Background Advance Care Planning (ACP) in Singapore is modelled after the Respecting Choices programme in the United States. Singapore, a multi-ethnic nation with an ageing population, implemented the ACP programme in public hospitals since 2010.
Aim This paper studies the profile of the first 450 patients and families with completed ACPs in an acute hospital in Singapore.
Methods We reviewed retrospectively patients’ demographics, principal diagnosis, choice of substitute decision maker (SDM) and their preferences with regard to medical intervention and their preferred place of treatment and death.
Results Most of the patients were Chinese (79%) with a median age of 81 years. 52% were female. Adult offspring were most commonly appointed by patients as first SDM (76.4% of the time), followed by spouses (13.3%). 74% of the patients preferred to have limited additional intervention if their condition deteriorates and 58% preferred to pass away at home.
Discussion It is highly feasible to conduct ACP discussions among patients in an acute hospital, even though it is time-consuming. The large number of geriatric patients represented in this group mirrors the ageing population of Singapore. The racial groups represented conform to the ethnic pattern of Singapore. The tendency to delegate decision-making to offspring is prevalent among the elderly in Singapore. Preferences on medical intervention remain largely conservative among patients and families.
Conclusion There is urgency among the elderly in Singapore to address existential issues by discussing ACP. Further research can be done to assess the correlation between one’s ethnicity and culture with decision-making and preferences.
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