• Vol. 41 No. 11, 483–493
  • 15 November 2012

Improvements in End-of-Life Care with a Protocol-based Pathway for Cancer Patients Dying in a Singapore Hospital



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Introduction: More than half of all deaths in Singapore occur in hospitals. Little is known about the quality of care received by dying patients in hospitals. The Liverpool Care Pathway (LCP) provides a framework of providing good end-of-life care for dying patients and has been used with success in the United Kingdom (UK). In this study, we investigate whether adoption of a modified LCP in a Singapore hospital translated to better end-of-life care for cancer patients.

Materials and Methods: The LCP was adapted and implemented as a pilot project on an oncology ward in Singapore General Hospital. A baseline review of 30 consecutive death records was performed, followed by a 4-month pilot and post-implementation audit of 30 consecutive patients on the adapted LCP.

Results: Five types of end-of-life symptoms were analysed. There was only 1 uncontrolled symptom at death in the post-implementation group compared to 24 uncontrolled symptoms in the retrospective audit group. The prescription of breakthrough medications for symptom control increased from 21% in the retrospective audit group to 79% in the post-implementation group. Inappropriate monitoring was discontinued in 25 patients in the post-implementation group compared to none in the retrospective audit group. The documentation of resuscitation status and religion of the patient was improved, achieving full documentation in the post-implementation group.

Conclusion: This study shows promising results for improving end-of-life care in cancer patients with a protocol-based pathway in a Singapore hospital. Extension of this care pathway to other settings should be explored to maximise its benefits to patients dying from all causes in hospital.

In 2010, there were 17,125 recorded deaths in Singapore, of which 9893 (55.3%) occurred in public sector hospitals. Singapore General Hospital (SGH) is the largest tertiary public sector hospital in Singapore with more than 1500 beds. Between January 2010 and December 2010, 19.5% (434/2218) of all deaths in the hospital occurred in the medical oncology ward in SGH (Singapore General Hospital, unpublished data). To date, there is scant data regarding the quality of end-of-life care received by patients in Singapore. One study of elderly dying patients in Singapore showed that end-of-life care received in hospital significantly improved with specialist palliative care input.

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