Palliative Care for Older People in Viet Nam: Integrating Symptom Relief, Goals of Care and Family Support Across the Care Continuum

Palliative Care for Older People in Viet Nam: Integrating Symptom Relief, Goals of Care and Family Support Across the Care Continuum

AGE-FRIENDLY CARE QUALITY, INTEGRATED CARE & CARE TRANSITIONS

Last reviewed: October 2026

An older person living with advanced heart failure may still be receiving active treatment but struggle with breathlessness, fatigue and repeated hospital admissions. Someone with dementia may gradually lose the ability to communicate pain or eat independently while their family becomes increasingly exhausted. Another person may be living with cancer, chronic lung disease or severe frailty and want to remain at home for as long as possible, while still needing reliable symptom relief and access to clinical support.

In each situation, good care involves more than treating the underlying disease. It also means asking whether suffering is being recognized and relieved, whether treatment still reflects what matters to the person, whether family caregivers have the support they need, and whether care remains coherent as the person moves between hospital, rehabilitation or transitional care, home, community services and long-term care.

That is where palliative care belongs.

Palliative care is not only care for the last days of life

Palliative care is still sometimes understood as something offered only after disease-directed treatment has stopped or when death is very near. WHO’s concept is much broader. Palliative care is a crucial part of integrated, people-centered health services and aims to relieve serious health-related suffering, whether physical, psychological, social or spiritual. WHO specifically identifies conditions including cardiovascular disease, cancer, major organ failure, drug-resistant tuberculosis, advanced chronic illness and extreme frailty of old age as situations in which palliative care may be needed, and emphasizes that it should be available across levels of care.

Viet Nam’s national clinical guidance takes the same broad approach. Ministry of Health Decision No. 183/QĐ-BYT of 25 January 2022 issued the national Palliative Care Guidelines. The guidance states that palliative care can be introduced early in serious illness and provided alongside potentially curative or life-prolonging treatment. It also emphasizes supporting access to appropriate disease treatment when that treatment is consistent with the person’s wishes and states that palliative care should not intentionally hasten death.

For older people, this distinction is particularly important. The choice is rarely simply between “active treatment” and “palliative care.” An older person may continue treatment for heart failure or cancer, participate in rehabilitation and, at the same time, need relief from pain, breathlessness, anxiety or caregiver stress. As health and function change, the balance among these elements may change as well.

Older people may need palliative care for complex and changing needs

Serious illness in later life often does not follow the trajectory of one disease. An older person may simultaneously live with heart failure, chronic kidney disease, diabetes, frailty and cognitive impairment. Another may have advanced dementia without one clearly defined terminal episode. Symptoms may fluctuate, prognosis may remain uncertain, and repeated hospitalizations may gradually reduce function and resilience.

Decision 183 explicitly addresses palliative-care needs beyond cancer, including advanced heart and lung disease, multidrug-resistant tuberculosis, dementia, serious neurological conditions, trauma and frail or vulnerable older people. Its guidance for older people recognizes that significant physical, psychological, social or spiritual suffering may occur even when no single progressive disease defines the whole clinical picture.

Advanced dementia illustrates why this matters. A person may gradually lose the ability to walk, eat or toilet independently and may no longer be able to describe pain or breathlessness reliably. Care teams may need to observe behaviors such as grimacing, moaning, agitation or changes in breathing rather than wait for a verbal complaint. Families may also carry substantial physical and emotional burden over a long period.

Not every older person with frailty or multimorbidity needs specialist palliative care. Decision 183 differentiates basic, intermediate or advanced, and specialist palliative-care capability. Its model places basic palliative care within primary and community care while more specialized services support people whose symptoms, psychosocial needs or treatment decisions are more complex.

The goal is not to turn every older-person service into a specialist palliative-care unit. It is to make recognition and relief of suffering part of ordinary high-quality care.

