Authors: Palliative Care Multidisciplinary Team, Dr. Chih-Wei Chang, Dr. Yeong-Yuh Juang
Dr. Chang is currently the attending physician at the Palliative Care Department of KFSYSCC. He specializes in palliative medicine, family medicine, geriatric medicine, health risk management, and health promotion. He graduated with a medical degree from Taipei Medical University. In 2006, he served as a resident physician in the Family Medicine Department of Taipei Veterans General Hospital. In 2009, he became a chief physician in the same department. In 2010, he was a research physician at the Geriatric Medicine Center of Taipei Veterans General Hospital. In 2011, he became the attending physician in the Family Medicine Department of Taipei Veterans General Hospital's Taoyuan branch. He has been serving at this institution since 2015. He participates in the hospital's interdisciplinary palliative care team and the psychosomatic interdisciplinary treatment team.
Dr. Juang is currently the Senior Attending Physician in the Psychosomatic Medicine Department at KFSYSCC and the Deputy Convener of the multidisciplinary palliative care team. His areas of expertise include consultation-liaison psychiatry, psychosomatic medicine, anxiety disorders, depression, psycho-oncology, and dementia assessment. He graduated with a medical degree from Taipei Medical University. In 1996, he served as a Resident Psychiatrist at Linkou Chang Gung Hospital and an Attending Psychiatrist in 2001. In 2002, he served as a researcher in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center in the United States. In 2006, he took up a part-time lecturer role at Chang Gung University. In 2015, he became the Chairman of the Taiwan Psycho-Oncology Society. Since 2016, he has been serving at this hospital. He participates in the hospital's multidisciplinary palliative care team, the blood and bone marrow hematopoietic stem cell transplantation multidisciplinary team, and the psychosomatic multidisciplinary team.
Fulfilling the Promise of Companionship through Difficult Times
Palliative care, originating from end-of-life care, has evolved into the ultimate care for patients and their families suffering from ailments. Through unwavering efforts that address physical, emotional, and spiritual needs, the commitment of accompanying patients through their darkest hours is realized.
Two years ago, Mr. Fang was diagnosed with lung cancer. After receiving treatment at KFSYSCC, his condition stabilized. However, six months ago, he began experiencing persistent back pain and increasing coughing. Further examination revealed a tumor had spread to the other lung and multiple metastases were found in the spine. Despite introducing new medications, the tumors seemed particularly resistant, and Mr. Fang's condition deteriorated, with worsened coughing and pain.
Three months ago, he was re-admitted due to severe breathing difficulties. Not only had the tumors not shrunk, but new ones were also found, and the bone metastasis was more severe. A family meeting was called to discuss the prognosis and future treatment plans.
During the meeting, Mr. Fang's wife broke down upon hearing the grim news, desperately asking if there were any other treatment options, even if they were costly. The doctor explained that Mr. Fang had tried multiple lines of treatment with poor results. Given his frail state, undergoing another treatment might be too much for him. The family struggled to accept this news. Their son suggested seeking a second opinion from a medical center. The attending physician agreed to provide a summary of the treatments but also mentioned that based on the current condition, other medical centers might not offer better solutions. He recommended consulting the palliative care team to help manage the symptoms.
Throughout the discussion, Mr. Fang remained silent and pensive. When the palliative care team visited him, his wife reiterated her determination not to give up. The team noticed that Mr. Fang seemed to have something on his mind and invited a psychologist to speak with him. Encouraged to share his feelings, Mr. Fang expressed gratitude for the care and support he received from his family and the medical team over the past two years. Diagnosed two years ago, he had mentally prepared himself but chose to fight on for his family. Initially, the diagnosis was hard to accept. He had looked forward to retirement, spending quality time with his family, but this illness interrupted those plans.
Yet, during these two years, his daughter got married and gave birth to a lovely grandchild, and his son found a stable job and girlfriend. He felt he had no regrets, except for not being able to spend a lifetime with his wife. Hearing this, his wife wept bitterly, lamenting the unfairness of life. The palliative care doctor then adjusted Mr. Fang's medication. Previously, he struggled with the side effects of morphine, which left his cough and pain unmanaged. With the change in medication, he felt much relief. He also consulted with a psychiatrist, which finally allowed him to sleep soundly.
With Mr. Fang's birthday approaching, the social worker collaborated with the family to organize a surprise birthday party in his ward with the help of the palliative team and volunteers. The event deeply moved Mr. Fang, and the team documented the heartwarming celebration for the family. Afterward, his condition stabilized, allowing him to be discharged and receive home care from the palliative team. This gave Mr. Fang more precious moments to spend at home with his family.
Palliative care, rooted in end-of-life care, has now evolved into the ultimate support for patients and families grappling with illnesses. Through relentless dedication, it meets the physical, emotional, and spiritual needs of patients, embodying the promise of guiding them through their most challenging times.
