O5 Competing expectations: advanced care planning from the perspectives of doctors and nurses in the south-east asian context

Abstract

Introduction Singapore has the fastest ageing population in the world, with the number of individuals aged 65 and older increasing to an estimated 9 00 000 in the next thirty years. Corresponding demand for health and social care among the aged could surge, especially in terms of palliative care, which will more than double by 2020 to over 10 000 patients per year. In response, the national Advance Care Planning (ACP) programme was launched in Singapore in 2011 with the purpose of improving quality of palliative care through enabling patients to express their end-of-life care needs and wishes to healthcare professionals and caregivers. The purpose of this study is to examine the perspectives of doctors and nurses on facilitation of end-of-life care conversations and decision-making in Singapore Methods Eight focus group discussions and dyadic interviews were conducted with physicians and nurses. Discussions were facilitated by members of the research team and focused on participants understanding of their role as a healthcare professional in the context of end-of-life care and their adherence to precepts of ACP. Transcripts and audio recordings of FGDs were stored digitally and analysed through QSR NVivo. Themes emanating from transcripts were identified through a framework analysis approach. Results Facilitation of end-of-life conversations and decision-making processes were influenced by life and death culture. The ACP programme was mostly conducted in acute medical settings, wherein the prevailing institutional philosophy was that of the biomedical model of care. Consequently, the organisation of services was primarily focused on curation, with doctors playing a leading role in terms of decisions on patients’ care. Nurses were often disempowered in terms of making decisions on patients’ pathways through care. Conclusion End-of-life conversations were often conducted in acute care settings, in which the structure of services were often hierarchical and predicated on the biomedical model of care.