Background The overall rates of Advance Care Planning (ACP) discussed and uptake have remained low in Singapore. Therefore, this study aimed to explore the attitudes and barriers towards the uptake of ACP among our community-dwelling residents with chronic diseases.
Methods A descriptive exploratory qualitative study involving face-to-face and semi-structured interviews were conducted between July and December 2022. Purposive and convenience sampling were used to recruit community-dwelling residents who were aged 50 years and above, with chronic diseases, spoke English, and resided in the Southeast region of Singapore. Basic sociodemographic data including marital status, living arrangement and number of chronic diseases were collected. Interviews were audio-recorded and transcribed verbatim. Data were analyzed inductively using thematic analysis.
Results Ten participants were recruited and interviewed either at a community nurse post or in their own home. Four themes were identified: 1) Attitudes towards life and past experiences, 2) Knowledge on ACP, 3) Family relationships and socialization opportunities, and 4) Psychological readiness. Participants’ own attitudes towards life and past experiences of family members and friends who were seriously ill shaped their perceptions and uptake of ACP. Being an ACP advocator and receiving information from other healthcare professionals and media encouraged uptake. Lack of insights was associated with confusion with other advanced healthcare directives and ACP workflow as well as ambivalence towards personal care preferences. Maintaining harmonious family relationships encouraged uptake while the lack of socialization opportunities hindered uptake. Without psychological readiness, participants felt that ACP evoked fear of the unknown and death which led to denial and procrastination.
Conclusions The findings shed light on the complexity of factors affecting ACP uptake. The implementation of ACP need to address specific facilitators and barriers, including increasing awareness and knowledge on ACP, encouraging socialization opportunities, and broaching about psychological readiness, personal self and family members’ past experiences.
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