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The Collaborative Care Model
13 March 2013

Why Star PALS is dubbed ‘collaborative care for children’.

Before Star PALS was launched, Dr Chong Poh Heng, Deputy Medical Director and Programme Director of Star PALS embarked on a research study to fine-tune the programme model. This research study has just been published in the European Journal of Palliative Medicine, Jan 2014.

In order to increase accessibility to palliative care for children with life-limiting conditions, it was vital that we had the buy-in of the primary physicians who held the most control over these children’s treatment.

So, instead of focusing on the patient or their families, his research explored what 36 physicians from the National University Hospital thought about paediatric palliative care.

‘These doctors need to trust that our organisation can do good and help the children,’ Dr Chong said. ‘Actually, parents are sometimes more prepared than doctors to have their children under our care.’

Findings showed that a majority of physicians were willing to refer their patients to a paediatric palliative care service, mainly for psycho-emotional and social support, bereavement support, terminal care and co-ordination of care.

Dr Chong also noted that ‘pain’ and ‘symptom control’ were listed only as the 5th and 6th highest reasons for physicians’ referral - contrary to that shown for adult palliative care. Along with the concerns shared – that the palliative care team would not hold the necessary disease-specific expertise and might contradict the management plan of the primary physician – the physicians generally showed a greater confidence in their own ability to manage these issues in the patients.

Further to this, physicians were also worried that

  • Referral to palliative care might be perceived negatively by patients and their families - as ‘giving up’ or having ‘no hope’ for the patient;
  • Referrals might be made too early due to uncertain prognosis.

The 3P Collaborative Care Model

In response to these concerns, Dr Chong then went on to develop the ‘3P’ Collaborative Care Model – where ‘3P’ stood for patient, primary physician, and paediatric palliative care.

Even as the paediatric palliative care team becomes increasingly involved in the patient’s care, the primary physician’s involvement must be maintained, remaining visible to the patients and caregivers and kept in the loop by the paediatric palliative care team.

By improving the shared care and decision-making, the close collaboration between palliative care teams and the children’s primary physicians – as in the current Star PALS model – will enhance the quality of life for the paediatric patients.

With this increased partnership, Star PALS hopes to earn the trust of its patients’ doctors, and be given the privilege of providing palliative for the many children who need it.

Find out more about our paediatric palliative care services on www.starpals.sg. Feel free to contact us at communications@hcahospicecare.org.sg should you have any queries. Star PALS is a service by HCA Hospice Care.