Background When COVID-19 hit Singapore in 2020, the public was advised to avoid visiting the hospitals unless for essential services. Advance Care Planning (ACP) services in hospital and community had to be stopped to reduce exposure for the public. However, it was not feasible for ACP services to stop with no foresight of when it could resume. Ironically, ACP should all the more be advocated amidst the pandemic.
Henceforth, the team planned and implemented a tele-ACP workflow in February 2020 to ensure accessibility in continuity of care and reduce waiting time for ACP appointments.
Methods Tele-ACP is conducted only via Zoom, given its security and encryption features. Criteria of patients include ability to read basic English, having electronic device with internet access, and having no severe hearing or speech impairment.
Pre-ACP appointment: Zoom details including a guide were sent to patients and/or NHS.
On appointment day: Before session starts, ACP Facilitator will ensure that patient and/or NHS are at a space where there is privacy. Internet stability will also be checked.
Post-ACP appointment: Signatures will be obtained electronically or via post, while ensuring personal data is well-protected.
Results From February 2020 to November 2022, 105 tele-ACPs (14 General ACPs and 91 Preferred Plan of Care) were completed. 45 were completed in 2020 and 2021 each, while 15 were done in 2022 (as of November). The average duration for tele vs in-person ACPs is both about 90 minutes, indicating that the effort and time spent are not any less despite ACP discussions being done virtually.
Conclusions Looking at the number of tele-ACPs completed and how it is still actively carried out despite COVID-19 situation being stable and restrictions lifted, tele-ACP is clearly in healthy demand. This shows that tele-ACP is here to stay, being both sustainable and transferable to multiple settings.
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