Academic Journal
Evaluating the impact of a home palliative programme for terminally ill non-cancer patients with end-stage organ failure and severe frailty in Singapore.
| Title: | Evaluating the impact of a home palliative programme for terminally ill non-cancer patients with end-stage organ failure and severe frailty in Singapore. |
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| Authors: | Kaur P; Health Services and Outcomes Research, National Healthcare Group, National Skin Centre, 1 Mandalay Road, Singapore, 308205, Singapore., Pereira MJ; Health Services and Outcomes Research, National Healthcare Group, National Skin Centre, 1 Mandalay Road, Singapore, 308205, Singapore., Manohari A; Health Services and Outcomes Research, National Healthcare Group, National Skin Centre, 1 Mandalay Road, Singapore, 308205, Singapore., Suan LK; Department of Palliative Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore., De Castro Molina JA; Health Services and Outcomes Research, National Healthcare Group, National Skin Centre, 1 Mandalay Road, Singapore, 308205, Singapore., Yaw WH; Department of Palliative and Supportive Care, Woodlands Hospital, 17 Woodlands Drive, Singapore, 737628, Singapore. Huei.Yaw.Wu@nhghealth.com.sg. |
| Source: | BMC palliative care [BMC Palliat Care] 2026 May 13; Vol. 25 (1). Date of Electronic Publication: 2026 May 13. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: BioMed Central Country of Publication: England NLM ID: 101088685 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-684X (Electronic) Linking ISSN: 1472684X NLM ISO Abbreviation: BMC Palliat Care Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London : BioMed Central, [2002- |
| MeSH Terms: | Palliative Care*/methods , Palliative Care*/standards , Palliative Care*/statistics & numerical data , Home Care Services*/standards , Home Care Services*/statistics & numerical data , Terminally Ill*/psychology , Terminally Ill*/statistics & numerical data , Frailty*/psychology , Frailty*/therapy , Frailty*/complications, Program Evaluation/methods ; Terminal Care/methods ; Humans ; Female ; Male ; Singapore ; Aged ; Middle Aged ; Prospective Studies ; Aged, 80 and over ; Cohort Studies ; Retrospective Studies |
| Abstract: | Objective: To evaluate Programme IMPACT, a home-based palliative care initiative for terminally ill non-cancer patients with end-stage organ failure and severe frailty at the end-of-life, in achieving palliative outcomes, honouring end-of-life care preferences, and reducing acute healthcare utilisation. Methods: Patients with non-cancer diagnoses, prognosis of ≤ 6 months, palliative goals of care, and preference for home as a place of care or death were enrolled between October 2017 and December 2021. First, we employed a single-arm prospective cohort design to assess symptom control and concordance between preferences and delivered care. Second, we compared healthcare utilisation, costs and place of death between programme decedents and non-cancer controls without palliative care identified retrospectively. Utilisation was analysed with Poisson regression, costs with generalised linear models (gamma log link), and logistic regression for home deaths, adjusting for baseline confounders. Results: A total of 387 patients were enrolled in the programme. Patients experienced significant clinical benefit, with mean symptom scores improving by 2.5 points on the Edmonton Symptom Assessment Scale. Concordance between preferences and outcomes exceeded 94% for CPR status and medical treatments and 89% for place of death. Compared with controls, programme decedents incurred significantly lower utilisation and costs: admissions and length of stay (Rate Ratio [RR]: 0.65-0.85, p < 0.005), admission-related and total costs (Mean Ratio [MR]: 0.56-0.75, p < 0.001), and ED visits and costs (RR & MR: 0.69-0.81, p < 0.008). They were also 16.6 times more likely to die at home (95% CI: 10.2-27.0; p < 0.001). Conclusion: Home-based palliative care improves symptom control, aligns care with preferences, and reduces acute hospital use and costs among this population. (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the National Healthcare Group Domain Specific Review Board (NHG DSRB 2019/00583), and the study adhered to the Declaration of Helsinki. All data were de-identified and anonymised by an independent third party. Informed consent was obtained from all patients and/or their next of kin prior to participation in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. |
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| Grant Information: | 24:42/5-16 Ministry of Health -Singapore |
| Contributed Indexing: | Keywords: End-of-life care; End-stage organ failure; Home-based palliative; Non-cancer; Palliative care |
| Entry Date(s): | Date Created: 20260514 Date Completed: 20260707 Latest Revision: 20260813 |
| Update Code: | 20260813 |
| PubMed Central ID: | PMC13340280 |
| DOI: | 10.1186/s12904-026-02137-6 |
| PMID: | 42129744 |
| Database: | MEDLINE |
| ISSN: | 1472-684X |
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| DOI: | 10.1186/s12904-026-02137-6 |