SYMPOSIUM 1: SYMPTOMS MANAGEMENT
S1.1 : UPDATE ON CANCER PAIN CPG
Dr. Aaron Hiew Wi Han
Consultant Palliative Care Physician, Hospital Kuala Lumpur
Cancer pain is a prevalent and distressing symptom affecting numerous patients with advanced cancer. Despite the availability of effective treatments, cancer pain remains inadequately managed in various healthcare settings. Contributing factors include insufficient assessment, limited knowledge and skills, ineffective communication, and barriers to accessing analgesics.
Inadequate management of cancer pain can significantly impact physical, psychological, social, and spiritual well-being. Therefore, a comprehensive pain management strategy is crucial to address all these dimensions utilising the Total Pain Concept.
During the development of the second edition of the cancer pain clinical practice guideline, several key insights emerged. Fundamental clinical skills continue to serve as the cornerstone of effective cancer pain management. These skills encompass concise and accurate assessment, personalized management plans, and a balanced approach that integrates both pharmacological and non-pharmacological methods
S1.2: APPROACH TO MALIGNANT BOWEL OBSTRUCTION IN PALLIATIVE CARE
Dr. Fazlina Ahmad
Consultant Palliative Care Physician, Hospital Kedah
People with advanced cancer who experience bowel obstruction by a malignant tumour have a variety of symptoms impacting their general well-being. Clinical management of malignant bowel obstruction is often challenging, with limited prospective data to support a standardized management strategy. Often, the majority of decision-making is influenced by the provider’s preference and resource availability. The management requires a multidisciplinary setting that takes a holistic view of the person and their needs.
This session highlights the evidence-based and expert panel recommendations on the management of malignant bowel obstruction-related issues such as nausea and vomiting, bowel movement pain, options for bowel decompression, and nutrition, including psychosocial-spiritual support.
S1.3: MANAGING DEPRESSION AND ANXIETY IN PALLIATIVE CARE PATIENTS
Professor Ng Chong Guan
Consultant Psychiatrist, University Malaya Medical Centre
Psychiatric conditions such as depression and anxiety are prevalent in cancer patients. It may relate to the cancer progress, psychosocial stressors, cancer treatment and physical impairment. In many instances, the use of psychotropic drugs are needed in cancer patients. However, there are various concerns on the use of psychotropic drugs in this group of patients. The concerns include interaction with cancer treatment, side effect, reduced alertness, additional cost and stigma.
We have conducted several systematic reviews on the safety of psychotropic usage in cancer patients. We also conducted two trials on the treatment of depression in cancer patient. One was involving psycho-stimulant as augmentation therapy and another was on the use of multi-modal antidepressant for depression in cancer patients. The results showed that psycho-stimulant as augmentation therapy had rapid reduction of depression in cancer patients. Multimodal antidepressant not only improved depression but also quality of life and cognitive function in cancer patients.
SYMPOSIUM 2: SPIRITUAL CARE
Panel Discussion: “Interfaith forum on Spirituality and EOL care”
Dr. Diana Katiman
Consultant Palliative Care Physician, Hospital Al-Sultan Abdullah, UiTM Puncak Alam
Part of providing quality palliative care is to address spiritual issues. However, many practices and researches use spirituality and spiritual needs interchangeably with religiosity and religious needs. For patients not identifying or conforming to a particular faith or organised religion, this can be problematic, as one may have spiritual needs whether or not they are religious.
A well-accepted consensus defined spirituality as “A dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.” Other groups of researchers defined spirituality as having four aspects or domains, namely religious needs (transcendance), existential needs (meaning/purpose), inner peace needs (peace) and generativity needs (connection/relationship).
A person is said to have spiritual symptom(s) if it concerns any of the four aspects/domains. However, when the spiritual symptom(s) is significant enough to directly or indirectly (through other physical or psychological causes) cause suffering, the person is said to have a diagnostic term of ‘spiritual distress’. Having a diagnosis means that a condition can be assessed and potentially addressed. This is particularly important for palliative care providers managing patients facing end-of-life, and supporting their caregivers. It is therefore important for palliative care providers to know how to assess for spiritual distress, offer appropriate early responses, or make referrals for specialists interventions.
