Background In developed countries, patients receiving Palliative Homecare (PHC) service are more likely to discuss care preferences and fulfilment of preferred place of death (PPOD). Amid Singapore’s aging society, the Ministry of Health (MOH) is boosting palliative care in the community to enable more people to demise in their PPOD. A 2014 Lien Foundation survey on death attitudes found that over three-fourths of Singaporeans prefer home death, yet only a quarter of deaths in 2020 occurred at home. In comparison, Singapore Hospice Council (SHC) found that 55% of patients referred to PHC were able to die at home. This retrospective study aims to determine the rates of Advance Care Planning (ACP) discussion in a homecare setting, its associated rates of fulfilled PPOD, and possible reasons for unfulfilled PPOD.
Methods De-identified data of 402 patients from Dover Park Hospice (DPH) homecare who demised between January and December 2022 were reviewed. 12 patients were excluded due to inconclusive data. Data of 390 patients were analysed for completed ACP discussion initiated by the homecare team, and the fulfilment of PPOD.
Results ACP was initiated by the homecare team for 373 (95.6%) of 390 patients. Only 2 (0.5%) patients declined or were not ready, while the remaining 15 (3.9%) demised before the initial home visit. PPOD was fulfilled for 344 (92.2%) patients, of which 249 (72.4%) patients managed to demise at home.
Conclusions Majority of patients receiving PHC have ACP discussions, which may be attributed to consistent interactions and rapport between patients and the homecare team. The rates of fulfilled PPOD home deaths are higher than the national average (72.4% vs 55%), which suggests homecare patients and families referred to PHC are well-supported at the end-of-life. Hence, building the capacity to provide PHC service in the community may improve fulfilled PPOD rates.
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