When to start the conversation: Palliative care is for living, not just dying

**SPEAKER_1** (0:02)
This is a podcast by The Straits Times.

**Joyce Teo** (0:08)
Hi, I'm Joyce Teo, and you're listening to Health Check.
Today we're discussing a shift in how two Singapore hospitals are handling critically ill patients in their intensive care unit or ICU.
When we think of ICUs, we picture highly clinical, stressful environments with patients hooked up to machines and flashing lights and alarms around them. I mean, the focus is solely on saving lives. But what happens when the machines aren't enough? And what if a patient needs more than technology to navigate a medical crisis? That's when an often misunderstood specialty comes in, and that is palliative care. Palliative care is about caring for people while they are living. It is appropriate at any stage of a serious illness, not just the terminal phase, by addressing physical pain, emotional distress and spiritual needs, palliative care treats the whole person and supports their family when medicine alone isn't enough. So here in Singapore, Tan Tock Seng Hospital and National University Hospital, they recently launched a new initiative called A Kinder ICU that is supported by a 3.93 million grant from the Lien Foundation. Their aim is to integrate palliative care into standard ICU treatment. But what does this mean? Why is this significant and how is it going to happen? So these are questions that will be addressed by our two guests today. They are Assistant Professor Neo Han Yee. He's a Senior Consultant and Head of the Palliative Medicine Department at Tan Tock Seng Hospital. He pursued a second specialization in palliative medicine after obtaining a Specialist Board Certification in Geriatric Medicine.
We also have Ms Charmaine Sim. She's an Advanced Practice Nurse at the Medical Intensive Care Unit at the National University Hospital. She's a highly skilled nurse who has received palliative care training. Hi Dr. Neo. Hi Charmaine. Welcome to Health Check.

**Neo Han Yee** (2:04)
Hi Joyce.

**Joyce Teo** (2:06)
Good to have you both with us here. So we'll start with Dr. Neo. Dr. Neo, let's talk briefly about palliative care because I think the terms scare some people.
It's often misunderstood as something that's only delivered in the final days of life. So how do you explain ICU palliative care to the family of an ICU patient?

**Neo Han Yee** (2:23)
So maybe I'll just set the context a little. Perhaps 10 to 20 years ago, you have been right, that palliative care is really delivered at the end of life and people think of palliative care as a specialty that the doctor will come by, declare that time is short, make sure the patient is comfortable and patient dies within short days. But that have changed in the recent one to two decades globally.
The definition of palliative care has since changed to a service that can be initiated once a diagnosis of an advanced life-limiting illness is made.
In such a situation, the ICU, you have then a very interesting conflict of concepts. Because in intensive care, critical care, what you want to do is to give the person the best chance to survive. It is very technology-driven, you want the best outcome for the patient in terms of life prolongation. But palliative care brings in this notion of comfort, symptom relief, peaceful, any idea of life.

**Joyce Teo** (3:20)
It means, understood as having it in the last days of life, I mean, how do you actually broach the subject, right? Given that people think about it this way.

**Neo Han Yee** (3:28)
Yes, yeah. So I think nowadays in the ICU setting, it's very cleverly engineered into the conversation. So for example, if the ICU specialist know that this particular patient isn't going to do too well, right, based on signs, based on medical facts and assessment, the ICU doctors will then bring the Palliative Care team in, usually into a family meeting or what we call a family conference. And they will then introduce us as part of the team, right, very naturally, and say that this is my team from Palliative Care. They are just part of my crew, you know, and if things don't turn out too well or if your family members will suffer from any symptoms, they will be here to make sure that all distressing symptoms are taken care of, and they will be comfortable. These treatments are not going to affect how your loved one is going to do, be it for good or for bad. Their role is to support me so that I take care of your family member well.

**Joyce Teo** (4:22)
I see that that sounds more reassuring, yeah. But with the kinder ICU, you're bringing the care earlier, right? Like Charmaine, you talk to patients as well, right, before the specialists actually come in. How do you do that? And we were talking about misconception because you also mentioned that people will think that when you introduce Palliative Care, they assume that there's no hope for them.