Panel Discussion: Spirituality and End Of Life Care
Venerable Tian Wen
Spiritual Counsellor, ASPAC
Spirituality is essential to end-of-life care. Spirituality can be defined as that part of people that seeks ultimate meaning in life, especially in the midst of suffering (Puchalski, 2007). Research have shown that spiritual care not only serves as important coping mechanism that support terminally ill patients but also helps improve their quality of end-of-life care (Balboni et al, 2010, Vallurupalli et al. 2012).
Spiritual care is the provision of specific interventions to support patient’s spirituality. It involves ‘being with’ or companioning and walking alongside patients rather than ‘doing to’ the patient (Puchalski, 2007). Spiritual care honours the dignity of each patient and provides care that is holistic and patient-centred. It involves communicating with patients about their spiritual needs, identifying spiritual distress, and integrating patients’ spirituality into care plans following the spiritual assessments conducted by the healthcare chaplain or other spiritual care professionals (Puchalski, 2012).
In Malaysia’s context, recent review studies proposed that there is a growing need of professionally trained Muslim chaplains to provide spiritual care services in healthcare settings (Shariff, 2021), and the role of spiritual care in palliative care (Chik, Sa’ari & Loh, 2017). Also, another study informs the invitation of Association of Clinical Pastoral Education (ACPE) by Malaysian medical professionals to develop an innovative approach in offering spiritual care to Muslim women in Malaysia (Cadge et al. 2021). These studies suggest the growing awareness of healthcare chaplaincy and their contribution towards Malaysian healthcare settings. However, there is a lack of empirical research on healthcare chaplaincy in Malaysia that investigates the training and utilization of Muslim and non-Muslim healthcare chaplains, their provision of spiritual care on patient end-of-life outcomes.
SYMPOSIUM 3: NEW FRONTIERS IN PALLIATIVE CARE
S3.1: Upstreaming Palliative Care – Opportunities and Challenges
Dr Frank Ferris
Associate Director, Palliative Medicine Education, OhioHealth, Columbus, Ohio. Member, International Affairs Committee, ASCO International Programs
&
Dr Shannon Moore
Consultant Palliative Care Physician. Member, International Affairs Committee, ASCO International Programs
Upstream Palliative Care benefits everyone involved: less suffering, improved prognosis, more effective (and less stressful) communication and decision-making, and often better resource utilization.
While you may be worried that engaging patients earlier in their illness experience will require more time and more resources, that does not need to be the case. The early integration of effective communication takes less time and is less stressful for everyone than communication during a crisis. The resulting decision-making will often lead to goals of care and treatment choices that are more satisfying for the patient, family, and the team. These choices will often also change resource utilization.
The rigorous practice of consultation etiquette ensures we share one or more educational “pearls” and offer support to the referring physician and teams. Over time many referring physicians and teams begin to provide better palliative care themselves. By sharing their feelings with us, they may also experience less stress and be more resilient.
S3.2: Advancing Palliative Care in Malaysia: Harnessing Project ECHO for Knowledge and Practice Enhancement
Dr. Ng Woon Fang
Consultant Palliative Care Physician, Hospital Kuantan
The critical need for increased access to palliative care in the communities, particularly in larger states where rural patients face unmet palliative care needs, underscores a pressing challenge. The year 2020, marked by the COVID-19 pandemic, witnessed a surge in online education and meetings. This unprecedented situation not only catalyzed the adoption of virtual platforms but also fostered a sense of solidarity, especially among hospice providers in Malaysia.
In response to this collective spirit, a group of dedicated volunteer doctors initiated a transformative endeavor – Project ECHO. Emerging from the initial impetus of providing free online talks to isolated hospice nurses, Project ECHO evolved into a vital platform for collaborative learning in the realm of community palliative care.
