MyMedR

Fulltext Paediatric Palliative Care during the COVID-19 Pandemic: A Malaysian Perspective

Chong LA, Khoo EJ, Kamar AA, Tan HS

Asian Bioeth Rev, 2020 Aug 13.

PMID: 32837563 DOI: 10.1007/s41649-020-00142-2

Malaysia had its first four patients with COVID-19 on 25 January 2020. In the same week, the World Health Organization declared it as a public health emergency of international concern. The pandemic has since challenged the ethics and practice of medicine. There is palpable tension from the conflict of interest between public health initiatives and individual's rights. Ensuring equitable care and distribution of health resources for patients with and without COVID-19 is a recurring ethical challenge for clinicians. Palliative care aims to mitigate suffering caused by a life-limiting illness, and this crisis has led to the awareness and urgency to ensure it reaches all who needs it. We share here the palliative care perspectives and ethical challenges during the COVID-19 pandemic in Malaysia.

Matched MeSH terms: Palliative Care; Hospice and Palliative Care Nursing

Paediatric palliative care around the world: Malaysia

Khoo EJ

Curr Probl Pediatr Adolesc Health Care, 2024 Jan;54(1):101452.

PMID: 37945387 DOI: 10.1016/j.cppeds.2023.101452

The evolution of paediatric palliative care in Malaysia has followed a distinct trajectory compared to adult palliative care. While adult palliative care was well-established by the mid-1990s, paediatric palliative care was still then largely ad hoc, with individual paediatricians and NGOs taking on the responsibility. Despite progress over the last decade, challenges persist. There is a shortage of trained paediatricians in this subspecialty, and financial constraints hinder progress. Decision-making in paediatric palliative care is also influenced by cultural values, religious beliefs, and societal norms. Parents are steered by cultural practices and the guidance of elder family members in a setting of communitarian traditions that are prevalent in Asian cultures. Discussions about end-of-life matters are hampered by cultural taboos. Additionally, the hierarchical medical culture, where doctors are seen as authoritative, hinder patients, including parents, from taking an active role in decision-making. The paper exemplifies these complexities through a case study, where the family's hopes and concerns were overlooked in a hectic and hurried hospital environment. The narrative calls for a compassionate, collaborative ecosystem that bridges cultural gaps and embraces shared decision-making in paediatric palliative care. It emphasizes the need to harmonize palliative care with societal values, involving healthcare providers, families, and the community. However, recognizing individual preferences and avoiding cultural assumptions are crucial. Healthcare professionals must develop skills in cultural diversity, delivering distressing news with compassion, and effectively communicate to involve families in decision-making, all while respecting their beliefs and values.

Matched MeSH terms: Palliative Care*

Fulltext Paediatric palliative care at home: a single centre's experience

Chong LA, Khalid F

Singapore Med J, 2016 Feb;57(2):77-80.

PMID: 26893078 DOI: 10.11622/smedj.2016032

There is increased awareness of paediatric palliative care in Malaysia, but no local published data on home care services. We aimed to describe the paediatric experience at Hospis Malaysia, a community-based palliative care provider in Malaysia.

Matched MeSH terms: Palliative Care/organization & administration*

Paediatric palliative care in the Asia Pacific region: where are we now?

Chong PH, Hamsah E, Goh C

BMJ Support Palliat Care, 2017 Mar;7(1):17-22.

PMID: 26338851 DOI: 10.1136/bmjspcare-2014-000812

Paediatric palliative care services have increased both in numbers and capacity around the world in response to the needs of children living with life-limiting conditions. Members of the Asia Pacific Hospice Network, who render care to children, have increasingly realised the need to map existing services for enhanced collaborative, educational and advocacy efforts. An online survey was conducted over 2 months among professionals in the region to document current service provision, and at the same time to explore individual training needs and practice challenges. A questionnaire crafted through consensus by members of a new special interest group within the network was used to collect data. 59 distinct responses from 16 countries were obtained to build a directory, which has already been circulated. Content analyses of narrative responses yield further findings. Half of these services catered to adults as well as to children. Staffing and service provision varied across the region but most members worked in teams consisting of multidisciplinary professionals. Numerous service and funding models were found, reflecting wide differences in local conditions and responses to diverse patient populations unique to paediatric palliative care. The highest training needs centred around bereavement and spiritual care. Capacity and funding issues were expected, but significant lack of support by paediatricians was found to be alarming and warrants further study. Amid the heterogeneity, these services share common struggles and face similar needs. Identifying individual profiles of different services potentially helps to draw everyone together, towards a common vision, and towards creating opportunities for sharing of expertise and experience.

