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PP24.002 Understanding moral distress and adaptive responses of healthcare professionals in advance care planning
  1. Jia Ying Tang1,
  2. Chou Chuen Yu1,
  3. Siew Fong Goh1,
  4. James Alvin Yiew Hock Low1,2,
  5. Andy Hau Yan Ho3,
  6. Chong Jin Ng2,
  7. Maria Teresa Cruz4,
  8. Roland Chong5,
  9. Ka Yan Kathleen Cheung6,
  10. Sumytra Menon7 and
  11. Raymond Ng1,8
  1. 1Geriatric Education and Research Institute, Singapore
  2. 2Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
  3. 3School of Social Sciences, Nanyang Technological University, Singapore
  4. 4Department of Advanced Internal Medicine, National University Hospital, Singapore
  5. 5Department of Ops (DICC), Tan Tock Seng Hospital, Singapore
  6. 6Department of Medical Social Services, Singapore General Hospital, Singapore
  7. 7Centre for Biomedical Ethics, National University of Singapore, Singapore
  8. 8Palliative and Supportive Care, Woodlands Health, Singapore


Background Advance Care Planning (ACP) allows for communication of patient’s preferred care plans in the future with family members and healthcare professionals (HCPs) in the event if patient falls seriously ill. Oftentimes, HCPs and ACP facilitators may face moral distress in honouring and facilitating the ACP. The aims of this current study are to examine factors of moral distress and ethical conundrums faced, differentiate those who cope well with moral distress, their coping strategies, and derive information usable for developing future training programmes.

Methods This abstract will present the findings of the qualitative phase of a two phase mixed-methods study. In-depth interviews using the phenomenological approach will be conducted with a sample of ACP facilitators and frontline healthcare providers (n=30). Views on moral distress faced and their coping strategies, as well as their recommendations for future ACP-related moral distress will be explored. Framework analysis will be use to interpret the results and these findings will likely help to calibrate the questions for the survey in the subsequent phase.

Results We expect to identify common scenarios that might cause moral distress during ACP. These include (i) family making choices that are not in the patient’s best interests, (ii) proceeding with expressed preferences knowing that it is difficult to honour and (iii) making decision based on ACP documentation that lack clarity. Findings will highlight the coping strategies, problem solving techniques, sources of resilience and support, as well as training needs of ACP facilitators.

Conclusion This study hopes to unveil factors of moral distress and ethical conundrums during the process of ACP implementation, coping strategies, and to derive potential recommendations in ameliorating such distress as well as gaps in knowledge and systems. The findings will hopefully help in the development of future training programmes and policies to aid ACP implementation.

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