The inaugural years of Project ECHO focused on establishing a shared space where practitioners could meet to exchange insights on patient care. This was facilitated by experts presenting modules covering diverse topics in palliative care, including revisiting core principles, effective communication, symptom control, end-of-life care, grief and bereavement, and ethical applications. The impact was profound, breaking down the walls of isolation that many hospice personnel experienced, fostering an environment of mutual learning, and enhancing collaboration.
As Project ECHO progressed into its second year, the connections among different hospice teams deepened. Renowned local and international speakers were invited to share their perspectives on various palliative care subjects. Discussions on topics such as grief and self-care elicited candid reflections from participants, especially nurses, sharing their vulnerabilities and the challenges encountered in delivering palliative care at home. Real-life cases underscored the complexities of symptom management and the dynamic interplay of psychosocial circumstances.
The third year marked a pivotal moment as Project ECHO welcomed the involvement of the Ministry of Health’s domiciliary division of primary care. Embracing the philosophy of “All teach, all learn,” this collaboration aimed to bridge gaps and extend palliative care access to residents in rural areas. With a focus on non-cancer palliative care, Project ECHO emerged as a potent tool to expand the horizons of palliative care beyond cancer and end-of-life scenarios.
In essence, Project ECHO has become a beacon of transformative learning and collaboration, forming a culture of shared knowledge and best practices that is enhancing palliative care delivery in Malaysia. The integration of diverse perspectives, real case presentations, and the collaborative ethos of “All teach, all learn” is propelling the mission to ensure that no patient, regardless of location or condition, is left without the compassionate care they deserve.
S3.3: Experience of Using PCOC to Improve Delivery of Care
Dr. Oo Loo Chan
MD, Charis Hospice, Penang
Charis Hospice is a small community palliative care service provider in Penang, Malaysia since 2004. The Palliative Care Outcomes Collaboration (PCOC) is a national program established in Australia to mprove the quality and consistency of palliative care. Charis Hospice incorporated the PCOC system when it embarked in the process of transitioning to electronic medical records in July 2021. It took more than a year of testing the system before we finally launched it in January 2023.
The PCOC benchmarks are based on a range of indicators measuring responsiveness of care delivery, healthcare outcome of the patient after care is being instituted and spiritual distress of both the patient and the caregiver as well. Having standardized tools and measures to assess and monitor the needs of our patients holistically can help us in our delivery of care and gives the whole team a common language to use when we report patient-care to one another.
Incorporating PCOC into our daily work effective from 1st January 2023 has been challenging. As we went along, we had to define, and redefine, our own guidelines on how we assess patients using the PCOC tools – to be as objective as possible yet recognizing the uniqueness of our local healthcare system and culture. We believe it is a worthwhile effort.
Our PCOC results can give us an indicator of the quality of our service to allow subsequent comparisons to be made and drive towards improvement. There are definite differences between the Malaysian & Australian systems and it is important to establish our own baseline. Palliative care is less well-coordinated in Malaysia and we do not have national benchmarks yet. It will be advantageous to compare our data with other service providers in Malaysia and also to collate data towards developing our own national benchmarks.
SYMPOSIUM 4: INTEGRATING PALLIATIVE CARE SERVICES IN MALAYSIA
Panel Discussion: Public-Private Palliative Care Service Collaborations – The Sarawak Experience
Dr Sharon Choo
Palliative care Physician, Sarawak General Hospital
The collaboration between public hospital and private non-profit organisations, namely hospices in Sarawak represent a pioneering approach to palliative care, blending the strengths of both sectors to provide comprehensive and compassionate palliative care, to address the unique needs of individuals facing life-limiting illness.
At the core of this collaboration is a shared commitment to enhancing the quality of life for patients and their families during challenging times. This synergy not only bridges gaps in continuum of care but also extends the reach of palliative care service across diverse settings. Patients benefit from seamless transitions between hospital-based interventions to personalized community-based care. This approach improves patients’ outcomes and empowers families to actively participate in caregiving, fostering a holistic support system.
