Development and evaluation of new models of supportive and palliative care for patients with serious illnesses and their caregivers
Supportive and palliative care aims to improve the quality of life of patients and their families when they are facing serious illnesses such as cancer, end-organ failures, advanced dementia and late frailty. The Division of Supportive and Palliative Care (DSPC) seeks to do health services research on developing, evaluating and implementing new models of care that can extend the benefits of supportive and palliative to more patients earlier in their illness trajectory. These projects include:
Accessible Cancer Care to Enable Support for Cancer Survivors (ACCESS)
This study evaluates a model of supportive care for patients with breast or gynaecological cancers. In this model, the distress thermometer is used to screen for high distress and problems that may be contributing to the distress. For patients with high distress, a supportive care nurses will make contact, review the problems and address any problems identified.
Supportive and Palliative Care Review Kit in Locations Everywhere (SPARKLE)
SPARKLE is a model of care that aims to pro-actively monitor patients with advanced cancer for symptom problems, identify problems early and address them promptly. The overall goal is to improve quality of life for patients and their caregivers.
Educate, Nurture, Advise, Before Life Ends (ENABLE)
The ENABLE intervention is delivered by a nurse coach who guides patients and caregivers in principles of problem-solving coping, decision-making, advance care planning, symptom management, self-care, communication, and life outlook and review. When provided to individuals with newly diagnosed advanced cancer, clinical trials of ENABLE have demonstrated better quality of life and mood, with additional benefits of earlier initiation on patient survival and family caregiver mood and burden. The main aim of this study was to evaluate the cultural relevance of the ENABLE model of early palliative care and identify modifications for an adapted ENABLE-SG intervention for pilot testing in patients with advanced cancer and their caregivers in Singapore.
Educate, Nurture, Advise, Before Life Ends (ENABLE) intervention for patients with heart failure (HF) and their caregivers in Singapore (ENABLE-HF-SG)
There are separate ongoing studies evaluating the cultural relevance and effectiveness of ENABLE for patients with advanced heart failure, and their caregivers in Singapore.
Empirical study on End of Life ethics issues
With the goal of addressing the dearth of clinical studies in ethical issues, the Division of Supportive & Palliative Care 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.
Serious illness communication program
It is imperative that we communicate effectively and sensitively with patients who have serious illness. Good communication allows healthcare providers to understand patients’ concerns and priorities better and paves the way for shared decision-making regarding treatment decisions and care plans. In collaboration with Ariadne Labs, there is an ongoing study evaluating the cultural relevance of the Serious Illness Communication Guide in patients with advanced cancer, heart failure and renal failure in Singapore. After completion of the cultural adaption of the Serious Illness Conversation Guide, further studies will also be undertaken to pilot the Serious Illness Communication Program in Singapore amongst patients with life-limiting illnesses.
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