Submitted by: APHN Editorial Team (Taiwan) – Hospice Foundation of Taiwan
JKT Research Project is a cross-national research project started in 2013. It involves 3 different cross-national research projects and yearly academic exchanges. This year, Hospice Foundation of Taiwan has the privilege to invite Prof. Yoshiyuki Kizawa from Japan, Prof. Young Seon Hong from Korea and Dr. Chun-kai Fang from Taiwan to share their point of views in the JKT Research Project TAIPEI.
The symposium is honored to have Prof. Yuh-Cheng Yang and Dr. Shih-Tze Tsai gave opening speeches to welcome the speakers and participants. In Prof. Yang’s speech, he explained the origin and purpose of this cross-nation research project, and also expressed his gratitude to co-host – Taiwan Academy of Hospice Palliative Medicine. Echoing the leadership theme of the symposium, Prof. Yang shares his point of view with a beautiful verse:
“As there is an old saying goes ‘the leader is like wind and the follower grass. When the wind blows, the grass must bend.’ The leadership in hospice and palliative care is most crucial to a successful care.”
HFT secretariat has sum up for our readers here:
Prof. Kizawa is currently the Secretary General of Japan Society for Palliative Medicine (JSPM) and the Designated Professor, for the Department of Palliative Medicine of Kobe University Graduate School of Medicine. He elaborated the development of palliative care in Japan is first lead by the private sector, as the first Seirei Hospice established in 1981 which is the first hospice hospital in Asia. In 2007, Japanese government passed the Cancer Control Act, recognized the needs for palliative care to cancer patients and thus actively promoted palliative care. With the increasing needs, private sectors like JSPM decided to first start with education and certification. By train-the-trainer strategy and board certification, qualified palliative professionals can be produced to meet the demand and at the same time under the supervision of JSPM. In 2010, there were 1,197,012 registered deaths, and was expected to rise to 1,660,000 by 2040. Among the total deaths in 2010, 30% death of cause was cancer, 16% and 11% were caused by cardiac diseases cerebral and vascular accident. Currently 79% deaths occurred in Hospitals and only 3% in hospice. The medical fee of palliative care has been included in Japan’s NHI coverage system for hospitals with certified palliative units; patient only requires paying 30% of all medical cost. Monthly payment does not exceed a threshold of about USD 1,000. Each patient has the access to freely consult any hospital and make own decision. The Education training systems currently provided are PEACE project for physicians, ELNEC-J for nurses and CLIC for pediatric palliative care. Besides Education and certification, benchmarking has been adopted to make further follow-up review. The current palliative care system in Japan is an organized and comprehensive network, with pragmatic and efficient education system.
Prof. Hong recently retires and is now the honorary professor of the Catholic University of Korea. Hospice was first bought in and began at the Calvary Hospice by Sisters of the Little Company of Mary in 1965. In 1998 Korean Society for Hospice and Palliative Care (KSHPC) was established, its memberships include physicians, nurses, social workers, pastors and volunteers. With the inauguration of KSHPC in 1998, KSHPC has started with Case Conference, CMR program for Physicians and Nurses, and also published the textbook for hospice and palliative medicine. During 2002-2004, KSHPC opened Busan and Daejon chapters, and also the Hospice Palliative Model Project for Terminal Cancer. During 2004-2008, two more chapters of Taegu and Chungbuk, holding 6th APHC and hold the Presidency of 2007 APHN council. 10 Year Cancer Control Plan was also published in 2006 and also the Standards for role of hospice and palliative care and for the hospice facility. Since 2012, two more chapters in Kwangju and Chunbuk was established. This year, Korean government announces the Law on the Hospice and Palliative Care and the Determination of Life Sustaining treatment for Terminally Ill Patients and Reimbursement of National Medical Insurance system for hospice palliative care.
Overall, Prof. Hong pointed out five aspects that worth paying attention to:
- Comprehensive national palliative care policies are vital for extending access to palliative care, especially like NHI reimbursement, Hospice law, and Provincial distribution of PCU.
- Government and all interested parties in medical, academic and social sectors prepare and collaborate together to make effective Enforcement Ordinance and Regulations of the Hospice law with the process of emerging consensus.
- Hospice palliative care service currently target terminal cancer patients and their families only. Patients with serious, life-threatening illness will still need to be included under NHI’s palliative care scope.
- Standardization of training and operation of advanced training program for all types of professionals who participate in the hospice palliative interdisciplinary team are required.
- The general public is still unfamiliar with Hospice palliative care services, more public campaigns are required to raise awareness.
For the leadership KSHPC is looking, is a leader with VISION ASIA quality, which means Vision: hospice spirit; Ability to attract donation; Social relationship; International relationship; and Academic interest. Prof. Hong concluded that the development and growth of Hospice in Korea has been largely dependent upon the vision and the ability of the institution leaders. Korean hospice is at the very important period of in its history, enactment of hospice law, which is containing determination of life sustaining treatment for terminally ill patient. So the role of leadership and management is even more important in palliative care in Korea.
Dr. Chun-Kai Fang is currently the head director of Hospice and Palliative Care Center in Mackay Memorial Hospital, Board of Hospice Foundation of Taiwan and Council Member of Asia Pacific Hospice Palliative Care Network. He points out that though with honor Taiwan has significantly improved the ranking in the 2015 Quality of Death report to No. 6, there are still many things needed to be done to establish a sustained palliative care development strategy.
Dr. Fang stressed the core force of quality palliative care as staff. Only when you have enough and healthy staff, can they provide palliative care service from their hearts. Based on Dr. Fang’s SWOT analysis of current Taiwan palliative care, the strength of Taiwan is well developed academic societies, national policies and National health insurance system, and also the common knowledge people have with palliative care; however, Taiwan has a serious weakness of not having enough financial support. Take Mackay Memorial Hospital for example, since 2015 Mackay has expanded the 4 Full Care to 6 Full Care, including Whole Community and Whole Mind along with Whole Person, Whole Family, Whole Team and Whole Process. You can notice the quality Dr. Fang is after is no longer from hardware, but the softer side of patient’s heart. Whole mind means full heart and soul, Psychological services, and Psycho-oncology services; as for Whole Community, it means when patients are discharged from the hospital, the care will be continuous offered by the community/society.
As also being the Chairman of Asia Pacific Psycho-Oncology Exchange Foundation, Dr. Fang shares with us the application of Distress thermometer (DT) and Family Relationships Index (FRI). Both of DT and FRI are currently adopted by the family service systems. FRI is developed by the SaTSG of Medical Research Department based on grief theories and services of social workers and psychologists, and it is evident proved.
In conclusion, no matter it is in Japan, Korea or Taiwan, its clinical palliative professionals and the academic experts are both contributing, hoping to make every life worthy and being respected. Besides these private sector efforts, public sectors like Korean and Taiwanese governments have also published the latest legislation on palliative care this year. Korean government announces the Hospice and Palliative Care and the Determination of Life Sustaining treatment for Terminally Ill Patients and Taiwanese government announces the Patient Self-Determination Act. This is surely a vibrant and cheerful update and a big step forward. This is the third year of speaker exchange between Japan, Korea and Taiwan. We are looking forward to seeing more sparks and more exchange and cross-nation collaboration continue on.