Matched MeSH terms: Palliative Care/standards; Palliative Care/statistics & numerical data*

Fulltext Pain issues from the palliative perspective: a survey among doctors in Hospital Melaka

Taye GAWC

Med J Malaysia, 2006 Oct;61(4):405-9.

PMID: 17243516

This survey was intended to gauge the management of pain in palliative cancer patients by the doctors in Melaka Hospital. It also sought to identify possible barriers to adequate pain management among doctors and gauge their response to the adequacy of medical school teaching on cancer pain issues. A 39 item survey was used to cover the issues involved. Overall, the doctors displayed a lack of systematic approach to cancer pain management with inadequate knowledge of analgesia handling. Medical school exposure to cancer pain issues was lacking. Formulation of accepted clinical practice guidelines and new education strategies can improve cancer pain management.

Matched MeSH terms: Palliative Care*

Fulltext Pain management and the role of pain clinics in Malaysia--is there a place for alternative medicine in pain clinics?

Delilkan AE

Med J Malaysia, 1998 Sep;53(3):201.

PMID: 10968153

Matched MeSH terms: Palliative Care*

Palliation and breast cancer

Yip CH

J Surg Oncol, 2017 Apr;115(5):538-543.

PMID: 28097656 DOI: 10.1002/jso.24560

Metastatic breast cancer is an incurable disease. With improvement in systemic therapy, survival has improved over the past few years. Removing the primary tumor has shown improved survival in retrospective studies, but this may be due to selection bias. The first reported randomized controlled trial (RCT) from India showed no difference in survival with surgery. However another RCT from Turkey showed that a select group of patient with bone-only metastases have a survival benefit.

Matched MeSH terms: Palliative Care*

Palliative Care Research in the Asia Pacific Region: A Systematic Review and Bibliometric Analysis of Peer-Reviewed Publications

Cheong WL, Mohan D, Warren N, Reidpath DD

J Palliat Med, 2019 May;22(5):545-552.

PMID: 30570416 DOI: 10.1089/jpm.2018.0447

Background:
The state of palliative care research is closely linked to the development of palliative care services in a country or region.
Objective:
To systematically review the current state of palliative care research in the Asia Pacific region and analyze its relationship with the performance of each country in the region on the Economist Intelligence Unit's 2015 Quality of Death Index.
Design:
Systematic review and bibliographic analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol 2015 (PRISMA-P).
Data Sources:
The PubMed/MEDLINE, EMBASE, SCOPUS, CINAHL, and PsychiNFO databases were searched on February 4, 2018.
Results:
One thousand six hundred sixty-seven articles were reviewed. Eighteen out of 32 countries in the region published research. Around 74.15% (1236) of the articles were produced by high-income countries. Research output (articles per 1 m population) was closely linked to country performance on the Economist Intelligence Unit's 2015 Quality of Death Index (adjusted R2= 0.85). Palliative care research in the region is overwhelmingly focused on cancer (80.13% of articles reviewed). The most common themes of research were "palliative care service (24.45%)" and "clinical" (15.38%).
Conclusions:
Palliative care research in the region is growing but remains largely centered on the high-income countries, with many low- and middle-income countries having little published research output. Much work is required to drive research in these countries to generate the evidence required for the development of palliative care services. The emphasis on cancer in research also indicates that the needs of patients suffering from noncancer-related diseases may be neglected.

Matched MeSH terms: Palliative Care/organization & administration*; Palliative Care/statistics & numerical data*; Hospice and Palliative Care Nursing/organization & administration*; Hospice and Palliative Care Nursing/statistics & numerical data*

Fulltext Palliative care approach for preemie – an ethical case learning

Fahisham Taib, Lee, Chee Chan

Education in Medicine Journal, 2018;10(2):55-59.

MyJurnal

Palliative care for life limiting conditions usually starts at birth. In neonatal period, planning,
discussion and goal of care should focus towards improving the baby quality of life. It does not mean
palliative care in this age group mainly as end of life care. We illustrate a complex 30 weeks baby
who was born with genetic abnormality complicated with intracranial bleeding and acute myeloid
leukaemia. There were various ethical issues related to the approach of death and dying infant and
psychosocial challenges surrounding the case.

