Applicant: Buddhist Compassion Relief Tzu Chi Foundation (Singapore)
Programme Name:Conservative (Non-Dialysis) Management of Patients with End Stage Renal Disease
Singapore ranks the 4th highest in the number of end stage kidney failure globally. On average, 5 people are diagnosed with end stage kidney disease every day, based on the Singapore Renal Registry 2018, and this number is expected to increase, with an aging population and with increasing prevalence of diseases like diabetes. Besides dialysis and transplant, conservative care is another modality to care for the patients with end stage kidney disease.
Comprehensive Conservative Management (CM) is an active management without dialysis. These includes a shared decision-making process, interventions to delay kidney disease progression and minimise the adverse events and complications, management of symptoms related to end stage kidney failure without dialysis, and psychological, social and family support. The elderly patients with multiple health conditions, are frail or have declining health where the risks for dialysis are high - CM is an alternative treatment to support these patients in order to maintain their quality of life and to support their love ones.
For this pilot programme, Tzu Chi (TC) plans to:
- increase ESRD patients’ awareness of CM so they can make informed decisions on care options;
- partner Sengkang General Hospital (SKH) to identify ESRD patients who would not benefit from dialysis and refer them to the CM programme;
- upskill its Home Nursing and Home Medical teams to provide continuity of care for these patients who opt for CM (e.g. renal failure symptoms, e.g. swelling, anaemia, etc.);
- discuss Advance Care Planning (ACP) with patients; and
- transit CM patients to its Home Palliative team if prognosis is 12 months or less (or refer to hospice if patients’ condition could not be managed at their home).
The pilot would help to inform policy, support the scale up of CM capabilities in other community care providers, and evolve the support for home care patients.