Background Advance Care Planning (ACP) aims to establish shared understanding of patients’ values and preferences, that acts as a guide for future medical care decisions. However, promoting conversations through ACP have come under scrutiny as patients’ preferences are rarely static and influenced by a variety of factors. Though barriers of healthcare professionals regarding initiation of ACP have been investigated, how patient factors influence ACP completion have not been well reported.
Methods We conducted a retrospective review of patients discharged or demised from 1st January 2019 to 31st December 2021 at HCA Hospice Limited, the largest home hospice palliative care service provider in Singapore. Completed ACP was defined as completion of all four domains: Resuscitation status, Extent of medical interventions, Preferred place of care (PPOC) and death (PPOD). Demographics and socioeconomical factors were studied. Duration of illness, length of stay (LOS) under home hospice service, and place of documentation were also compared.
Results Among a total of 7588 patients, 2249 (29.6%) had completed ACP. It was observed that patients with lower ECOG status, higher socioeconomic status, and those who were separated tend to have lower completion rates. There were no observed differences in age, gender, race, education, religion, or cancer versus non-cancer primary diagnoses. Patients with shorter LOS were also observed to have higher incompletion rates. Among those incomplete ACPs, most had discussions that were in progress (23.6%), while other reasons included patients being terminally ill or cognitively impaired. Patients with any unfilled ACP domains were also observed to have lower PPOD honoured rates as compared to those with their respective domains filled.
Conclusion Only a minority of patients have completed ACPs. This preliminary data may guide better identification of patients with ‘risk factors’ for incomplete ACP. Strategies to improve completeness can include education of healthcare professionals and streamlining documentation processes.
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