Background In Singapore, Advanced Care Planning (ACP) for patients who lack mental capacity is often conducted with the patient’s family or proxy. The mismatch of perspectives between patients and proxies has been known in the West and this study investigated how perspectives differ in an Asian context.
Methods Twenty ACP discussion sheets completed with the patients, with or without a proxy decision maker and 20 ACP discussion sheets completed only with proxy, without the patient, were chosen at random for analysis. Thematic analysis was used to identify salient themes from both sets of discussion sheets and compared to understand the differences between decisions made by patients and proxies.
Results While overarching ideas on suffering and living well remain largely similar between the groups, there were marked differences in the area of medical interventions, place of care and religion. More proxies wanted comfort measures only for their loved ones, while patients tended to opt for additional interventions, such as intravenous medications or antibiotics. Similarly, while proxies preferred a trial of treatment at home or in a hospice before transferring to hospital, more patients wanted to be transferred to hospital immediately upon illness onset. Many patients mentioned religious beliefs as of importance whereas this was less mentioned by proxies.
Conclusions There are differences between the perspectives of patients and proxy decision makers in making ACPs. Future investigation should look at ways to align the proxy’s perspectives with that of the patient especially in dyad pairs including means to reduce differences during ACP facilitation.
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