Masterclass 10 - Better Palliative Care Support for Terminally-ill Patients-from Hospital to Community

Along of aging population with increase in chronic disease, demand for palliative care (PC) service is expanding. PC service is mainly provided by PC team to those terminally-ill patients with complex physical or psychological needs. Majority of the other patients were taken care of by other specialties such as medical & geriatric, surgical units and community nursing service. However, limit PC training has been provided to them.


To fill the service gap, a phase I, 3-year time-limited Annual Plan Program coordinated by Central Committee(PC), Nursing Service Division & Institute of Advanced Nursing Studies was conducted in 2018 while another phase II, 3-year program has been started since 2021. 1 APN(PC) as trainer and 4 RNs upsurge per cluster to provide operational support to parent teams in releasing nursing staff for a 4-months clinical attachment to PC units.


Objectives of the training program are to equip the following roles: 1) Timely identify patients in need of PC specialist support; 2) Provide shared care with input from PC specialists; 3) Adopt integrated palliative approach in care continuum for patients suffer from life-limiting diseases; 4) Initiate ACP discussion for appropriate patients.


Up to Nov. 2022, though interruption by the COVID pandemic, no. of nurses completed the training are 201 while the projected no. of trained nurses would be ~400 by the end of both phase I&II training. If with the target of 1 trained nurse per 2 wards and 3 trained nurses per CNS center, there would be training needs of 296 trained nurses and 100% target would be achieved. 


Intermediate evaluation showed enhancement of confidence & competence of trainees in following aspects: 1) communication skills, especially ACP, breaking bad news & emotional support; 2) Played more proactive role in initiating referral to PC teams; 3) symptom management, especially adequacy of pain-killer & liaised on treatment plan, using morphine & subcutaneous fluid infusion; 4) Acted as End-of-life resource person in parent team to help in related programs. 


Plan was proposed at both cluster and corporate level on enhancement of sustainability of liaison nursing colleagues in Parent Wards.

There is no doubt that, given adequate support in community, most people with terminal illness would prefer to be cared for in their own beds and in the bosom of their families. It is a win-win situation - while hospital stay and health care cost can be reduced, patients can enjoy better quality of life. 


The needs of people with terminal illness staying at home and their families include 1. Adequate symptom management, 2. Psychological and spiritual support, 3. Practical advice and support for caregiver, and 4. Access to information and community resource. All along palliative home care has been serving a crucial role in this part of a patient’s journey. As a case manager, the home care nurse also helps patients and families to navigate through different sets of services and supports available. 


Existing community support for terminally ill patients from Hospital Authority would be covered in this session. We would also discuss on the current and anticipated opportunities and challenges.