The Sarawak experience is marked by a commitment to community engagement and education. This partnership facilitates the training of healthcare professionals in both sectors, ensuring a shared understanding of palliative care principles and practices and ultimately improving the standard of palliative care on a broader scale. The model of palliative care in Sarawak is one that leverages the strengths of each sector, and by combining resources, it facilitates holistic and responsive healthcare service for individuals receiving palliative care.
Panel Discussion: Community Hospices/Palliative Care Services – Triumphs and tribulations
A Journey of Compassion: 25 Years of Hospice and Palliative Care Service Negeri Sembilan
Datuk Dr. Anthony Gilbert
MD, Hospice Negeri Sembilan
In the past 25 years, our organization has embarked on a remarkable journey, dedicated to providing hospice and palliative care services to those in need. This synopsis encapsulates the trials and tribulations we faced while setting up our non-profit organization and highlights the transformative impact we have had on countless lives.
Our journey began with a vision to alleviate suffering and provide compassionate care to individuals facing life-limiting illnesses. However, the path to establishing our hospice and palliative care service was not without its challenges. We encountered bureaucratic hurdles, financial constraints, and scepticism from some individuals who questioned the need for such specialized care. Nonetheless, fuelled by our unwavering commitment, we persevered.
Overcoming these obstacles, we laid the foundation of our non-profit organization, assembling a team of dedicated professionals and volunteers who shared our vision. Together, we navigated the intricate landscape of healthcare regulations, fundraising efforts, and community outreach initiatives. Through tireless determination, we garnered support from individuals, local businesses, and government agencies, enabling us to provide comprehensive care to those in need.
Our hospice and palliative care service has since become a beacon of hope and solace for patients and their families. We have created a nurturing environment that focuses on enhancing quality of life, managing pain, and providing emotional support during the most challenging times. Our interdisciplinary team of doctors, nurses, social workers, and counsellors work collaboratively to address the physical, emotional, and spiritual needs of our patients. The impact of our organization extends far beyond the walls of our hospice facility. We have actively engaged with the community, conducting educational programs, workshops, and awareness campaigns to dispel misconceptions surrounding end-of-life care. By fostering partnerships with other healthcare providers, we have expanded access to palliative care services, ensuring that individuals receive the support they need, regardless of their financial circumstances.
As we reflect on the past 25 years, we are humbled by the countless lives we have touched and the profound difference we have made. Our journey has been one of resilience, compassion, and unwavering dedication. We have witnessed the transformative power of hospice and palliative care, providing comfort, dignity, and peace to individuals during their final moments. Looking ahead, we remain committed to our mission, continuously adapting to the evolving needs of our community. With the support of our dedicated team and the generosity of our supporters, we strive to be a guiding light for those navigating the complexities of life-limiting illnesses. Together, we will continue to provide compassionate care, ensuring that no one faces the end of life alone.
SYMPOSIUM 5: PALLIATIVE CARE NURSING
S5.1: Palliative Care Nursing In Malaysia : A Pioneer’s Journey
Morna Chua (Kota Kinabalu)
Retired Matron, Queen Elizabeth Hospital, Kota Kinabalu
Palliative Care is specialized medical care for people living with a serious illness such as cancer or end stage organ failure. Managing pain and other distressing symptoms are paramount to improve quality of life of these patients and their families. It is holistic care dealing with a whole person approach involving physical, psychological, social and spiritual needs. In 1995, Datuk Dr, Ranjit Oommen, a renowned surgeon, initiated the Palliative Care service in Queen Elizabeth Hospital (QEH) and back it up with a homecare program. I had been part of the team since its inception. This new specialty provided seamless care that sent patients home once their symptoms were controlled. When patients have difficult symptoms needing admission, they can gain direct admission to the Palliative care unit. It was clear that palliative care is not about end of life although it can include end of life care. Initially patients were referred once diagnosed with incurable cancer but later it was extended to diseases of end stage organ failure. All patients registered with the palliative care unit were cared for from the time of referral till they die. My journey in palliative care had made me a ‘complete’ nurse being able to practice holistic care and working in partnership with doctors. We were extremely new but the knowledge on the use of medications, non medical therapies, the art of communication, wound care and practical sessions taught by experts in palliative care had been instrumental in our success as the role model for the country. I had the privilege to work in the Palliative care unit in QEH from 1997 till 2018 and continued to work as a homecare nurse for 3 years after my retirement. It is rewarding and fulfilling as even with the slightest effort in relieving the suffering of their loved ones meant so much to the family.
