Abstract
Dear Editor:
As one of the fastest aging societies around the world, Taiwan is expected to become a “super-aging” society in 2025. 1 Although enjoying high-quality and easily accessible healthcare, the patient–doctor relationship is changing over time with a continued emphasis on cure and an increase in the provision of futile and potentially inappropriate medical care. Given the aging population and the growing number of individuals with chronic illness and multimorbidity, it is imperative that healthcare institutions and all level of governments be enlisted to address the increasing burden of illness. An essential component of addressing these challenges is to support the promotion of patient-centered palliative care that is integrated and coordinated throughout the entire healthcare system. Building upon the advancing theory and practice of palliative care all over the world2,3 and the recent advent of P4 Medicine, 4 the 2016 Taipei International Symposium created a declaration calling for access to P4 Palliative Care for all people with serious illness, regardless of their age or specific disease. 5 This declaration is built on the following six basic principles:
Our healthcare system must:
1. Develop and redraft national healthcare policies to promote access to palliative care integrated across all healthcare settings for all patients with serious illness. 2. Improve and recognize access to palliative care as a core component of our national health system, with an emphasis on integration of palliative care into primary healthcare and community and home-based care. 3. Recognize the importance of patient's individualized and personal concerns regarding comfort and dignity. 4. Recognize the family's essential role in the healthcare of the patient and recognize the need for emotional support for the family during provision of care to the patient and after the patient's death. 5. Recognize the importance of supporting clinicians in caring for patients with serious illness to ensure high-quality care and minimize burnout and moral distress among clinicians. 6. Establish continuous and seamless mechanisms of palliative care service delivery across all settings of care and ensure sustainable healthcare team capacity to meet the needs of patients and their families.
We further declare that integration of palliative care into our healthcare system should adhere to the four principles of P4 Palliative Care:
1. Personalized: Deliver patient-centered and family-focused care for all patients with serious illness, based on tailor-made care plans for each individual. Palliative care is the ultimate personalized medicine. 2. Participatory: Collaborate with patients, family members, healthcare professionals, volunteers, and others to create dynamic partnerships for sharing decision making and high-quality, patient-centered care as well as reciprocal respect and care. 3. Predictive: Identify the care needs of patients and family members as early as possible and accurately predict prognosis and outcomes for patients, identifying potential problems and risks among patients and their family members. 4. Preventive: Prevent patients and their family from suffering by offering integrated, high-quality home-based care on a foundation of mutual respect, reconciliation, and cherishing.
It is our hope that, with the implementation of the contents in this declaration, prevention of suffering can be achieved for all patients with serious illness, their families, the interdisciplinary healthcare team, as well as the whole society.
Launched in Taipei, July 17, 2016