A survey of symptoms in hospice patients in Singapore.

A descriptive study was done on patients referred to a hospice home care service in Singapore. The demographic profile, type of disease, presenting symptoms and performance status were noted. Particular attention was paid to the incidence of pain and types of analgesics used. The patients referred were representative of the population at large, as was their incidence of cancer. Eastern Cooperative Oncology Group (ECOG) performance status was poor (ECOG 3 or 4) in 93 (93%) of the patients referred, indicative of the lateness of referral in many cases. The number of symptoms per patient averaged 5.8, and pattern of symptoms were similar to those of comparable groups of patients in other parts of the world. Pain was present in 82 (82%) patients and controlled only in 22 (22%) of these at presentation. Strong opioids had been prescribed for 51 (51%) patients. In these, oral morphine mixture was incorrectly prescribed in 17 (47%) out of 36 cases. Education in palliative care is needed so that patients are referred to palliative care services appropriately. Though there is some indication of improvement, medical education in pain management continues to be necessary, particularly in the correct prescription of morphine.