Not that way: Advance Care Planning

How, Choon How; Koh, Lip Hoe

doi:10.11622/smedj.2015005

Cited by 16 publications

(10 citation statements)

References 4 publications

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“…In practice, a social care or healthcare professional may facilitate a conversation between the patient and his/her family members to explore his/her values, beliefs and how this impacts preferences towards medical care at the end of life. ACP is not legally binding in Singapore and, therefore, there is no need to engage a lawyer for its discussion or documentation 24. All participating patients are encouraged to identify a substitute decision-maker (SDM) who can make healthcare decisions on their behalf in the event of incapacitation.…”

Section: Methodsmentioning

confidence: 99%

Retrospective cohort analysis of real-life decisions about end-of-life care preferences in a Southeast Asian country

Tan

Bajpai

et al. 2019

BMJ Open

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ObjectiveTo describe the end-of-life care preferences of individuals, and to examine the influence of age and gender on these preferences.Design, setting and participantsA retrospective cohort study was conducted. Participants included all adults (≥21 years old) (n=3380) who had completed a statement of their preferences as part of a national Advance Care Planning (ACP) programme in Singapore. Data were extracted from the national and Tan Tock Seng Hospital ACP database.Main measuresEnd-of-life care preferences were obtained from the ACP document and differentiated by health status (healthy, chronically ill or diagnosed with advanced illnesses). To analyse the data, descriptive statistics and logistic regression analysis were used.ResultsAcross healthy and chronically ill patients, the majority did not opt for cardiopulmonary resuscitation (CPR) or other life-sustaining measures. Among individuals with advanced illnesses, 94% preferred not to attempt CPR but 69% still preferred to receive some form of active medical treatment. Approximately 40% chose to be cared for, and to die at home. Age and sex significantly predict preferences in those with advanced illnesses. Older age (>=75 years) showed higher odds for home as preferred place of care (OR 1.52; 95% CI 1.23 to 1.89) and place of death (OR 1.29; 95% CI 1.03 to 1.61) and lower odds for CPR (OR 0.31; 95% CI 0.18 to 0.54) and full treatment (OR 0.32; 95% CI 0.17 to 0.62). Being female was associated with lower odds for home as preferred place of care (OR 0.69; 95% CI 0.57 to 0.84) and place of death (OR 0.70; 95% CI 0.57 to 0.85) and higher odds for full treatment (OR 2.35; 95% CI 1.18 to 4.68).ConclusionThe majority preferred to not proceed with life-sustaining treatments, but there was still a strong preference to receive some form of limited treatment. Better understanding of end-of-life care preferences through ACP can better guide end-of-life care programme planning, and resource allocation decisions.

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Section: Methodsmentioning

confidence: 99%

Retrospective cohort analysis of real-life decisions about end-of-life care preferences in a Southeast Asian country

Tan

Bajpai

et al. 2019

BMJ Open

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“…Given that ACP is an ongoing conversations and process of engaging patients in their care arrangement, primary care physicians are uniquely advantaged to initiate ACP conversations because of their longitudinal therapeutic relationships with their patients and their comprehensive understanding of patients’ health priorities and social circumstances [ 50 ]. Some experts argued primary care physicians are in the best position to introduce and start the conversation regarding ACP [ 51 , 52 ]. Our paper serves to stimulate further research on what is the most suitable form of intervention to promote ACP in an Asian primary care setting.…”

Section: Discussionmentioning

confidence: 99%

Increasing the completion rate of the advance directives in primary care setting – a randomized controlled trial

Shi

Chee

et al. 2021

BMC Fam Pract

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Background The completion rate of Advance Directives (ADs) has been low. This study aims to examine the effectiveness of two interventions 1) active counseling sessions coupled with passive patient education pamphlets, and 2) patient education pamphlets alone, compared with 3) control group (usual care), in increasing the completion rates of ADs in the primary care setting. Methods Multicenter randomised controlled trial in four public primary care clinics in Singapore under Singapore Health Services. Randomization was performed via block randomization with Sequential Numbered Opaque Sealed Envelopes. Participants were randomized into 1) active intervention group (both counseling by primary care physicians and patient education pamphlets) or 2) passive intervention group (only patient education pamphlets), and 3) control group (usual care) with follow-up at 6 weeks. The main outcome measure is the proportion of participants who completed / planned to complete) ADs six weeks post-intervention. Results Four hundred five participants were eligible to participate in the study. One hundred eighty-eight participants were recruited into the study (response rate = 46.4%), of which 158 completed the study. There was no significant difference between the control group, passive intervention group, and active intervention group, in terms of completion rates of ADs (29.4, 36.4, and 30.8% respectively). Conclusions This randomized controlled trial did not support the use of patient education pamphlets with or without active counseling sessions in increasing the completion of ADs in a primary care setting in Singapore. The optimal intervention strategy depends on each health system’s context and resources, taking into consideration patients’ profiles, which deserves further studies. Trial registration Registered on April 17, 2018 clinicaltrials.gov (NCT03499847).

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“…(3) Patients who are diagnosed in the prodromal or mild cognitive impairment (MCI) stages of Alzheimer's disease can be encouraged to talk with their loved ones about their personal beliefs and goals of care and plan for their future health and personal care options. (4) A referral for a Lasting Power of Attorney and Advance Care Planning (5) can be arranged, if requested.…”

Section: How Relevant Is This To My Practice?mentioning

confidence: 99%

Approach to the forgetful patient

Yoon

Ooi

How

2018

smedj

Self Cite

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Singapore has an ageing population with a projected 53,000 people aged ≥ 60 years living with dementia by 2020. Primary care doctors have the opportunity to initiate early work-up for reversible causes of cognitive dysfunction, allowing identification of comorbidities and discussion of medical therapy options. Early diagnosis confers the sick role on the patient, which allays frustration and explains events and behaviour that may have strained relationships with family and friends. The patient can be encouraged to plan for future health and personal care options with a Lasting Power of Attorney and/or Advance Care Planning. Objective cognitive tests (e.g. abbreviated mental test and Mini-Mental State Examination) and brain imaging are adjuncts that help in formulating the diagnosis. Referral to a hospital memory clinic activates a multidisciplinary team approach to dementia, including clinical consultation, dementia counselling, physiotherapy sessions on gait/fall prevention, occupational therapy sessions on cognitive stimulation and caregiver training.

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Not that way: Advance Care Planning

Cited by 16 publications

References 4 publications

Retrospective cohort analysis of real-life decisions about end-of-life care preferences in a Southeast Asian country

Retrospective cohort analysis of real-life decisions about end-of-life care preferences in a Southeast Asian country

Increasing the completion rate of the advance directives in primary care setting – a randomized controlled trial

Approach to the forgetful patient

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