Shatin End of Life Care Programme
Prince of Wales Hospital and Shatin Hospital

A dignified end-of-life journey

“For elderly patients facing end-stage chronic diseases with limited life expectancy, the emphasis may not be on medical therapy which prolongs survival. Rather, they wish to be surrounded by their loved ones and free from pain and sufferings. The main objective of our End-Of-Life (EOL) Care Programme is to fulfil our patients’ last wishes and preferences for care, and maintain their dignity until the very end,” says Dr Elsie Hui, Service Director (Primary & Community Health Care) of New Territories East Cluster; and team leader of the Shatin EOL Care Programme.

In 2013, the Community Geriatric Outreach Team (CGAT) of Prince of Wales Hospital (PWH) introduced a pilot EOL Care Programme for patients living in Residential Care Homes for the Elderly (RCHEs) at the late stage of chronic illness, with life expectancy of a few months. The team facilitates Advance Care Planning (ACP) by communicating with patients and their family members. The care options focus on minimising pain and sufferings associated with medical treatment, and bestow choice and dignity on patients and their loved ones. Through collaborating closely with several stakeholders, including Department of Medicine and Geriatrics (M&G) of Shatin Hospital (SH), Accident and Emergency Department of PWH, Non-Emergency Ambulance Transfer Service, and RCHEs, 80% of EOL patients who require hospitalisation can be diverted from acute medical wards of PWH to designated EOL wards of SH, which is a convalescence hospital. The programme achievements consistently stand out among other teams in Hospital Authority.

Advanced dementia is a very common disease among EOL patients. They are frequently hospitalised for inadequate food intake and dehydration because of dysphagia. Conventional treatments comprise intravenous fluids for rehydration and nasogastric tube which inflict pain and discomfort on patients. Thus, the team has introduced an alternative way of oral feeding by working with dietitians and speech therapists. The flavour and texture of food are tailor-made for each and every patient so as to stimulate their appetite and minimise their risk of aspiration. Cesilia Ho, Advanced Practice Nurse, Department of M&G of SH, shares the story of a patient who was anorexic because of a persistent bitter taste in everything she ate. After thorough assessment of risk of aspiration and communication with family members, she was allowed to enjoy a lollipop before meal. Miraculously a lick of lollipop could stimulate her appetite and she was able to feed herself happily before discharge from hospital.

Dr Bosco Ma, Associate Consultant, CGAT of PWH, echoes “Many EOL patients can still enjoy oral feeding if we pay extra attention to the texture of food and time of meals. We should always think out of the box. Food enjoyment, be it a taste of lollipop, a sip of milk-tea or a lick of some ice, is a kind of psychological relief to patients and their family members.”

Medico-social collaboration enhances the quality of EOL care in RCHEs. Cheng Hau-ming, Advanced Practice Nurse, CGAT of PWH, elaborates, “Our team provides on-going clinical support and regular training to RCHE staff on EOL care, such as feeding technique and identification of signs and symptoms. We also administer subcutaneous fluid replacement in RCHEs for some EOL patients who have poor oral intake. This helps avoid hospitalisation and allows the patient to be looked after in a more familiar setting.”

The team serves a catchment population of 4,200 elderly patients in 40 RCHEs located in Shatin. Currently, the EOL Care Programme is serving 160 patients. The team aims to expand the scope of service, improve the quality of care and convey a message of ‘blessed to survive, relieved to perish’ to the public.