Matched MeSH terms: Palliative Care

Palliative care development in the Asia-Pacific region: an international survey from the Asia Pacific Hospice Palliative Care Network (APHN)

Yamaguchi T, Kuriya M, Morita T, Agar M, Choi YS, Goh C, et al.

BMJ Support Palliat Care, 2017 Mar;7(1):23-31.

PMID: 25012126 DOI: 10.1136/bmjspcare-2013-000588

BACKGROUND: Although palliative care is an important public healthcare issue worldwide, the current situation in the Asia-Pacific region has not been systematically evaluated.

OBJECTIVES: This survey aimed to clarify the current status of palliative care in the Asia-Pacific region.

METHODS: Questionnaires were sent to a representative physician of each member country/region of the Asia Pacific Hospice Palliative Care Network (APHN). The questionnaire examined palliative care service provision, information regarding physician certification in palliative care, the availability of essential drugs for palliative care listed by the International Association for Hospice and Palliative Care (IAHPC) and the regulation of opioid-prescribing practice.

RESULTS: Of the 14 member countries/regions of the APHN, 12 (86%) responded. Some form of specialist palliative care services had developed in all the responding countries/regions. Eight member countries/regions had physician certifications for palliative care. Most essential drugs for palliative care listed by the IAHPC were available, whereas hydromorphone, oxycodone and transmucosal fentanyl were unavailable in most countries/regions. Six member countries/regions required permission to prescribe and receive opioids.

CONCLUSIONS: The development of palliative care is in different stages across the surveyed countries/regions in the Asia-Pacific region. Data from this survey can be used as baseline data for monitoring the development of palliative care in this region.

Matched MeSH terms: Palliative Care/organization & administration; Palliative Care/statistics & numerical data*

Fulltext Palliative care for a child: role of a primary care doctor

Tan CE, Md Radzniwan R, Khairani O, Ednin H

Malays Fam Physician, 2011;6(1):26-28.

PMID: 25606216 MyJurnal

A 7-year-old boy with a diagnosis of advanced medulloblastoma refractory to treatment was discharged from hospital for further palliative care at home. During this short and eventful period, the child developed spinal cord compression with progressive weakness of upper and lower limbs, neck pain, faecal and urinary incontinence. This case highlights the important roles of a primary care doctor in the provision of palliative care for a child in the community.

Matched MeSH terms: Palliative Care

Fulltext Palliative care for lung cancer patients in Penang Hospital

Hooi LN

Med J Malaysia, 2003 Mar;58(1):144-5; author reply 145.

PMID: 14556344

Matched MeSH terms: Palliative Care*

Fulltext Palliative care in Malaysia: a decade of progress and going strong

Lim RBL

J Pain Palliat Care Pharmacother, 2003;17(3-4):77-85; discussion 87-9.

PMID: 15022953 DOI: 10.1080/j354v17n03_11

Palliative care first began in Malaysia in 1991, and since then there has been a growing interest in the field and its development both from the government and nongovernmental organizations. It is important to recognize the potential advantages and disadvantages of palliative care provided by both government and private programs to maximize development for the greater benefit of patients. A close relationship between these two bodies must be created so that there is smooth continuity of service and no overlapping of roles. This article highlights some thoughts on how palliative care has developed over the years from the perspective of a clinician who is currently working in the government sector and cooperating with nongovernmental organizations to develop a palliative care network in the region.

Matched MeSH terms: Palliative Care/organization & administration*; Palliative Care/standards

Palliative care in neurology

Cheong WL, Reidpath DD

Lancet Neurol, 2017 11;16(11):868.

PMID: 29029842 DOI: 10.1016/S1474-4422(17)30321-6

Matched MeSH terms: Palliative Care*

Fulltext Palliative care--a beginning

Devaraj TP

Med J Malaysia, 2002 Dec;57(4):384-9.

PMID: 12733161

Matched MeSH terms: Palliative Care/organization & administration*

Fulltext Palliative care: experience with 156 cases in a general hospital

Khoo SB

Med J Malaysia, 2002 Dec;57(4):408-17.

