Page 15 - HA Convention 2016 [Abstracts (Day 1)]

Special Topics HOSPITAL AUTHORITY CONVENTION 2016

T3.1 Care for the Dying 13:15 Convention Hall A

Leadership for Better End-of-life Care in Current Times
Wee B
Nuffield Department of Clinical Medicine and Harris Manchester College, University of Oxford, UK

The hospice movement was born out of the inspirational leadership of Dame Cicely Saunders and built on the many years of
quiet and generous hospitality on the part of those who ran hospices before then. Palliative care in each country continues to
thrive or falter depending on the strength of its leadership. In this presentation, the notion of leadership for current times and
the foreseeable future will be explored. In the “new” world, the traditional “command and control” style of leadership may be
less effective than an adaptable partnership-building style of leadership. This will not be an academic dissection or formal
critique of leadership theories. Instead, thoughts and ideas about what kind of leadership we need for palliative and end of
life care in these times will be explored: when the world is more complex; when we need collaboration and cooperation to
do more for less; when we need to forge forwards more or less together whilst keeping open and enquiring minds and being
prepared to investigate innovations. This presentation is more likely to provoke questions in your mind rather than provide you
with clear answers about how to approach leadership in your own context. That is for you to figure out.

Tuesday, 3 May

T3.2 Care for the Dying 13:15 Convention Hall A

Meeting the Needs of Patients with Life-limiting Illness: Advance Care Planning in Local Setting
Tse DMW
Caritas Medical Centre, Hong Kong

The importance and need for advance care planning (ACP) cannot be over emphasised for now and for future. In modern
medicine, instead of mostly dying from acute life-threatening illnesses or conditions as in previous centuries, more people are
now “living” with chronic life-limiting diseases with a typical trajectory of gradual decline in biological parameters and bodily
functions over a period of years. Secondly, patient’s autonomy and involvement in medical care have been promoted widely
and patient’s informed choices in chronic life-limiting illness should be preceded by the communication process of ACP.
Thirdly, the rapidly aging population poses a great challenge to our healthcare system and its sustainability, knowing that
over 95% of deaths in Hong Kong occurred in public hospitals. Growth in elderly population is associated with an increase in
mortality. There is also a sharp age gradient in the use of hospital beds and use of accident and emergency services, most
remarkably for the group of “old” old.

The Hospital Authority (HA) of Hong Kong has recently revised the Guidelines on Withholding and Withdrawing Life Sustaining
Treatment in the Terminally Ill in 2015. In this revised version, a section on Advance Care Planning is included to acknowledge
the importance of ACP as an integral part of chronic disease management and with the following key features: (1) to include
communication with family members or parents of mentally incompetent patients and the minors respectively in the scope
of ACP; (2) to give suggestions on the triggers for ACP discussion; (3) to emphasise on the consensus building approach in
local culture; (4) to give guidance on the contents of discussion in ACP; and (5) to advice on the followup actions after ACP,
including the use of the HA Advance Directive (AD) forms.

The ACP is an important overarching process of communication before patient decides on the medical and personal care of
choice at end-of-life. Completion of AD after ACP is only the means and not the end. More outcome studies related to quality
of dying are warranted and some studies have reported that ACP is associated with a higher chance of patients’ wishes being
known and followed, lower stress level in family members and a higher utilisation of palliative care service. With the ultimate
goal of ACP in mind, ensuring access to good palliation is fundamental.

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