At KFSYSCC, the palliative care team is committed to delivering exceptional care. The team, deeply rooted in the hospital's unique ethos, bases its approach on the holistic needs and values of the patients and their families. Throughout the stages of diagnosis and treatment, they continuously weave an intricate support network, consistently offering assistance and warmth to enhance the quality of life.
The palliative care team emphasizes a team-centric approach right from the beginning. This ensures comprehensive care, optimal resource integration, and a steadfast commitment to patient welfare.
This dedicated team consists of professionals passionate about covering all facets of a patient's and their family's needs. Key members of the palliative care team include:
Palliative Care Physicians: Experts in pain management and symptom control, they assist patients and their families in understanding the nuances and challenges of their medical conditions. Together with the team, they outline comprehensive care objectives and plans.
Psychiatrists: They assess and address the psychological symptoms of patients and their families. Leading the team, they offer psychosocial support and spearhead the creation and execution of psychosocial care goals.
Nurses: The linchpin of palliative care, nurses embody professional evaluation, holistic patient care, and meticulous attention. Their roles vary from specialty nurses in charge of ward care, regular ward nurses, home-visit nurses, to case management nurses coordinating team operations and resource allocation.
Social Workers: They delve into understanding the dynamics, structures, and adjustments within families, fostering connections between families, hospitals, and community resources. They are instrumental in assisting patients and their families during critical health transitions and challenging times.
Psychologists: Their role involves facilitating patients and their families in adjusting to their illnesses, both mentally and physically. They explore psychosomatic issues, weave together life experiences and memories, and assist in realizing and fulfilling life's value and meaning.
Spiritual Counselors: They focus on spiritual well-being, offer spiritual guidance, promote spiritual growth, and assist patients and families in concluding their life journeys with peace.
Volunteers: They bring a sense of life and purpose through their service, foster emotional connections with compassion, and create touching moments through their dedication.
In order to provide timely care to those in need of palliative support, the palliative care team has designed a comprehensive and adaptive care model. The objective is to engage with with patients and their families at the right moments, corresponding to the various stages of illness and physical conditions. This ensures trust is built and maintained while continuously collaborating with the oncology team. Adjustments to care direction and goals are made based on feedback and consensus, always aiming to offer the most appropriate services and care.
As per the settings for palliative care:
Palliative Outpatient Services: This setting allows patients, depending on their physical capabilities, to undergo palliative care assessments in an outpatient environment. Here, symptoms are managed, conditions are discussed, and care objectives and plans are fine-tuned.
Palliative Home Care: For terminal patients who have mobility challenges and cannot easily visit the hospital, we offer home visits. These visits consist of symptom assessment and management, care of medical devices, and adjustments in home care based on the progression of the illness. Discussions about end-of-life care at home are also initiated. This service acts as a bridge between the patient, their families, and the medical team.
Palliative Ward Care: For patients requiring inpatient palliative care, we offer integrated care centered around our palliative medical team. Our facility has a dedicated area for palliative care, equivalent to the hospice or palliative wards in other hospitals. Within this area, our multidisciplinary team provides holistic care to both the patient and their families. We also have various infrastructure and spaces for activities, aiming to cater to all care needs and improve the overall care experience.
Based on the stages of the disease, palliative care models can be divided into:
Collaborative Palliative Care: During the treatment of the disease, various palliative care needs may arise due to symptom control or adjustments related to the disease. When the oncology treatment team deems a referral appropriate, they discuss with the patient and their family. Once a consensus is reached, the palliative medical team is brought in for comprehensive symptom and care plan evaluation. The team offers palliative care recommendations, links up with various specialists and resources, and strives to alleviate the physical and emotional burdens on the patient and their family, enhancing overall quality of life.
Palliative Medical Team-led Care: As the disease progresses and cancer treatments become less viable, the oncology and palliative care teams, along with the patient and their family, can opt for comfort care as the primary medical goal. The palliative care team will then take over, based on discussions and agreements with the patient and their family. Moreover, many patients travel from afar to seek high-quality treatments. As their disease reaches a terminal stage, arranging local care becomes crucial. Our team can provide information about local hospice and palliative services and assist in transitions to ensure patients and their families receive seamless care.
The Palliative Medical Care Team not only delivers high-quality clinical palliative services but also actively participates in the hospital's continuous education initiatives. They provide training for the hospital staff and interns interested in palliative care, continuously enhancing and expanding our resources and expertise. They actively seek collaboration and advancements in care models and academic research, including international exchanges with top experts in the field.
Under the leadership of Director Andrew T. Huang, all medical personnel wholeheartedly strive for the best treatment outcomes for every patient seeking treatment at our hospital. However, there are times when results might not meet expectations. We believe that, throughout this process, while curative treatments have their limits, the care and compassion towards the patients and their families only grow stronger. Our mission is to ensure that each patient receives comfort and dignity until the very end, while their families get the support and solace they need. This is the founding principle of our palliative medical team, an ongoing effort, and an unwavering commitment.
