Singapore Hospice Council Releases Landmark Study on Palliative Care Practitioners' Professional Identity

The Singapore Hospice Council (SHC) has published a pioneering exploratory qualitative study in Frontiers in Health Services, shedding light on how palliative care practitioners (PCPs) in Singapore experience professional identity formation (PIF). This process involves internalizing new experiences to reconcile with one's pre-existing sense of self, ultimately leading to improved patient care and staff wellbeing. Conducted amid Singapore's expanding palliative care needs due to an ageing population, the study draws from focus groups with 35 representatives across 19 SHC member organisations, including major institutions like National Cancer Centre Singapore and Assisi Hospice.

PIF is crucial in high-stakes fields like palliative care, where practitioners manage complex emotional, ethical, and clinical demands. The research highlights a multi-faceted identity shaped by biomedical expertise, psychosocial skills, interprofessional collaboration, and leadership expectations, offering actionable insights for workforce development.

Understanding Professional Identity Formation in Palliative Care

Professional Identity Formation (PIF) refers to the ongoing process by which individuals integrate professional roles, values, and experiences into their core sense of self. In palliative care, this is particularly challenging due to frequent encounters with death, suffering, and moral dilemmas. PCPs must balance clinical skills with empathy, often navigating cultural sensitivities in multicultural Singapore.

Prior to this study, little was known about PIF among Singapore's PCPs. The SHC's work fills this gap, using a relativist ontological position—acknowledging multiple realities—and constructivist epistemology to explore subjective experiences. This approach ensures a nuanced view of how identity evolves in real-world practice.

Methodology: Capturing Voices from the Frontlines

The study employed seven focus group discussions (FGDs) from August to September 2024, each lasting 1-1.5 hours. Participants represented diverse roles—doctors, nurses, allied health professionals—from SHC members like Tan Tock Seng Hospital and Singapore General Hospital. Data was audio-recorded, transcribed, anonymised, and thematically analysed, yielding three core themes and seven subthemes.

This rigorous qualitative design allowed for rich, context-specific insights, reflecting Singapore's unique healthcare landscape where palliative care integrates hospital, hospice, and home-based services.

Theme 1: The Prevailing Professional Identity of PCPs

PCPs described their identity as rooted in holistic care, encompassing pain management, emotional support, and family involvement. Subthemes included biomedical competence (e.g., symptom control) and psychosocial expertise (e.g., navigating grief). Many viewed themselves as 'companions' rather than mere clinicians, emphasising presence and dignity in dying.

This identity fosters resilience but demands continuous skill-building. For instance, practitioners highlighted the need for advanced training in cultural competence, given Singapore's diverse population including Malays, Indians, and Chinese.

Theme 2: Dilemma Between Self-Sufficiency and Interprofessional Collaboration

A key tension emerged: pride in individual expertise versus reliance on teams. PCPs valued autonomy in decision-making but recognised interprofessional collaboration (IPC) as essential for comprehensive care. Challenges included role overlaps and communication barriers, yet successful IPC enhanced identity affirmation and reduced burnout.

The study underscores how IPC practices directly support staff wellbeing, recommending structured team-building to resolve this dilemma.

Theme 3: Expectations of Organisational Leadership

Participants expected leaders to align organisational goals with frontline realities, providing resources, recognition, and psychosocial support. Strong leadership reinforced professional identity by validating efforts and mitigating systemic stressors like workload pressures.

This theme highlights the role of hospice and hospital management in fostering a supportive culture, crucial as Singapore scales palliative services.

Implications for Palliative Care Workforce Development

The findings advocate a multi-pronged strategy: (1) competency development in biomedical and psychosocial domains, (2) IPC fostering for mutual support, and (3) leadership alignment with service needs. Implementing these could improve retention amid projected 20-30% workforce shortages by 2030.

• Enhance training programs to build holistic skills.
• Promote IPC through regular debriefs and simulations.
• Invest in leadership development for hospices and hospitals.

Future research should test these interventions' effectiveness. Explore career advice for healthcare researchers to contribute to such studies.

Palliative Care Landscape in Singapore: Growth and Challenges

Singapore's National Strategy for Palliative Care (2023) aims to expand home care by 50% to 3,600 places by 2025, with inpatient hospice up 15%. Yet, surveys show only 40% of healthcare workers feel trained, exacerbating shortages. Burnout is prevalent, linked to workload and emotional toll.

SHC, formed in 1995, unites 20+ members including university-linked centres like National University Cancer Institute, Singapore (NCIS). For more on SG healthcare, visit AcademicJobs Singapore.

Higher Education's Role: Training the Next Generation of PCPs

Universities are pivotal in addressing PIF through specialised programs. Duke-NUS Medical School's Lien Centre for Palliative Care (LCPC) offers certificates for nurses, social workers, and therapists, plus postgraduate courses for doctors. NTU's Holistic Palliative Care Programme (HoPE) trains multidisciplinary teams.

These initiatives align with SHC findings, emphasising psychosocial training and IPC. NUS and NTU graduates are primed for roles strengthening professional identity. Aspiring professionals can find higher ed jobs in palliative care education.

Addressing Burnout and Retention in Singapore's Hospice Sector

High burnout rates among PCPs stem from emotional demands and staffing gaps. The SHC study reveals how strong PIF buffers these, but systemic support is vital. Home hospice faces acute shortages as demand surges with ageing demographics—over 1 million seniors by 2030.

• Workload management via better IPC.
• Psychosocial debriefs post-cases.
• Leadership advocacy for resources.

Universities like Duke-NUS integrate resilience training, preparing graduates for sustainable careers. Check Rate My Professor for insights into palliative educators.

Future Outlook: Building a Resilient Palliative Care Workforce

The SHC study paves the way for evidence-based reforms. By 2026's 9th Singapore Palliative Care Conference, expect discussions on PIF integration into national training. Partnerships between SHC, MOH, and universities will drive capacity-building.

Prospects are bright for faculty positions in palliative education at NUS or NTU. Professionals seeking growth can explore higher ed career advice.

Photo by Albert Vincent Wu on Unsplash

Opportunities in Palliative Care: Join Singapore's Growing Field

Singapore's palliative sector offers rewarding careers amid expansion. With university programs equipping PCPs for strong identity formation, now's the time to specialise. Visit university jobs, higher ed jobs, or career advice for openings. Post your profile at post a job to connect with employers.

This study not only illuminates PIF but inspires a supportive ecosystem for compassionate care.