Pediatric palliative care in Thailand

Abstract

Pediatric palliative care is essential and needs to be integrated early into the care of children who have life-limiting diseases. Perinatal conditions, fatal congenital/genetic diseases and cancers are the leading causes of pediatric death in Thailand. 'The Tertiary Prevention and Palliative Care Plan' was included in the National Cancer Prevention and Control Plan 1997-2001. Palliative and end-of-life care has been initiated but principally for adult patients. Parallel pediatric palliative/end-of-life care has been introduced, although principally at tertiary hospitals and regional cancer institutions. Significant obstacles include a lack of systematic guidelines, limited or non-existent financial resources and few (if any) specifically assigned personnel. Access to opioids to treat pain is restricted to tertiary centers and frequently unavailable at primary health care units near to the patient's rural home. This is problematic since death at home is culturally preferred. Lack of effective pain medication therefore forces patients to remain in hospital to die, which imposes a further financial burden on the family and separates them from community support. Importantly, the concepts of palliative and end-of-life care have not been widely integrated into medical and nursing curricula and more needs to be done to enable healthcare personnel to discern when the treatment should change from the standard curative approach to a palliative one. Pediatric palliative care in Thailand therefore needs (a) strategies for capacity development and education of doctors and nurses (b) adoption of palliative care guidelines and planning/making decisions on acceptable/desired end-of-life medical actions and (c) assignment of a budget/staff to empower palliative care.