Overcoming the Obstacles in Promoting Hospice Palliative Care - Sharing Experiences of the Taiwan Changhua Christian Hospital

摘要

Hospice palliative care for terminal patients is necessary, yet challenges are on the way worldwide. This study demonstrated that hospice palliative care has been quickly developed in Taiwan due to the support of the National Health Insurance system, the promotion by civil societies and religious groups, patient's legal right for DNR, easier access to pain killers through medical prescription, and well-planned hospice staff training programs. This paper introduces how hospice consultation is provided by a comprehensive hospice palliative team at Changhua Christian Hospital to establish trust and cooperation with the medical team, and to improve hospice-palliative care referral and utilization rates. Introduction Many researches have shown that hospice palliative care is able to improve the quality of life and medical satisfaction of terminal ill patients, and reduce the burden of personal and national medical cost. The dominant three palliative care delivery models in the world are hospital palliative care, community palliative care, and hospice. Yet obstacles are encountered worldwide because of national health policies, legal regulations, limited access to pain killers, attitudes towards death and dying, caring ability of medical professionals, and public understanding.Also, hospice palliative care is not well conducted in in-patient, consultation, and referral systems. The barriers of in-patient hospice palliative referral are doctors, the general public, and referral system procedures. The Doctor is the key person to decide if consultation or referral is necessary. Thus, a referral physician is considered as one of the primary stakeholders of hospice and palliative care. The referral and utilization rates of hospice palliative care are low because the physician 1) is unfamiliar or does not believe in the benefits that hospice could provide, 2) is afraid to lose patients,3) fears to be considered a medical failure, 4) is worried that the families of patients will be disappointed and depressed.