S5.2: Charting The Path For A Career In Palliative Care Nursing
Nurul Izzah Yusub
Palliative Care Nurse, Kasih Hospice Foundation
Palliative care in Malaysia have been gaining more recognition and more people are aware of the work we do. Palliative nurses play an important role in helping to ensure patients receive the best quality of care they need no matter where the patient is. In Malaysia, there have been increasing program for doctors to become more specialize in Palliative care, but nurses do not have the same pathway for advancement in the career as Palliative care Nurse. In countries like Singapore and Australia, there are a clear guideline and pathway that nurses can take until they can be recognize as Advance Practicing Nurse. The talk will review the current career pathway in Palliative care Nursing available in Malaysia, the challenges and discuss how we can try to move on from there.
S5.3 Panel Discussion: Palliative care Nursing
Emily Yap Lee Peng (Hospis Malaysia, Kuala Lumpur)
Jenny Ak Budum (Palliative Care Unit, Sibu Hospital)
Sofia Bt Jaman (The National Cancer Society of Malaysia Sarawak Branch)
Palliative care Nurses play a crucial role in assessing and managing patient symptom to enhance their overall quality of life. They conduct through assessments of physical, emotional and psychological symptoms experienced by patients with serious illness. This involved closed communication with patients and their family to understand their unique needs and concern. Palliative care nurses then collaborate with the healthcare team to develop personalized care plans, focusing on symptom relief and improving the patient’s comfort. Regular monitoring and adjustments to the care plan are made to address evolving symptoms and ensure optimal support for patient and their families.Palliative care teams strive to enhance the overall quality of life, even when facing serious illness. The goal is to promote a sense of well-being and dignity for individuals receiving palliative care.Establishing a healthy work-life balance, setting realistic expectation and recognizing personal limitations are also important. Ultimately addressing these challenges require a holistic approach that combines individual self-care efforts with organizational support and a culture that values the well-being of healthcare professional in the care field.
SYMPOSIUM 6: FREE PAPERS PRESENTATION
SYMPOSIUM 7: PAEDIATRICS PALLIATIVE CARE
S7.1: Perinatal and neonatal palliative care
Dr. Fahisham Taib
Consultant Paediatrician and Palliative Care Physician,
University Sains Malaysia, Kelantan
Perinatal and neonatal palliative care focuses on providing specialized support and comfort to infants and their families facing life-limiting conditions during the perinatal and neonatal periods. It emphasizes on enhancing the quality of life for both the baby and the family, acknowledging the uniqueness of each individual’s needs and the challenges associated with the dynamic of life. Communication between healthcare providers and parents is essential in order to explore treatment options and address emotional impacts. In neonatal palliative care, care is done by supporting families dealing with a newborn’s life-limiting conditions by relieving symptoms using a multidisciplinary team of healthcare professionals based on similar goals of care. The key elements of the palliative care approach in this group include appropriate communication, shared decision-making, pain management, emotional and psychosocial support, and respect for the family’s cultural and spiritual beliefs. This would help families navigate this challenging journey with compassion and feel empowered by the choices based on their values and preferences.
