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13฀ Community฀Palliativ e฀Care฀in฀Hong฀Kong฀ Faith฀Chun฀Fon g฀LIU฀ Palliative฀Car e฀i n฀Hon g฀Kon g฀ The purpos e o f palliative care is to enhance th e quality and meanin g o f lif e and death for both terminal patients (thos e with cancer or non-cancer disease ) and thei r famil y member s an d i n thei r bereavemen t period . A s a moder n health-care specialty , palliative car e ha s rapidly developed i n th e last decad e in Hong Kong. The Co-ordinating Committee (Hospice ) o f Hospital Authority (HA) o f the Hong Kong SAR Government define s hospice/palliativ e car e as1 "the car e o f th e patient s & their familie s wit h activ e progressiv e advance d disease an d a limited prognosi s for who m th e focus o f care is the qualit y of life". The terms "hospice " and "palliative" , with respect to service and care, are used interchangeabl y i n thi s chapter . Community palliativ e care was established a s a health car e policy by th e HA, in order to provide continuous and holistic care for discharged terminall y ill patients and their family members. The development of community servic e aims to improve access across the population and improve the standard of care at site s for thos e livin g with advance d disease . This i s seen a s an economi c necessity.2,3 There i s also a strong perceptio n tha t th e provisio n o f palliativ e care should be carried out at home an d enabl e th e patient to be cared for i n the environmen t o f choice.4 The Britis h Governmen t White Paper - 'Caring for People', 5 views community care in th e following way: Community฀car e฀means฀providing฀the฀right฀level฀of฀intervention฀and฀support฀ to฀enable฀people฀to฀achieve฀maximum฀independenc e฀and฀control฀over฀their฀ own฀lives .฀For฀this฀aim฀to฀become฀a฀reality,฀the฀development฀of฀a฀wide฀range฀ of฀services฀provided฀i n฀a฀variety฀of฀ways฀is฀essential.฀ 184฀Faith ฀Chun฀Fong ฀LIU฀ Model฀of฀Community฀Palliative฀Care฀ In Hon g Kong , communit y palliativ e care , operate d a s cluster-based , i s provided by either the Palliative Home Care Service or the Community Nursing Service. Bot h programme s facilitat e transitio n fro m hospita l t o home , encompass th e car e o f th e patien t an d famil y an d targe t sympto m management. Palliative฀Home ฀Care ฀Service฀ The mai n worker s i n th e servic e ar e palliativ e home-car e nurse s wh o ar e trained and experienced in hospice care, supported by a multidisciplinary team designated solel y to take care of terminally ill patients in the community. Th e multidisciplinary experts , e.g. , palliativ e physician , clinica l nurs e specialist , social worker, clinical psychologist, physiotherapist, occupational therapist an d pastoral worker, are also accessible for consultation and home visits as needed. The service is supported b y palliative in-patient units. Self-referral i s accepted to facilitate th e accessibilit y of the service . Community฀Nursing ฀Service฀ Another service model is provided by community nurses in a general hospital . The nurse s are often traine d i n hospice car e but are not necessarily clinicall y specialized i n takin g car e o f terminall y il l patients . Suppor t fro m othe r disciplines is relatively minimal. Evaluation฀of฀these฀models฀ No local research ha s yet been conducte d t o investigate the cost-effectivenes s and efficienc y o f communit y palliativ e models . According t o th e literatur e review6 i n examinin g th e effec t o f specialis t model s o f palliativ e car e o n consumer satisfaction , opinio n an d preference ove r the past twenty years an d eighty-three relevan t paper s were identified . Researc h finding s consistentl y indicate that patients and care-givers are more satisfied with specialist palliative care than with general care,7 and the care- receivers of cancer perceive quality of services from specialist s as better tha n generi c services. 8 Service฀development...

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