Background Advance care planning (ACP) gives patients the opportunity to make their care plans and communicate it to their loved ones and healthcare providers (patient autonomy). While this principle is widely valued in Western societies, healthcare decision making in Asian societies such as Singapore’s are less straightforward. Here, healthcare decision making is more often a corporate agreement within the wider family unit than an individual undertaking.
Aim This one-year descriptive study looks at collective decision-making affecting the effectiveness of ACP for patients receiving palliative care at home.
Methods Patients admitted to care from 1st January to 31st December 2014 were included, and information on ACP progress was obtained from the patients’ case notes.
Results Despite high ACP initiation rates, completion of ACP was achieved in less than 50% of patients. The patient and/or the family’s refusal, reticence or impedance stood out as factors affecting the completion of ACP discussions.
Discussion In our Asian setting, the family is recognised as still having considerable authority as a decision-making unit. Some families requested for the patient not to be involved in the discussion, believing that it would distress the patient (collusion), and so the process could not continue as such.
Conclusion This study reports on familial influence in medical decision-making observed in Asian societies. Further studies should explore this influence and its underlying reasons to determine if addressing them could improve the rate of ACP completion.
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