Symptom relief should address the whole person

Pain is important, but palliative care is not simply pain management. Older people with serious illness may experience breathlessness, fatigue, nausea, constipation, loss of appetite, sleep disturbance, anxiety, depression, delirium or several problems at the same time. Treatment for one symptom may also affect mobility, cognition, nutrition or another symptom.

Assessment therefore needs to be repeated as the person’s condition changes, particularly when communication is impaired by dementia, stroke, delirium or severe illness. A person who cannot describe pain clearly still needs a reliable process for recognizing and treating it.

Palliative-care assessment also extends beyond physical symptoms. Serious illness can threaten independence, identity and meaning. Families may face financial strain, uncertainty about what will happen next and fear about whether they can continue providing care at home. Spiritual or existential concerns may become more important as illness progresses.

Decision 183 reflects this multidimensional approach. Its assessment framework includes physical symptoms, psychological and emotional problems, social and financial circumstances, spiritual concerns, living arrangements, caregiver support, risk of caregiver exhaustion, decision-making and safety issues.

For an older person, good symptom control should therefore not be judged only by a lower pain score. It also matters whether the person can sleep, communicate, eat, move, spend time with people who matter to them and live with as little avoidable distress as possible.

Goals of care connect treatment with what matters, and need to change when circumstances change

As illness becomes more complex, treatments may remain technically available even when their contribution to the person’s priorities becomes less clear. Another hospital admission, invasive procedure or intensive treatment may offer substantial benefit in one situation and limited benefit in another. These decisions become particularly difficult when prognosis is uncertain, several illnesses interact or treatment may prolong life while also creating significant burden.

This is why goals of care are central to palliative care. Goals of care are not simply decisions about cardiopulmonary resuscitation or whether treatment should continue. They clarify what care is trying to achieve. Depending on the person and clinical situation, goals may include cure, longer survival, maintaining function, remaining at home, controlling symptoms, preserving cognition, spending meaningful time with family or maximizing comfort. Several goals may coexist.

Decision 183 instructs care teams to consider what the patient values, discuss prognosis and goals of care, and explain the potential benefits and harms of life-sustaining treatments. Its examples include disease treatment despite significant adverse effects, comfort-focused care, combining treatment and comfort, or treating reversible conditions while prioritizing comfort when reversal is not possible.

The guidance also emphasizes communication. Clinicians should understand what the patient and family know about the condition, correct misunderstandings sensitively, ask what matters most to the person, explain options honestly, encourage questions and be prepared for strong emotional responses.

Shared decision-making does not mean asking families to make technical medical decisions without clinical guidance. It brings together the best available clinical information, the likely benefits and burdens of available options, and the patient’s values and preferences.

Goals also need to be revisited. A care plan that made sense when someone was living independently may need reconsideration after recurrent hospitalization, severe frailty or major cognitive decline. Decision 183 specifically recommends reviewing goals when the clinical condition changes substantially and describes future care planning as something that should begin early enough for the person to participate meaningfully.

For organizations, the practical implication is that a goals-of-care discussion should not disappear into one clinician’s note. Relevant decisions need to be visible to the next team and updated as circumstances change. Otherwise, families may be forced to reconstruct important decisions during an emergency when the person can no longer participate.

Viet Nam already has a substantial clinical and legal foundation

It would be inaccurate to describe palliative care as something Viet Nam still needs to introduce from the beginning. Decision 183 is a detailed national clinical guideline covering palliative-care principles, communication, symptom management, psychosocial and spiritual care, serious illnesses, dementia and frailty, end-of-life care, home care, discharge planning and integration into the health system.

Its integration model is particularly relevant to older-person care. The guideline states that palliative care should be accessible across levels of the health system. Commune-level services can provide basic palliative care, continue care initiated in hospital, monitor symptoms, arrange home visits where appropriate and refer people whose suffering cannot be adequately managed at community level. Decision 183 describes home care as an important and indispensable component of the palliative-care system.

