Dying with dignity

SINGAPORE — When 28-year-old Christopher Hawkes succumbed to a four-year battle with cancer in August, he did so in his own bed, surrounded by his family, partner and six pet cats.

The death that he had planned for himself was made possible because of the Dover Park Hospice Integrated Home Hospice Care Pilot, which was started in April 2012.

The programme is run by Dover Park Hospice (DPH) in collaboration with Tan Tock Seng Hospital (TTSH), and aims to provide terminally ill cancer patients who opt for hospice care at home with quality, dignified, end-of-life care.

Mr Hawkes enrolled early this year and was one of the 790 cancer patients in the three-year pilot project, said Ms Tan Woan Shin, principal research analyst at National Healthcare Group’s Department of Health Services and Outcomes Research (HSOR).

HSOR is leading the evaluation of the project.

BETTER CARE

Mr Hawkes was diagnosed with advanced head and neck cancer when he was 24 and later developed bowel cancer.

His mother, Mrs Pat Hawkes, said he did not want to spend his remaining days in a hospice. “Chris was a very private person. He would not be able to have the life and freedom he wanted in a hospice,” said the 68-year-old special education tutor, who was one of his caregivers.

After enrolling in DPH’s integrated home hospice care programme, Mr Hawkes’ pain and other symptoms were managed around the clock by the DPH hospice home care team. He also had to be tube-fed and required a catheter to drain urine directly from his bladder.

Said Mrs Hawkes: “There was a day hotline and a night one. If a problem cropped up, Chris could call or text the team and help would be given promptly.”

Care is given according to the patient’s values and preferences, said Dr Angel Lee, senior consultant at TTSH’s Department of Palliative Medicine and the programme director of Dover Park Home Care at DPH. In doing so, pain and other symptoms are kept under control, she said.

FEWER EMERGENCY VISITS and admissions

Besides providing 24/7 nursing and medical care, the team also coaches caregivers on how to care for patients at home and helps them cope emotionally with the patient’s illness, said Ms Tan.

The TTSH tie-up admits the patients under the programme directly to the hospital or in-patient hospice if they require higher-intensity medical care. This helps to facilitate timely care and minimise visits to the emergency departments.

A preliminary analysis found that six months prior to death, patients in the DPH pilot programme had 39 per cent fewer admissions to the emergency department and 25 per cent fewer visits to hospitals, compared with patients who receive regular hospice care. When admitted into acute wards, they stayed for a shorter period of time, said Ms Tan.

SENSE OF CONTROL

A survey on death attitudes commissioned by Lien Foundation showed more than three-quarters of Singaporeans want to die at home, even if there was insufficient support from family, friends or medical professionals.

The survey also found that most people associate dying well with dying without illness, pain or suffering. A key component of a quality, dignified death is that the patient maintains a sense of control.

“Up until the end of his life, Chris was always in control,” said Mrs Hawkes. “The hospice team treated him with dignity and respect. Because of them, Chris lived a full life with cancer, not died from it.”

Dr Lee said: “How we care for the dying shows what kind of society we are.”

She added: “It is my hope that as our society matures, we will be able to develop comprehensive services, and have trained healthcare workers and environments that do justice to those whose lives are coming to a close.”

Said Mrs Hawkes: “We didn’t think we could do it at first because we weren’t sure how the end would be. But the team gave us the courage to go through with home hospice care.”