Integrating Palliative Care into Specialized Cares: When, Why and How


Chusana Khaiman, MD

Cheewabhibaln Palliative Care Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand


Pediatric palliative care service in King Chulalongkorn Memorial Hospital has been established and served approximately 70 patients per year with advanced illness. The majority of our patients were diagnosed with pediatric cancers. We provided great benefits for children and bereaved families. They could take the advantages from multidisciplinary team approach to receive the information of clinical outcome, disease trajectory and their lives as a whole. Comprehensive palliative care service in wards, outpatient clinics, home visit programs could provide continuity of care and support the family distress. We tried to fulfil their wishes as much as possible. Even for patients in the terminal phase who desired to pass away at their homes or nearby hospitals, we contacted community-based health care service. This helped the families to build-up their relationship early and provided the important information to the primary care team.  

The key of success was the dedication of team. We made a lot of effort to follow up patients regularly especially in-home care setting to assess clinical/psychosocial needs at homes. For patients who needed to be admitted to primary hospital, we tried to contact with the local team to visit our patients. This could support the families, non-abandon care. The patients’ symptoms would be effectively controlled by palliative care specialist recommendation. We also empowered the local teams to increase their potentials in palliative care. This is the important factors that provide end-of-life care at community-based setting seamlessly with tertiary hospital. 

However, there are some barriers about integration pediatric palliative care service in our institute. From our experience, active total care that aims for quality of life usually is performed very late at the terminal stage of diseases due to limited resources (e.g. lack of educational medical staffs, assessment tools and budget). Therefore, we design the project that can reduce barriers and effectively integrate palliative care service parallel with the disease modifying treatment. The methodology will run step by step. 

Step 1 for health care professionals: we will raise awareness, promote them to understand philosophy of palliative care and be able to identify early palliative care needs in all children with advanced illness. We plan to provide palliative care workshop, regular educational activities and practical tools/materials.

Step 2 for patients: we plan to set up child life, psychosocial service for children with advanced illness to early integrate quality of life care by promoting child life/psychosocial professional training in year 1 and build-up team consultation service in year 2. 

Step 3 for parents: we plan to initiate novel activities for parent (e.g. education class, parent support group) that will improve quality of care to their beloved child, promote adaptation to the child’s illness and practicing self-care. 

We hope our program will bring better quality of life to our patients, fulfil their wishes earlier and give them more happy time with their families. Beside intra organizational benefits, this will serve as a role model to many hospitals in Thailand.


Assistant Professor Kittiphon Nagaviroj, MD

Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand


Palliative care is specialized medical care for people with serious illnesses. According to the WHO, the main purpose is to improve the quality of life of patients and their families, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, including physical, psychosocial and spiritual issues. Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment. Patients with cancer make up a significant portion of those people who have a high symptom burden and/or with advanced illness. Of all patients with metastatic cancer, nearly half have incurable diseases but they can live for years after initial diagnosis. Palliative management focuses on the care of patients with advanced illness or a significant symptom burden by emphasizing medically appropriate goal setting, honest and open communication with patients and families. 

The Faculty of Medicine, Ramathibodi Hospital, Mahidol University, had a project on the development of palliative care for people in the Bangkok metropolitan area beginning in 2010. The project is aimed at the integration of palliative care services into mainstream medicine by providing a variety of services, including inpatient consultation, palliative care clinic, telephone consultation, a 6-bed palliative care unit as well as providing home-based palliative care. In 2018, around 1,100 patients and their families participated in our program. During this session, we will demonstrate how we align palliative care service with oncology care and address the key success factors as well as challenges for future direction.


Pratamaporn Chanthong,MD

Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand


WHO defines palliative care as “An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual”. Palliative care services include establishing goal of care, symptom control, and psychosocial, spiritual and bereavement support. Palliative care is an interdisciplinary approach; assist patients and families control over their care plans and in receiving care in the setting most appropriate to their needs and resources by coordinating care throughout the illness. Many studies have shown that palliative care services improve patients’ symptoms and quality of life, allow patients to be cared at home, avoid hospitalization and improve coping skills of patients and family through the end of life. 

It is now recognized that the principles of palliative care are applicable earlier in the course of serious illness and palliative care should be provided alongside the disease treatment. The American Society of Clinical Oncology published the integration of palliative care into standard oncology care guideline recommended that “inpatients and outpatients with advanced cancer should receive dedicated palliative care services concurrently with active treatment in the early course of disease”. Palliative care approach for patients with advanced cancer should therefore occur as early as possible, rather than be reserved until the last days of life. 

Palliative care services can be provided in the hospital, ambulatory setting, and community-based services. Models of hospital-based palliative care services include palliative care consult services, dedicated palliative care units and integrated palliative care models in the services. Community-based services include the continuity care of patients who were discharged from hospital, coordination of home care needs, including housing, transportation, and equipment. These services can be provided within the home and coordinate within an outpatient clinic. The optimal palliative care model for an individual institution is determined by several factors and resources.

Event Hours(1)

  • Lotus 1-2

    02:45 pm – 04:00 pm

    1. Dr. Chusana Khaiman (CU)
    2. Dr. Burapen Boonchoo (CRA)
    3. Asst. Prof. Kittiphon Nagaviroj (RAMA)
    4. Dr. Pratamaporn Chanthong (SI)
    Asst. Prof. Kittiphon Nagaviroj (RAMA)