Page 101 - HA Convention 2015

Special Topics

ST8.1 Palliative Care in Non-cancer Patients 14:30 Room 228

Palliative Care in Non-cancer Patients — Lessons Learnt in Hong Kong West Cluster Monday, 18 May
Sham MMK
Palliative Medical Unit, Grantham Hospital, Hong Kong

A collaborative model has been established between Palliative Medical Unit (PMU) and Acute Geriatric Unit (AGU) of
Grantham Hospital since 2011. Patients with palliative care needs were identified during joint rounds and were referred by
geriatricians for palliative care. Two thirds of these patients suffered from diseases other than cancer. The scope of services
includes inpatient palliative care, consultative service, outpatient care, home care and bereavement care. Two thirds of
patients subsequently passed away in PMU or AGU. Bereavement service coverage reached 100% in patients who died in
PMU, and 85% for those who died in AGU. For elderly patients with renal failure, combination of metolazone and frusemide
were prescribed with weaning of oxygen. They discharged early with few adverse effects.

Collaboration between PMU and nephrologists include, in addition to the whole range of palliative care services, an
integrated clinic in Tung Wah Hospital with multidisciplinary input. More frequent follow-ups resulted in improved symptom
control including pain, depressed mood and edema, which lowered emergency attendance. Erythropoiesis-stimulating
agents were not only effective in maintaining haemoglobin levels, but also alleviated fatigue and decreased all-cause
hospitalisation, with possible cost saving. There were no serious adverse effects. Sertraline was found to be effective in
managing pruritus.

Lessons were also learnt from collaboration with cardiologists. Home palliative care was found to improve dyspnea, quality
of life and satisfaction of patients.

PMU also provides palliative care to patients in residential care homes. In addition to symptom management and
psychological support, advance care planning is conducted for patients and their families, even in those with intellectual
disabilities. The preference for “Do Not Attempt Cardiopulmonary Resuscitation” (DNACPR) is respected in all patients.
Recommended topics in advance care planning include identification of patients’ priorities and their proxies, pros and cons
of medical treatment, with emphasis on continuing conversation to better understand patients’ wishes.

ST8.2 Palliative Care in Non-cancer Patients 14:30 Room 228

Palliative Care for Patients with Motor Neurone Disease through Multi-specialties Collaboration HOSPITAL AUTHORITY CONVENTION 2015
Chen TWT
Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong

Motor neuron disease (MND) is a life-limiting illness with challenging progressive course that results in a wide range of
ever-changing spectrum of care needs. The symptoms in MND are diverse and challenging. They include weakness,
spasticity, limitation in mobility and activities of daily living, communication deficits and dysphagia; and in those with bulbar
involvement, compromised respiratory system, fatigue, sleep disorders, pain and psychosocial distress are found.

During the course of illness, neurologists will assess, diagnose and manage the disease. Rehabilitation specialists will assist
with disability management and adaptive equipment provision, e.g. strategies and aids for mobility, ability to perform daily
activities, and procedures for spasticity. Palliative care team helps in the management of distressing symptoms, providing
emotional, psychological and spiritual support as needed, and to support the family in bereavement. Involvement of palliative
care team at an earlier stage of disease is important to allow discussion of advance care planning before the person loses
the ability to communicate.

Developed by the Department of Health of the United Kingdom, the National Service Framework provides quality
requirements for the inspection authorities to measure local progress of long term neurology conditions (LTNC). It advocates
the need for integrated care in managing LTNC including MND. The guidelines issued by Royal College of Physicians for
persons with LTNC recommend the interface between neurology, rehabilitation and palliative care to address the diagnostic,
restorative and palliative phases of illness.

In order to address the gaps in MND care, a MND taskforce consisting neurologist, rehabilitation specialist, respiratory
physicians and palliative care specialist was formed in our hospital. With the coordination between services and
communication between specialties, we hope to provide a coordinated care for persons with MND.

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