Background The Agency for Integrated Care has endeavoured to implement ACP nationally, starting with public hospitals and in the last year more community-based providers. End-of-life discussions are often considered to be taboo in this South East Asian city-state. This presentation examines its strategies, learning and future plans for ACP.

Aim To examine the strategies employed in Singapore’s 5-year national ACP journey, share key learning points and the plans forward.

Methods Diverse cultural composition and family structures that place familial harmony over autonomy has enabled a “uniquely Singapore” approach to ACP design and delivery, from documentation to outreach. The development of an Advocacy training programme has created opportunity for involvement by social care and civic organisations.

Results Over 1,200 facilitators have been trained, including a growing number from non-healthcare backgrounds. ACP has spread beyond hospital walls to nursing homes, eldercare centres, home care and hospice care providers. The ACP website, www.livingmatters.sg in use since late-2014, enables exploration of care wishes using a guided web-based tool.

Discussion Facilitated ACP discussions are beneficial for elderly patients with complex health conditions and multiple care providers, while self-administered ACPs may be the way forward for younger and healthier segments of population.

Conclusion There is no one-size-fits-all approach to ACP implementation across care settings. Leeway for multiple iterations is necessary. Maintaining ACP as a non-legally binding framework has been beneficial.