The guideline also provides explicit continuity processes. When a patient receiving palliative care moves from one level of the health system to another, the clinician at the sending facility should contact the receiving clinician and provide a transfer summary. The specified information includes major diagnoses and treatment, palliative-care needs, the reason for transfer, current goals of care, current medications and drug allergies. For hospital discharge to home, the guideline recommends contacting the nearest commune-level clinician before the transfer and communicating the person’s palliative-care needs and expected follow-up.

Viet Nam’s legal framework has also evolved since the guideline was issued. The Law on Medical Examination and Treatment No. 15/2023/QH15, effective from 1 January 2024, provides rights to information and, subject to the requirements and exceptions in the Law, to refuse medical examination or treatment. Article 15 further provides that when an adult later loses civil act capacity, has difficulty with cognition or behavioral control, or has restricted civil act capacity, a lawful written expression of that person’s wishes concerning medical examination and treatment made beforehand is to be followed.

These provisions provide an important legal basis for respecting prior written wishes in defined circumstances. They should not, however, be presented as though Viet Nam has a separate, comprehensive advance-directive regime identical to those used in some other jurisdictions.

Decision 183 itself uses the concepts of advance care planning and advance directives, defining an advance directive as a written record of the person’s values or preferences for end-of-life care and how medical decisions should be made if the person later loses decision-making capacity.

The practical message is therefore straightforward: important conversations should happen while the older person can still participate meaningfully, and their values and preferences should be documented in a way that can inform future care within the requirements of Vietnamese law.

Palliative care should follow the person across settings

Palliative needs do not begin or end at a hospital door.

In hospital, palliative care may help with difficult symptoms, communication, treatment decisions and discharge planning while disease-directed treatment continues. During rehabilitation or transitional care, a person may need both functional recovery and symptom control. Rehabilitation and palliative care are not necessarily opposites; someone may be working toward enough mobility to return home while also needing treatment for breathlessness, pain, fatigue or anxiety.

At home, priorities may increasingly involve practical symptom control, medication continuity, caregiver preparation and knowing whom to contact when the situation changes. In primary and community care, clinicians and health workers can monitor symptoms, review the care plan, identify caregiver burden and reconnect the person with higher-level services when needs become more complex.

In long-term care, residents may live with progressive frailty, dementia or advanced chronic illness over months or years. Staff need to recognize deterioration, provide basic comfort-focused care within their competence and have clear clinical escalation pathways. Decisions about hospital transfer should reflect the person’s clinical needs, goals of care and available professional assessment rather than automatically defaulting either to transfer or to remaining in place.

This approach fits WHO’s broader view of palliative care as part of integrated, people-centered services rather than a separate system activated only in the final days of life.

It is also increasingly visible within WHO’s healthy-ageing work. The 2024 WHO Clinical Consortium on Healthy Ageing included a dedicated panel on palliative care and quality of dying as part of work on the continuum of integrated care for older people; the meeting report was published in 2025.

Viet Nam’s 2026 older-person care reforms create a potential implementation interface

Ministry of Health Decision No. 1976/QĐ-BYT of 1 July 2026 introduced professional guidance for older-person care at home and in the community. It covers areas including daily care, health support and guidance for those providing care, within the newer framework for home- and community-based older-person care.

Decision 1976 does not replace the Palliative Care Guidelines and does not itself establish a formal palliative-care pathway linked to Decision 183. Its significance is different: it expands the care infrastructure around older people at home and in the community.

For an older person living with advanced frailty, dementia or serious chronic illness, the two frameworks create a potential implementation interface. Functional and care-needs assessment, symptom recognition, caregiver support, individualized planning, referral and palliative-care follow-up should not operate as unrelated activities simply because they sit in different guidance documents.

This is an implementation opportunity rather than a current national requirement. The practical question is not which guideline “owns” the patient. It is whether the older person experiences a coherent journey in which health, function, symptoms, goals and caregiver needs remain connected.