S7.2: Holistic Care for Children with Cancer
Dr. Edi Setiawan Tehuteru
Paediatric Haematology-Oncology Consultant, Paediatric Palliative Care Practitioner, Indonesia Tzu Chi Hospital, Jakarta and Awal Bros Hospital, Batam
When we were at medical /nursing school, our teachers used to tell us that we have to take care all of our patients holistically. In reality, we have to admit that usually we look at our patient only from one aspect, that is physic. That is why, as a pediatric oncologist practicing pediatric palliative care, I feel that my knowledge and skill as an oncologist is complete. Now, when I take care of patients, I look at them not only from their physic, but also their psychology, social, and spiritual point of view. This is what we heard often as holistic care. WHO clearly stated holistic care in the definition of Pediatric Palliative Care. It is good if all health workers know about palliative care so we will be aware that we have to take care our patient holistically – not just think holistically but also act holistically so that we r better equipped to help our patients.
S7.3: Bridging the Gap in Palliative Care for Adolescents and young Adults
Dr. Chong Lee Ai
Consultant Paediatrician and Palliative Care Physician, Universiti Malaya Medical Centre
Adolescence is often accepted as a phase between the ages of 11 to 24 or when a child reaches adulthood. In this period adolescents experience rapid emotional and hormonal changes associated with puberty, development in higher cognitive functioning such as abstract reasoning and risk taking, emerging sense of identity, increasing need and ability to function independently from their parents or carers, and an increasing importance and intimacy in peer relationships. In this volatile period, there may be increase risk of mostly preventable injury, illness and death. For adolescents, a serious illness may impede and derail the development of normal milestones. The domains of palliative care for adolescents become more complex than the identified four domains for adults and children. Developmental, ethics and legal issues come to play in medical-decision making and delivery of care that is concordant to personal goals and values. In this lecture, we will address the gaps in optimal palliative care delivery to adolescents with case studies.
SYMPOSIUM 8: PALLIATIVE CARE IN NON-CANCER SETTINGS
S8.1: Supportive Care for Patients Living with Advanced Heart Failure : The Sabah Experience
Dr. Ng Wan Jun
Palliative Care Physician, Queen Elizabeth Hospital, Kota Kinabalu
Providing supportive care for patients with advanced heart failure (HF) poses several unique challenges. These patients generally follow a gradual functional decline trajectory interjected with acute episodes of decompensation which can be potentially reversible or life terminating. Apart from prognostic uncertainty, a study have shown that patients with HF also demonstrated high level of instability in end of life care preferences. Palliative care team members supporting patients with HF should also equip themselves with basic knowledge of the increasingly complex cardiac interventions for HF, as well as skills to titrate foundational HF medications which provide both prognostic and symptomatic benefits. There is growing evidence that integration of palliative care with usual HF management improves patient-centred outcomes, including symptom burden and quality of life. However consensus and details remain elusive for the referral timing as well as effective model of integration. This talk will provide an overview of palliative care integration into conventional HF care model in Kota Kinabalu, Sabah. This collaborative work between Sabah Heart Centre and Palliative Care Unit was one of the earliest effort in the country started since year 2015. Examples of work that will be showcased include the local care integration model, HF supportive care handbook, and the local Advance Care Planning programme.
S8.2: Palliative care for patients with ESRF: Perspective & Future
Dr. Sheriza Izwa
Consultant Palliative Care Physician, Universiti Malaya Medical Centre
As healthcare improves universally, more patients are living longer and expectation of individual healthcare is at the highest. Similar to End Stage Renal Disease (ESRD), characteristics of patients on dialysis have changed over the years. Essentially more elderly patients with co-morbidities are being newly diagnosed with ESRD. There have been a 4 -fold increase in the number of patients over 75 years in Western countries with ESRD.
Patients have always been aware of only renal replacement therapy (RRT) as the treatment of choice for ESRD. However, conservative management is now a recognised option with ESRD, provided the option is discuss optimally and all aspect have been looked into by both the patients and nephrologist. Studies have showed that overall patients with ESRD with or without RRT have a reduced life expectancy compared to age-matched controls. A useful starting point for recommending dialysis is an expectation of survival with a quality of life acceptable to the patient. Here, we will discuss what are core competencies in a “Palliative approach” for patients with ESRD in the conservative pathway and how to support both patients and their family.
