Many people misunderstand palliative care as “doing nothing” or “waiting for death.” In fact, palliative care is far from being passive; it emphasizes proactive care, helping patients live well throughout the course of their illness.
At the end of last year, Grandma A-Chun was diagnosed with colon cancer, which had already metastasized. Encouraged by her family, she fought the cancer aggressively. However, the discomfort caused by chemotherapy was unbearable. Dr. Huang-Ren Lin, Director of the Palliative Care Center at Lotung Poh-Ai Hospital, visited her to adjust her medication and alleviate her symptoms. He also took time to understand her and her family’s thoughts during this process.
After three months of treatment, the hematology and oncology team found that Grandma A-Chun’s chemotherapy results were not as expected. She was sent to the emergency room again due to severe nausea and vomiting. The medical team and her family urged her to try another form of chemotherapy. However, the suffering caused by chemotherapy was too much for her, and she longed for less pain. Having the support of the palliative care team, Grandma A-Chun felt she had fought hard enough and expressed her wish to transfer to the hospice ward.
That morning, after discussions with her family and the medical team, they decided to respect Grandma A-Chun's wishes and transfer her to hospice care. Dr. Lin believed she would overcome this crisis and be discharged stably. “After that, the home hospice team will take over her care.” Dr. Lin had accompanied her for more than three months and witnessed her pain during the treatments. Through full communication, he saw how she and her family moved from conflict to gradual understanding. “To outsiders, palliative care may seem like ‘doing nothing,’ but it actually fulfills the patient’s and family’s expectations for life.”
The Initial Motivation for Engaging in Palliative Care
As a resident, attending physician, and later the director of the hospice ward, Dr. Huang-Ren Lin often asked himself if he had done enough or done things right. He frequently reflected on what he truly cared about and pursued. “My mentor, Dr. Ying-Wei Wang, told me: ‘Whatever can help the patient and doesn’t cause harm, we must do our best to achieve it.’” Helping patients lead a complete and fulfilling life is what all advocates of hospice care strive to do throughout their careers.
More than four years ago, Dr. Huang-Ren Lin transitioned from Hualien Tzu Chi Hospital to the Palliative Care Center at Lotung Poh-Ai Hospital in Yilan. He found that while palliative care in Taiwan had been developing for nearly 30 years, Yilan lagged behind in holistic palliative care compared to Hualien. He attributed this to the lack of a large medical center in Yilan and the traditional mindset still prevalent among some of the elderly population. This also motivated him to promote palliative care in his hometown.
Dr. Lin offered a compelling explanation of palliative care: “We aim to enable patients to live the life they want, even at the end.” He pointed out that some people mistakenly equate palliative care with “giving up treatment.” In reality, palliative care allows patients to continue receiving treatment for other illnesses, regardless of their age or the severity of their condition. “Palliative care is not about doing nothing or doing less; it’s about being even more proactive. Anything that benefits the patient, where the pros outweigh the cons, should be pursued with greater effort.” The ultimate goal of palliative care is always to help patients live well.
The Essence of Immediate Palliative Care
In late 2022, Dr. Huang-Ren Lin launched the project “Comprehensive Provision of Immediate Palliative Care to Improve the Quality of Life for Patients with Advanced Cancer and Non-Cancer Diseases.” Through systematic evaluation, the goal was to include both advanced cancer and non-cancer patients in palliative care earlier, thereby improving their quality of life at the end of life. This project received funding from the Hospice Foundation of Taiwan, providing more research opportunities and resources for the team.
What exactly is proactive palliative care? Dr. Lin believes it involves “caring for patients who are not yet at death's door, giving them a period of quality life.” Unlike past hospice care, palliative care focuses on patients in the later stages of their illness. It’s not just about waiting for the final days but ensuring that patients can live with dignity and confidence while they still have time.
In summary, the palliative care team’s most distinct feature is its holistic approach to patient care. This involves a team of doctors, nurses, social workers, psychologists, and spiritual care personnel providing physical, emotional, and spiritual support to both the patient and their family. “Our goal is not only to ensure that the patient receives the highest quality of medical care but also to be a support system for their family and primary caregivers, providing comprehensive assistance and consultation.”
Given that immediate palliative care is time-sensitive, how should the intervention point be determined? Dr. Lin explained that the concept of immediate palliative care involves shifting from “Early” intervention to “Timely” intervention. This means that palliative care can be introduced as soon as a disease enters its advanced stage while treatments are still ongoing, allowing for timely intervention at any stage.
Immediate Intervention Enhances Quality of Life
The concept of immediate palliative care has been around for some time. Ten years ago, Lotung Poh-Ai Hospital established a Palliative Care Center to provide hospice and palliative services. However, many families, patients, and even healthcare professionals still believed that palliative care was only meant for the end-of-life stage. This perception gradually changed with the implementation of the project “Comprehensive Provision of Immediate Palliative Care to Improve the Quality of Life for Patients with Advanced Cancer and Non-Cancer Diseases.”
This project was planned in 2020 and officially began systematic patient intake in August 2022, running until the end of November 2023. Over the 15-month period, Dr. Lin evaluated the project’s impact, noting that “in the past, the average time from when patients began hospice care to their passing was 1.5 months. However, with the intervention of palliative care, this time has been extended by an additional month.” In other words, on average, patients now have 3 to 4 months after palliative care intervention to arrange their remaining lives, which is an improvement from the previous 1 to 2 months under hospice care alone. Furthermore, the immediate palliative care model has encouraged more patients to accept hospice care, increased the proportion of home care, and reduced unexpected hospitalizations and deaths.
Currently, Lotung Poh-Ai Hospital's immediate palliative care program targets both cancer and non-cancer patients. Initially, it includes patients with hematologic malignancies, breast cancer, and gastrointestinal cancers. For non-cancer patients, the focus is primarily on those with heart failure and chronic obstructive pulmonary disease, with plans to expand to other wards in the future.
Realizing the True Meaning of Holistic Care
Dr. Lin believes that, although advances in medicine have provided doctors with more sophisticated treatment tools, over-medication and unnecessary routine treatments that do not improve quality of life are not what patients want. The key is not simply surviving but dying peacefully while maintaining quality of life and dignity, allowing patients to make autonomous decisions about how they wish to live. “I believe the trend of palliative care is here to stay, but there is still room for improvement.” He emphasized that palliative care has evolved from hospice care and that the next challenge is to fully integrate patient autonomy into the care model.
He shared a story of a grandfather with prostate cancer who, after receiving palliative care, found new meaning and purpose in life. He decided to accept home care, and seven years later, he is still alive. His wife, who had originally helped care for him, passed away earlier due to a stroke and pneumonia. This example shows that patients who receive palliative care can live well and for a long time. “Grandfather often expressed his gratitude to us. Sometimes, I would jokingly ask him, ‘How do you plan to arrange things when your time comes?’ He would always smile and reply, ‘Of course, I’ll follow my wife’s example and pass away peacefully at home.’”
Dr. Lin firmly believes that palliative care is not just about medical treatment; it is about the human connection. This, he says, is the true meaning of holistic care.