Family caregivers need support as part of the care plan

Palliative care often depends heavily on families, particularly when an older person wants to remain at home. Family members may organize medicines, assist with feeding or personal care, observe changes in breathing or consciousness, accompany the person to appointments and provide emotional support as health deteriorates.

Decision 183 recognizes this role throughout its guidance. Its assessment framework includes caregiver circumstances and risk of caregiver exhaustion, while its end-of-life guidance emphasizes preparing families for what they may see and experience.

Family caregivers, however, are not an unlimited resource. An older spouse may have chronic illness of their own. Adult children may be balancing employment and other family responsibilities. Dementia, nighttime symptoms, repeated transfers and uncontrolled breathlessness can make home care extremely demanding even in committed families.

A safe plan should therefore ask not only, “Can the family provide care?” but also what exactly they are being asked to do, whether they understand how to do it safely, and what support is available when their capacity is exceeded.

Family involvement should strengthen continuity, not compensate indefinitely for gaps in formal services.

What Viet Nam’s existing evidence tells us about implementation

Published Vietnamese evidence remains much stronger in cancer palliative care than in broader older-person palliative care, so generalization needs to be cautious. Even so, it provides useful implementation lessons.

A 2023 study evaluated an integrated hospital- and home-based palliative-care service linked to Ho Chi Minh City Oncology Hospital. The home-care team included at least one physician and one nurse and served cancer patients living within a defined local radius. Among 81 consecutive patients, pain improved between the first home visit and follow-up, while people with severe breathlessness, nausea or vomiting, diarrhea, depression or illness-related worry also showed improvement; caregiver worry improved as well. The study demonstrated feasibility and improved people-centered outcomes in that specific cancer-center model, but it should not be generalized automatically to all older people or all regions of Viet Nam.

A 2025 qualitative study explored barriers to safe opioid access for cancer pain relief in Viet Nam through interviews with 17 participants: five healthcare professionals, six patients or caregivers and six regulators. Participants described barriers involving fear of addiction and adverse effects, professional knowledge and experience, medicine availability, regulatory processes and limited palliative- and home-care services. Because the study was small, qualitative and cancer-specific, these findings should be understood as stakeholder-reported barriers rather than national prevalence estimates or a complete description of the regulatory environment in 2026.

The broader lesson is that reliable palliative care depends on more than one intervention. Clinical capability, medicine availability, communication, care coordination, home support and governance need to work together. Weakness in any one part can interrupt the pathway.

Basic palliative-care capability should be part of routine care

A sustainable system cannot require a specialist palliative-care team for every older person living with serious illness.

Decision 183 describes basic, intermediate or advanced, and specialist levels of palliative-care training. Its integrated model expects basic palliative-care capability to extend into primary and community care while specialist services support more complex needs. THƯ VIỆN PHÁP LUẬT

In an acute hospital, this may mean clinicians and nurses can recognize uncontrolled pain or breathlessness, begin appropriate assessment, communicate sensitively about goals and obtain specialist consultation when complexity exceeds their competence. In primary and community care, it may mean recognizing deterioration, supporting relatively simple symptom-management plans, checking caregiver capacity and knowing when higher-level assessment is required.

In long-term care, basic capability should include recognizing palliative needs, providing comfort-focused support within staff competence and connecting the resident with appropriate medical or specialist services. Specialist palliative care remains important for complex or refractory symptoms, difficult communication, challenging psychosocial situations and complicated treatment decisions.

The objective is not to replace specialists. It is to ensure that relief of suffering does not depend entirely on whether a specialist happens to be available.

Measurement should ask whether suffering is relieved and continuity improves

Counting how many people receive a “palliative-care consultation” is useful for measuring service activity. It does not, by itself, show whether care improved.

A stronger quality approach would ask whether pain and other distressing symptoms are assessed and reassessed, whether psychological, social and spiritual needs are identified where relevant, whether goals of care are documented and reviewed after major changes, whether the transition plan explains how symptoms will be managed and whom the family should contact, whether caregiver needs are assessed, whether necessary medicines can actually be obtained, and whether relevant information reaches the next care setting.