S8.3: Reconnecting: Low And High-Tech Methods Of Communication In MND
Dr. David Capelle
Consultant Palliative Care Physician, Universiti Malaya Medical Centre
This presentation introduces the field of alternative and augment ative communication (AAC) in patients with MND, giving an overview of the complete spectrum of methods ranging from a piece of paper all the way to the latest generation of eye tracknig devices
SYMPOSIUM 9: ALLIED HEALTH / PSYCHOSOCIAL CARE
S9.1: The Palliative Heart in Pharmaceutical Care
Prita Nambbiar
Palliative Care Pharmacist, Institut Kanser Negara
As the scope of palliative care broadens, the crucial role of pharmacists in multidisciplinary teams is increasingly evident. Medication is a cornerstone of symptom management in palliative care, and pharmacists bring a unique perspective to the intricacies of medication management in a particularly vulnerable population. They offer expertise in medication reconciliation, medication rationalisation, addressing drug interactions and stability issues, formulary management and facilitating transitions of care, ensuring that patients receive the most appropriate and personalised care aligned with their goals
In sharing her personal journey and evolution as a palliative care pharmacist, Prita hopes to offer a glimpse into some of the challenges and rewarding moments encountered in this meaningful field. With a thematic connection to Dr. Ira Byock’s “The Four Things That Matter Most,” the discussion unfolds around forgiveness, gratitude, love, and saying goodbye.
Through real-life cases and examples, the talk will explore how pharmacists contribute beyond the technical aspects of pharmaceutical care and also play the role of educator, empathetic listener and mediator in addressing patients’ and their loved ones’ medication-related concerns.
Within the multidisciplinary team, the pharmacist regularly wears multiple hats, serving as a medication expert, a source of compassionate and reassuring support for colleagues and occasionally as the voice of questioning and advocacy for ethical considerations in patient care. These collaborative endeavours are dedicated to enhancing patient experiences, promoting well-being and placing patient dignity at the forefront of care during life’s most challenging moments.
S9.2: Tapping into Welfare Resources for the Needy
Janice Lim Chiew Lan
Welfare volunteer, Department of Social Welfare
The talk focuses on a crucial topic: accessing welfare resources for those in need. Accessing welfare resources for those in need is a multifaceted process that requires awareness of available assistance, understanding the application procedure, acquiring the requisite forms, and meeting eligibility requirements.
As a welfare volunteer with the Department of Social Welfare, I am committed to ensuring that every eligible individual receives the support they require. During the talk, I will share my personal experince as a welfare volunteer and explore the types of assistance the welfare department provide and discuss the practical aspects of tapping into these welfare resources – who is eligible, how to apply, where to obtain the necessary forms etc.
Throughout my time as a welfare volunteer, I have the privilege to assist numerous individuals in accessing the welfare support they need. Each experience has reinforced my belief in the importance of team work and community engagement in social work and how it can impact positively on people’s lives. Together, we can foster a more inclusive and supportive community for all members.
S9.3: Bridging the Gap in Community Palliative Care Needs- The Kuching Life Care Story
Mr Hung Sung Huo
Founder, Kuching Life Care Society
Kuching life care (KLC) was founded in 1996 with a heart to serve the local community focusing initially on organising regular blood donation drives. In 1997，KLC extended our outreach to cancer patients offering them psychosocial and emotional support。Regular activities include field trips and celebrations of various festivities for patients and their families which remain one of our core activities till today.
In 2010， KLC bought its first ambulance to help transport terminally ill patients home from hospital to fulfill their final wishes to die at home。To date, we have 6 ambulances serving the local community in Kuching and beyond. Driven by the great needs for an inpatient hospice facilty in Kuching, KLC started planning and fund raising tiredlessly for the building project since 2011. In true kampung Spirit, many came forth to contribute their time, effort and resources generously for this collabotative dream which inspired and propelled us further forward. After striving for more than a decade, the construction work for the first inpatient hospice in Kuching, Sarawak finally begun in early 2022. It was momentous for KLC and Sarawak community when the inpatient hospice passed its fire safery inspection and received its operation permit in April 2024 soon after its completion. KLC inpatient hospice looks forward to receiving its first patients later in the year upon receiving its CKAPS licence from the ministry of Health.
