Background Advance Care Planning (ACP) is an organised process of communication which helps individuals to discuss their preferences for future healthcare decisions. This documented discussion provides a guide for the medical team in making decisions regarding care in the time of a crisis. ACP, therefore, allows healthcare professionals to honour the patient’s wishes nearer the time of death.
Aim This paper studies the preferences and outcomes of the first 240 patients who have since passed away after the completion of their ACPs with an acute hospital in Singapore.
Methods We retrospectively reviewed completed ACP documents for patients’ preferences and compared these preferences with their death outcomes to see if their wishes were honoured. The cases where preferences were not honoured are further examined for reasons.
Results 88% of the patients died within a year of the ACP and 99% of them had their wishes honoured with regards to CPR. 66% had their choice of the place of death honoured.
Discussion Most of our patients had their final wishes honoured, in terms of the medical interventions given and resuscitation status. However, there were obstacles to honouring patients’ preferred places of treatment and death. Reasons include a lack of availability of immediate home care support, family’s lack of awareness of the dying process, urgent medical conditions, and other limitations of healthcare institutions.
Conclusion ACP allows patients to exercise their autonomy right to the last moments of their lives. Obstacles to honouring preferences should be considered by healthcare institutions in their efforts to facilitate dying-in-place.
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