ACP has been part of holistic care in Singapore since 2011. When patients do not have an ACP, healthcare teams often rely on surrogate decision-makers to determine patient’s values and preferences. Several studies have been done and demonstrated a discordance of 26–35% between patients and their surrogates in decisions on CPR and extension of life. There are no national statistics on the number of ACPs that are done by surrogates. There are few studies to demonstrate the concordance of ACP at the end-of-life.
A retrospective analysis was done for patients admitted to General Medicine Department in Tan Tock Seng Hospital in 2015, who had an ACP on admission. The aim was to determine how many ACPs involved patients, secondary aims were assessment of ACP concordance at the end-of-life care.
Our study involved 56 patients, 16.07% of the ACPs involved the patient. ACP discordance was highest in those who had chosen home as the preferred place of death (PPOD), with 69.23% passing away in the acute hospital instead of at home. 82.6% died within 1 year of the ACP and 39.47% died during the hospitalization when the ACP was first done.
ACP requires involvement of the patient to ensure an accurate reflection of their values and preferences. The biggest discordance in the ACP is in the PPOD. There are many factors that cause PPOD discordance. More training and support is needed in nursing homes and home medical services to allow patients to pass away peacefully in a place of their choice.
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