PMID: 12733165

The concept of Palliative Care is still quite new in Malaysia and there is a need to promote the awareness of its importance for patients with incurable and advanced illnesses, not only to the public but also to the nursing and medical professionals. These patients especially the poor ones very often have no one to turn to; they cannot afford to seek treatment from the private hospitals, they are turned away from acute General Hospitals and are told that there is nothing more to be done because their illnesses are no longer curable, they cannot pay for GPs to come to their homes, and there is difficulty in purchasing opiate drugs for pain relief. This is a retrospective observational study of the palliative care services we try to provide to those few patients referred to us. This study showed that out of the total of 156 patients, majority were Chinese, peak age between 50-59 years, referrals were mainly from the community and the Obstetrics + Gynaecology department, patients were referred rather late, 60% of patients died at home, most common malignancies being those of the breast, colorectal and cervix, common sites of metastases being the lungs, liver, bones, peritoneum and local infiltration, 87% of patients experienced pain, about 40% of patients were not fully aware of both diagnosis and prognosis, common drugs used being opiate analgesics followed by dexamethasone, H2 antagonist, antiemetics and NSAID.

Matched MeSH terms: Palliative Care/statistics & numerical data*

Palliative care: speciality or pastime?

Ednin H

Family Physician, 2001;11:34-34.

Matched MeSH terms: Palliative Care

Palliative medicine as an elective posting for undergraduates

Loh KY, Kwa SK, Nurjahan MI

Med Educ, 2006 Nov;40(11):1131-2.

PMID: 17054631

Matched MeSH terms: Palliative Care*

Palliative radiotherapy for advanced Cancer: Are we giving it to the right patient at the right time?

Syadwa AS, Anita ZB

Med J Malaysia, 2018 08;73(4):190-196.

PMID: 30121680 MyJurnal

AIM: Symptomatic relief following palliative radiotherapy for advanced cancers may take a few weeks up to a few months to achieve. Thus, accurate prognostication is important to avoid harm to these patients with limited lifespan. We conducted a retrospective cohort study to determine the median survival and 30-day mortality (30-DM) and factors associated with these parameters in our centre.

METHODS: Data from 585 eligible patients who received palliative radiotherapy between January 2012 and December 2014 were analysed. Median overall survival was calculated from the commencement of first fraction of the last course of radiotherapy to date of death or when censored. 30-DM was calculated as the proportion of patients who died within 30 days from treatment start date. Kaplan-Meier survival analysis was used to estimate survival. Chi-square test and logistic regression was used to assess the impact of potential prognostic factors on median survival and 30-DM.

RESULTS: The most common diagnoses were lung and breast cancers and most common irradiated sites were bone and brain. Median survival and 30-DM were 97 days and 22.7% respectively. Primary cancer, age, treatment course, performance status, systemic treatment post radiotherapy and intended radiotherapy treatment completed had an impact on median survival whereas mainly the latter three factors had an impact on 30-DM.

CONCLUSION: Median survival and factors affecting both survival and 30-DM in our study are comparable to others. However, a 30-DM rate of 22.7% is significantly higher compared to the literature. We need to better select patients who will benefit from palliative radiotherapy in our centre.

Matched MeSH terms: Palliative Care/methods*

Patterns of Suffering in Palliative Care: A Descriptive Study

Seng Beng T, Ting Ting T, Karupiah M, Xin Ni C, Li Li H, Chong Guan N, et al.

Omega (Westport), 2021 Dec;84(2):512-524.

PMID: 32019387 DOI: 10.1177/0030222820903221

Suffering experiences are common phenomena in palliative care. In this study, we aim to explore the different patterns of suffering in palliative care. Adult palliative care patients were recruited from the University of Malaya Medical Centre. Suffering scores were charted 3 times a day for a week. The characteristics of the suffering charts were analyzed using SPSS. The patterns of suffering were analyzed using structural pattern recognition. A total of 53 patients participated. The overall trends of suffering were downward (64%), upward (19%), and stable (17%). Median minimum and maximum suffering scores were 2/10 and 6/10, with an average of 3.6/10. Nine patterns of suffering were recognized from categorizing two key characteristics of suffering (intensity and fluctuation)-named S1 to S9. Understanding the different patterns of suffering may lead to better suffering management.

Matched MeSH terms: Palliative Care*

Displaying publications 61 - 80 of 121 in total