Ahead of tomorrow’s World Hospice and Palliative Care Day, the European Association for Palliative Care (EAPC) is delighted to present current developments in hospice and palliative care in Taiwan as part of a special series of posts to celebrate World Day. In June this year, Professor Sheila Payne, President of the EAPC, was invited to Taiwan; we are very pleased that three of the many palliative care practitioners and academics she met during her visit have agreed to share their experiences of research, spiritual care and clinical practice.
In this, the final part of the series, we hear from Dr Ping-Jen Chen, Consultant Geriatrician and Hospice Palliative Medicine Specialist in Palliative Care Center, Chi-Mei Medical Center; Academic Research and Ethics Committee, Taiwan Academy of Hospice Palliative Medicine and council member of the Formosan Association of Care and Education for Seniors.
Sponsored by Taiwan’s Ministry of Health and Welfare and the Chi-Mei Medical Center, I had a clinical placement at the Marie Curie Palliative Care Research Unit at University College London (UCL) from October 2013 to February 2014. My placement focused on the clinical practice and ethics of palliative care for patients with dementia.
During my stay in the UK, I worked with colleagues at UCL on a systematic review concerning patients with advanced dementia and cancer, and shadowed the investigators to evaluate participants and collect data for the prospective studies. At the suggestion of Dr Elizabeth Sampson, I also visited Professor Julian Hughes at the University of Newcastle to discuss ethical reasoning of dementia care, and Dr Adrian Treloar at the Oxleas NHS Foundation Trust to learn more about supporting patients with advanced dementia and their families at home. At the Cicely Saunders Institute in London, I met and exchanged information with Dr Jenny van der Steen from Amsterdam, the leading author of recommendations on palliative care in dementia from the EAPC. I also experienced some impressive real-world practice by staff at Marie Curie Hospice, Hampstead, and the palliative care team at the Royal Free Hospital, London.
Comparing the delivery of palliative care in Taiwan to that of the UK: first there is no independent ‘hospice’ in the community in Taiwan. Inpatient palliative care in Taiwan is based in a ‘hospice ward’, or in non-hospice wards covered by an outreach advisory service within acute hospitals. The expenditure for operating palliative care services in Taiwan is reimbursed by National Health insurance rather than by charitable donations, which is the main financial support for hospices in the UK. Another difference is that accredited specialist home care nurses can legally prescribe medication in the UK, which has facilitated the efficiency of patient care in the community. The dissemination of palliative care for non-cancer disease is still limited in Taiwan, especially for patients with dementia and renal failure. The awareness and implementation of advance care planning among patients and clinicians is less adequate in Taiwan. The Mental Capacity Act in the UK has established sanctioned principles to protect people who can’t make decisions for themselves, or lack the mental capacity to do so, whereas there is no such legislation to provide better care for patients with dementia or mental incapacity in Taiwan.
Inspired by my experience in the UK and the people I met there, I will continue to dedicate myself to dementia and palliative care through my links with professional societies and public advocacy.
In my opinion, shifting the paradigm of survival prediction towards care needs as the trigger for supplying palliative care to patients with advanced dementia is a top priority in Taiwan. I am grateful to Professor Sheila Payne for inviting me to share my cross-cultural learning on this blog.
Links and resources…
- Hospice Foundation of Taiwan.
- Taiwan Academy of Hospice Palliative Medicine.
- Marie Curie Palliative Care Research Unit at University College London.
- White paper on palliative care in dementia – recommendations from the EAPC.
Click here for other posts in our special series on Taiwan: Dr Chien-An Yao on the role of the Clinical Buddhist Chaplain in palliative care and Dr Sharlene Shao-Yi Cheng on the development of the Taiwan Research Network.
World Hospice and Palliative Care Day 11 October 2014 – Achieving Universal Coverage of Palliative Care: Who Cares? We Do!
Good luck to everyone who is involved in tomorrow’s World Hospice and Palliative Care Day. Please visit the World Day website to read about some of the inspirational initiatives that are being held across the world to celebrate World Day and raise awareness and funds for local hospices and palliative care services.