Patient- and caregiver-reported outcomes can also be valuable because they show whether suffering or caregiver worry actually improves rather than simply documenting what professionals did.

Organizations may also examine referral patterns, response times for complex symptoms, continuity after hospital discharge, staff competency and availability of essential medicines. Measures such as emergency-department use or hospital transfer near the end of life require particularly careful interpretation: lower use is not automatically better and should be considered against clinical need, patient preferences, available community support and agreed goals of care.

These are illustrative quality measures, not a proposed national palliative-care indicator set for Viet Nam.

Viet Nam can also build integration progressively. A hospital could begin with a defined group of older people with serious illness who have uncontrolled symptoms, repeated admissions, major functional decline or difficult treatment decisions. Existing teams could use a structured approach to symptom assessment and goals-of-care discussions, with clear criteria for specialist consultation.

Before discharge, the team could establish who will manage symptoms at home, which medicines are required, whether the caregiver understands the plan, what deterioration should trigger contact and which service will provide follow-up. Hospitals and selected commune health services could then test a shared transition process, while long-term-care providers could establish clinical links for residents whose symptoms or decision-making needs become more complex.

The purpose of such a pilot would not be to show that a palliative-care form can be completed. It would be to determine whether suffering is relieved, families are supported and continuity actually improves.

Palliative care is ultimately about better care during serious illness

Older-person care should not force people into a false choice between treatment and comfort. A person can want to live longer and also want breathlessness relieved. They can receive cancer treatment while needing help with pain and anxiety. They can participate in rehabilitation while also discussing what should happen if their health deteriorates again. Someone with advanced dementia still deserves careful symptom relief, dignity and support for the family even when they can no longer describe those needs themselves.

Viet Nam already has a substantial clinical foundation through Decision 183/QĐ-BYT, relevant legal provisions on patient rights and prior written wishes under the 2023 Law on Medical Examination and Treatment, and a developing home- and community-care architecture for older people in 2026. The challenge is not simply to issue another guideline. It is to make existing principles work together across real care journeys.

For health and care organizations, the most useful question is therefore not simply, “Is this person receiving palliative care?” It is:

“Are we recognizing and relieving this person’s suffering, understanding what matters to them, aligning treatment with those goals, supporting the family, and making sure that plan continues when care moves to the next setting?”

When those questions can be answered consistently, palliative care becomes more than a specialist service or a form of end-of-life care. It becomes part of the infrastructure for safe, compassionate, person-centered and integrated older-person care.

References

1. World Health Organization. Palliative care. WHO Health Topics.

2. World Health Organization. Palliative care. Fact sheet.

3. World Health Organization. WHO Clinical Consortium on Healthy Ageing 2024: Meeting Report. Geneva: World Health Organization; 2025.

4. World Health Organization. Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care. 2nd ed. Geneva: World Health Organization; 2025.

5. Ministry of Health of Viet Nam. Decision No. 183/QĐ-BYT issuing the Palliative Care Guidelines. 25 January 2022.

6. National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. 9 January 2023; effective 1 January 2024.

7. Ministry of Health of Viet Nam. Decision No. 1976/QĐ-BYT issuing professional guidance on care for older people at home and in the community. 1 July 2026.

8. Nguyen V, Khanh QT, Hocaoglu M, Huyen HTM, Thinh DHQ, Krakauer EL. Integrated Hospital- and Home-Based Palliative Care for Cancer Patients in Vietnam: People-Centered Outcomes. Journal of Pain and Symptom Management. 2023;66(3):175–182.e3. doi:10.1016/j.jpainsymman.2023.04.016.

9. Nguyen T, Dam A, Bui L, Pham T, Krakauer EL, Phelan C. I Wait for Leftover Morphine: A Qualitative Study of Barriers to Safe Opioid Access for Cancer Pain Relief in Vietnam. JCO Global Oncology. 2025;11:e2500026. doi:10.1200/GO-25-00026.