancer patients are in order to build a program that is tailored to support them. This study will provide much needed information on the specific care needs and referral patterns of the AYA cancer patient group, which will then be used to design an alternative service model specific to the AYA cancer patients to better address their care needs.
Additionally, in collaboration the Division of Medical Oncology and Division of Psychosocial Oncology, we plan to undertake a pilot study evaluating the effectiveness of a psychosocial intervention program for AYA cancer patients to inform future holistic programs for patients.
Development of a framework for mentoring in Palliative Medicine
Mentoring sits at the core of medical training yet the term and practice of mentoring remains poorly understood. With support from the medical education centres at the National University Singapore and the University of Dundee DPM hopes to carry out multicentre multinational studies on concepts and practices of mentoring.
Better elucidation of local and regional practices will better inform efforts to forward the first evidenced based guidelines on mentoring medical students and junior physicians in research and academic publications. To be produced in tandem with local studies of successfully mentored medical students and junior physicians we plan to forward local guidelines on mentoring for publications.
Further studies will also be undertaken to study concepts of professionalism and empathy within the region in an effort to forward culturally sensitive clinically relevant training curricula of these domains.
Development of the Enhancing Quality of life in Patients (EQUIP) intervention for patients with advanced lung cancer
Patients with advanced lung cancer have a high symptom burden and low quality of life. Early palliative care improves patient outcomes in newly diagnosed advanced lung cancer patients, but previously tested models are not feasible for widespread adoption. Hence, the aim of this study is to pilot a more sustainable nurse-led intervention – Enhancing Quality of life in Patients (EQUIP).
Recruitment for the pilot study is now completed and data analysis is now underway.
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