Thailand's experience in Advance Care Planning.

In 2007, Thailand enacted the National Health Act, which contains the Advance Directive (Section 12). Even though the Act was enacted nearly sixteen years ago, physicians have not fully adopted it, limiting the number of patients who can benefit from the Advance Directive. Thai culture values the role of extended family in end-of-life planning, which is frequently marked by a conspiracy of silence (inability to discuss end-of-life issues), so patients may have limited opportunities to participate in decision-making and care planning. Thailand introduced a Palliative Care Policy in 2014. The inclusion of palliative care in the health service plan is the most crucial factor for palliative care provision. Through health inspections, the Ministry of Public Health supervises, monitors, and evaluates the management of the National Palliative Care Program. Advance Care Planning (ACP) and three other major KPIs were to be included in health inspections by 2020. In 2021, the Office of the National Health Commission implemented ACP, including the formation of (a) a committee to create a national ACP form and standard operating procedures and (b) a steering committee to oversee the nationwide implementation of ACP.

Integration of Specialist Palliative Care into Tertiary Hospitals: A Multicenter Point Prevalence Survey from Thailand.

Background: Accessibility and quality of hospital-based palliative care in Thailand have received scant attention. Objective: To determine the prevalence of inpatients who require in-hospital palliative care, to identify the proportion with access to specialist palliative care, and to define the factors associated with accessibility to specialist palliative care. Design: A cross-sectional analysis of a multicenter survey. Setting/Subjects: We surveyed all hospitalized patients from Thailand's four regions admitted to 14 tertiary care hospitals. Measurements: We used the Supportive and Palliative Care Indicators Tool to identify palliative care patients then reviewed their medical records. We categorized hospitalized palliative care patients into a palliative care consultation group and a nonconsultation group. The odds ratio (OR) between patient characteristics and patient groups was estimated using binary logistic regression. Results: One-fifth (18.7%) of hospitalized patients were palliative care patients, whereas only 17.3% received a specialist palliative care consult. Of these, one-third (28.4%) received advance care planning (ACP) documentation. One-quarter of patients in pain were not prescribed analgesics. The logistic regression analysis revealed that palliative care consultations were associated with patients >65 years (OR = 1.830, 95% confidence interval [CI]: 1.122-2.987), a cancer diagnosis (OR = 2.640, 95% CI: 1.478-4.718), strong opioids prescription (OR = 5.519, 95% CI: 3.217-9.469), and ACP documentation (OR = 50.149, 95% CI: 28.239-89.059). Conclusions: The prevalence of hospitalized palliative care patients in Thailand is comparable with that in developed countries; however, accessibility remains a significant gap, as specialist palliative care is associated with the quality of palliative care service.