It is very meaningful when palliative care providers can journey with patients with terminal illness and their families, help manage their pain and other symptoms and support them psychosocially, spiritually and emotionally, so that patients’ can be more comfortable and live out the remainder of their lives journey with dignity.
This is our motivation.
SYMPOSIUM 10: END-OF-LIFE CARE
S10.1: Ethics and Cultural Considerations at End of Life
Dr Lam Chee Loong
Consultant Palliative Care Physician, Universiti Malaya Medical Centre
The end of life is a journey which sometimes poses both unique challenges but also opportunities to the healthcare professional to deepen and develop our proficiency and competency to care. Various medical ethical frameworks have been proposed to guide professionals in their choices, conduct and practice decisions, however cultural considerations relevant to the patient and their loved ones are also crucial elements of care. Our local culture is immensely diverse shaping the numerous learned behaviours, beliefs, values, and practices of the groups of people we care for, and these in turn impact their requests and choices regarding care. Such choices may sometimes conflict with medical recommendations when they differ from the health care worker’s own views and cultural perspective. Assumptions, stereotyping, and implicit biases must give way to attitudes of respect, cultural humility, and openness, in order that we can communicate and decide more inclusively despite our cultural differences. While common ground may not be always achieved in the first instance, the steps in pursuing this may enable shared goals to be agreed for patient centred care to truly be delivered.
S10.2: Managing End of Life Symptoms
Dr Diana Law
Family Medicine Physician, Siburan Health Clinic, Kuching
Recognising dying remains a challenge to most medical practioners. As a result, this precludes the appropriate management at the end of life. Ability to recognise that a patient is approaching the end of life care is invaluable as this will prevent unnecessary prescription of medication, futile intervention and preventing unnecessary anxiety and burden to the family. Common end of life symptoms like pain, shortness of breath, delirium, excessive secretion, nausea, vomiting etc. and its management will be discussed. Knowing the principles in management will give medical practioersl and palliative care providers the confidence in providing delicate management for patients and also their family in concordance with goals of care.
SYMPOSIUM 11: COPING AND CARING – PATIENTS’ AND CARERS’ PERSPECTIVE
S11.1: Living with MND-What I wish others will know
Leonard Chang Foh Soon
Retired Educator
Motor Neuron Disease (MND) is a group of rare and fatal, progressive, incurable neurodegenerative disorders that selectively destroy the motor neuron nerve cells which control the voluntary muscles of the body, leading to muscles weaknesses and eventual paralysis:
MND = DEVASTATING+FATAL+HOPELESS+INCURABLE+TERMINAL =
DEATH SENTENCE
Learning to Accept, Adapt and Aspire are the keys to living a meaningful, purposeful,and peaceful life with MND.
S11.2: Grief and Bereavement
Dr Nur Iwana Bt Abdul Taib
Dee Hati Centre for Grief, Bereavement and Trauma, Kuching
The journey following a cancer diagnosis for both patient and their caregivers can be harsh and brutal. Grief and bereavement play a big role in this experience and may begin the moment the news of cancer diagnosis was delivered. Palliative care aims to prioritize comfort and enhance quality of life, necessitating a holistic approach to address both physical and psychological difficulties. Individuals may emerge from this experience either with newfound resilience or profound trauma. Ensuring sufficient grieving support for both patients and their caregivers throughout this journey is essential to prevent psychological complications that may affect their quality of life. Understanding grief reactions and having the skills to identify and navigate it are fundamental for anyone involved in caring for cancer patients and their caregivers. This support can be provided not only by mental health professionals but also by the community, which may be more effective in many cases.