SINGAPORE – A visit to the Intensive Care Unit (ICU) is often highly distressing for patients and their family members alike. An average of 20%1 of ICU patients pass away in the ICU while undergoing treatment. When palliative care is offered, it may be introduced too late.
Recognising the need for a more human-centric model of ICU care, Tan Tock Seng Hospital (TTSH) and the National University Hospital (NUH) have launched A Kinder ICU programme. Supported by Lien Foundation with an investment of $3.93 million, the four-year programme aims to integrate palliative care earlier in the ICU care journey, so that critically ill patients can receive earlier symptom relief and psychological support in the ICU alongside life-sustaining treatment. This is expected to benefit more than 7,600 ICU patients over the next four years at both hospitals.
Mr Lee Poh Wah, CEO of Lien Foundation said, “The ‘kinder’ in A Kinder ICU signifies an intentional gentleness within an often fast-paced and technologically intense environment—gentleness in communication, in treating symptoms, and in guiding families through uncertainty and grief. By embedding palliative care, we redefine success not as survival at any cost but as care that honours human dignity, relieves suffering, and respects the natural limits of medicine.”
ICU care is primarily focused on life-saving treatment that can be aggressive and invasive. Introducing palliative care early in the patient’s care allows a longer runway to ease symptoms and pain as well as support families in navigating complex treatment in a way that is aligned with their goals and values.
A Kinder ICU leverages expertise from TTSH and NUH to advance a progressive model of palliative care integration within the ICU settings, building on existing efforts at both institutions. TTSH established its ICU-Palliative Care programme, the first of its kind locally, 12 years ago. At NUH, a community of Palliative Care Resource Nurses was developed to work with the intensive care doctors in delivering general palliative care, supported by palliative care specialists.
For patients, A Kinder ICU translates into several key interventions to facilitate early identification of palliative care needs and the delivery of appropriate care:
Assistant Professor Neo Han Yee, Head and Senior Consultant, Department of Palliative Medicine, TTSH said: “ICU and palliative teams deliver complementary physical, psychosocial and emotional care that benefits patients and families alongside ongoing curative treatment. While a mature collaboration exists at TTSH, with evidence-based protocols and guidelines in place to ensure patient-centered care, we hope this enhanced programme will drive a cultural shift across the entire intensive care landscape in Singapore, and for all ICU staff to adopt palliative care approaches in their daily work. Such palliative care will improve the lived experiences of both suffering patients and anxious families. This programme is aligned with the global advocacy to assimilate palliative care earlier in ICU settings.”
To operationalise these improvements, the hospitals will train about 800 ICU staff over the next four years consisting of ICU doctors, nurses, therapists and social workers that underpin this programme.
Nurses, in particular, play a vital role as advocates for patients as well as identifying caregivers in need of psychological support. They help strengthen communication between the hospital and families for better delivery of early palliative care.
“Because nurses are with ICU patients 24/7, we are often the first to notice subtle, non-verbal signs of distress,” said Ms Charmaine Sim Peizhen, Advanced Practice Nurse, Medical Intensive Care Unit, NUH. “Through strengthened palliative care training, nurses are better equipped to bring this sensitivity into every shift and translate bedside observations into timely action. This enables us to lead palliative care reviews, initiate difficult conversations with families, and advocate for patients who can no longer speak for themselves. Through A Kinder ICU, we hope to further advance nurses’ role in initiating and championing palliative care as part of everyday ICU practice.”
A community of practice of about 50 palliative care nurse champions across both hospitals will mentor and guide ICU nurses in daily practice, supported by Advanced Practice Nurses who lead knowledge sharing and professional development. Nursing leadership development will be progressively strengthened, with planned opportunities for overseas exposure and collaborations with established centres.
The hospitals will establish a training curriculum to equip the ICU multidisciplinary team with the knowledge and skills to incorporate core palliative care practices into routine intensive care. ICU staff will be trained to proactively identify physical discomfort of patients unable to speak and alleviate symptoms, support distressed and grieving families, as well as identify vulnerable patients for early specialist palliative care consultation. This is complemented by a tiered education approach under A Kinder ICU, delivered through targeted microlearning modules and onsite workshops that enable progressive skill-building and sustained practice integration.
This curriculum will be rolled out within TTSH and NUH, and across the NHG Health cluster, with plans to extend to partner institutions across Singapore and internationally, advancing a more consistent, compassionate model of ICU care across the system.
To download the PDF version of the media release, click here.
For more information about A Kinder ICU, please visit https://lienfoundation.org/project/a-kinder-icu/.
1 Vincent J, Marshall J, Ñamendys-Silva S et al. Assessment of the worldwide burden of critical illness: the Intensive Care Over Nations (ICON) audit. The Lancet Respiratory Medicine, 2014; 2, 380-386
