Background Since May 2020, MOH and AIC have worked with the ACP Steering Committee to issue a set of tele-ACP guidelines to institutions during COVID-19. The guidelines include guidance on enrolment criteria, consideration for video-conferencing platforms and work processes to note during ACP facilitation and documentation. In order to appraise the appropriateness of tele-ACP as one of the long-term strategies, AIC conducted an evaluation to understand the barriers and facilitators of tele-ACP implementation.

Methodology 11 focus group discussions (FGDs) were carried out in Feb 2022, with a total of 21 participants from 13 service providers. The FGDs explored current state of implementation, key workflows at different stages of tele-ACP, facilitators and barriers of implementation, and readiness of organisations to leverage on tele-ACP as a long-term modality. Qualitative inputs from participants were recorded for thematic analysis.

Results The participants (n=21) comprised of ACP facilitators and administrative staff who were directly involved in tele-ACP implementation at their respective institutions. The findings showed that most institutions have well-developed tele-ACP workflows that detail the work processes to identify and refer suitable clients for tele-ACP, and the preparations which should be done before, during, and after tele-ACP sessions. As of May 2022, at least 600 ACPs had been completed over tele-conferencing platform, with the frequency ranging from one to five tele-ACPs per month. Common challenges faced include sustaining client and family engagement, perceived lack of human touch, and added administrative workload which includes difficulties in obtaining signatures remotely. Despite these challenges, tele-ACP is mostly welcomed by ACP facilitators as a key modality to offer convenience to the enrolled patients.

Conclusion Tele-ACP is deemed appropriate and acceptable by providers, clients, and families involved. Sustainability of this intervention hinges on the efforts from policy and leadership to maintain process fidelity, provide appropriate training, and lower administrative barriers.