An exploratory study of the knowledge, attitudes and perceptions of advance care planning in family caregivers of patients with advanced illness in Singapore

Ng, Raymond; Chan, Susan; Ng, Tzer Wee; Chiam, Ai Ling; Lim, Sthenos

doi:10.1136/bmjspcare-2012-000243

Cited by 40 publications

(58 citation statements)

References 26 publications

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“…The reasons for pursuing ACP were consistent with those in extant literature4 11 12; personal welfare, family and financial matters. Planning for finances was foremost and comparable in importance to a previous Singapore study11 which involved a younger sample with presumably better education and knowledge, factors that are generally associated with higher uptake of ACP.…”

Section: Discussionsupporting

confidence: 73%

“…In East Asian culture, Confucianism and the high importance placed on an individual's relations with family and society have critical influence on end-of-life decisions 12. Within the traditional Asian context, patients may choose to leave decision-making to their children.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, family members are not always supportive of ACP engagement or may adopt a dismissive attitude to patients’ end-of-life decisions. Speaking about death and dying has traditionally been a cultural taboo among Chinese 11 12. This uniquely Asian phenomenon can present obstacles to ACP and thus deserves further research to explore ways to overcome this sociocultural barrier.…”

Section: Discussionmentioning

confidence: 99%

“…Singaporeans who felt ACP was necessary gave reasons such as ‘to lessen the financial burden and emotional burden on loved ones’, ‘to avoid prolonging suffering’, ‘respect autonomy and guide patients and family’ 11 12. Conversely, those who thought ACP was irrelevant remarked: ‘it was bad luck to talk about death and a cultural taboo’, ‘they were unlikely to be in a situation that required one’ and ‘they were fearful of destroying patient's hope’.…”

Section: Introductionmentioning

confidence: 99%

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Advance care planning in people with early cognitive impairment

Cheong

Fisher

Goh

et al. 2014

BMJ Support Palliat Care

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Background/aim: People with early cognitive impairment (ECI), comprising mild cognitive impairment and early dementia face the risk of diminished mental capacity with progressive disease. Advance care planning (ACP) is advocated as a means to uphold the autonomy of individuals and enable them to express their wishes for the future while they still possess mental capacity. This study aims to explore the perspectives of patients with ECI regarding ACP, and in particular, understand their reasons for resistance. Method: Consecutive patients undergoing a counselling service for persons with ECI who fulfilled inclusion criteria (Mini Mental State Examination score ≥18, Global Clinical Dementia Rating (GCDR)=0.5 or 1 were recruited. Demographic and clinical data was collected and the detailed documentation in the case records of the counselling sessions was subjected to a thematic analysis. Differences between patients who were willing to engage in ACP and those who declined were also analysed. Results: 93 patients (mean age 76, 60.2% female) were recruited of which 38.7% chose to engage further in ACP discussions. GCDR was the only factor that emerged significant on bivariate analysis for willingness to engage in ACP (t (79) =2.191, p<0.05, two-tailed) whereby milder CI was associated with a greater likelihood of ACP engagement. Among those who declined ACP, three main themes emerged from the thematic analysis. The majority deferred decision-making to their families. Some perceived ACP as irrelevant or unnecessary, and displayed avoidance and denial during ACP discussions. Conclusions: A large proportion of patients with ECI decline ACP discussions and the reasons are influenced by personal values, coping behaviours and sociocultural norms. These findings have important implications for practice

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Advance care planning in people with early cognitive impairment

Cheong

Fisher

Goh

et al. 2014

BMJ Support Palliat Care

View full text Add to dashboard Cite

show abstract

“…Ng et al listed some common barriers in exploring ACP, including it being culturally taboo to talk about end-of-life issues and a fear of destroying hope, especially for the older generations of Singaporeans. (5) …”

Section: How Relevant Is This To My Practice?mentioning

confidence: 99%