Background A background review of the baseline rate of Advance Care Plan (ACP) completion in patients admitted to the palliative department of Tan Tock Seng Hospital (TTSH) was 4.9%. As part of an ongoing effort to increase the rate of ACP completion, an improvement project was embarked on in March 2022. Initial efforts were encouraging, but the rate dropped 5 months after the project had started. An online survey was conducted to ascertain the attitudes towards completing the ACP.
Methods The survey was conducted in November 2022. The survey targeted clinical staff of the TTSH Palliative department. Responses were collated by a medical student who was part of the team.
The questions posed pertained to confidence in conducting ACP discussions, reasons for not completing an ACP, barriers that significantly deter one from completing an ACP and what would help staff conduct ACPs.
Results There were a total of 22 medical staff who completed the survey. 91% of respondents were confident in conducting an ACP. Responses were divided on whether patient-related factors had a part to play with non-completion. At times, family or patients are not ready for ACP discussions. >50% of staff found entering data into the national ACP platform portal very cumbersome. 22% felt that there is a lack of reminders to complete ACP.
Conclusions In conclusion, the main barrier in completing ACPs was that the national ACP platform portal is too cumbersome. Majority felt that post ward round reminders to screen for suitable patients would be useful. This survey has helped the project team understand and implement more relevant measures in trying to prioritize ACP appropriately at the end of life.
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