ACP Conversations Research Articles

PILOTING AN INTEGRATED APPROACH OF ADVANCE CARE PLANNING FOR AN ELDERLY POPULATION WITHIN A PROVINCIAL CITY

BackgroundAdvance Care Planning (ACP) has been introduced into New Zealand in recent years. New Zealand National ACP Cooperative has developed ACP tools and resources. Wanganui is a provincial region (population...

IMPLEMENTING A NATIONAL ADVANCE CARE PLANNING (ACP) PROGRAMME IN SINGAPORE

BackgroundSince its inception in 2011, ACP has steadily gained traction among healthcare providers in rapidly ageing Singapore. Efforts to implement ACP, beginning with public hospitals, are spearheaded by a National...

ADVANCE CARE PLANNING, A STEP-BY-STEP GUIDE FOR HEALTH CARE PROFESSIONALS ASSISTING PATIENTS WITH CHRONIC CONDITIONS TO PLAN FOR CARE TOWARDS END OF LIFE

BackgroundAdvance Care Planning encourages people to think about, and discuss their preferred about future health care. Many patients rely on their health professionals to initiate ACP discussions, however most health...

Co-designing ACP service delivery with consumers in New Zealand

Auckland District Health Board together with the New Zealand ACP Cooperative held co-design workshops with consumers to explore how consumers want ACP services delivered. The questions and topic areas covered...

Does physician remuneration improve advance care planning and end of life discussions in primary care?

It is not known how remuneration for advance care planning and end of life issues (ACPEL) discussions influences physician practice. In Calgary, AB family physicians get remunerated for completing a...

Advance Care Planning in terminally ill and frail older persons

ObjectiveAdvance Care Planning (ACP) – the communication process by which patients establish goals and preferences for future care – is encouraged to improve the quality of end-of-life care. Gaining insight into the views of elderly on ACP was the aim of this study, as most studies concern younger patients. MethodsWe conducted and analysed 38 semi-structured interviews in elderly patients with limited prognosis. ResultsThe majority of participants were willing to talk about dying. In some elderly, however, non-acceptance of their nearing death made ACP conversations impossible.Most of the participants wanted to plan those issues of end-of-life care related to personal experiences and fears. They were less interested in planning other end-of-life situations being outside of their power of imagination. Other factors determining if patients proceed to ACP were trust in family and/or physician and the need for control. ConclusionsACP is considered important by most elderly. However, there is a risk of pseudo-participation in case of non-acceptance of the nearing death or planning end-of-life situations outside the patient's power of imagination. This may result in end-of-life decisions not reflecting the patient's true wishes. Practice implicationsBefore engaging in ACP conversations, physicians should explore if the patient accepts dying as a likely outcome. Also the experiences and fears concerning death and dying, trust and the need for control should be assessed.

Introducing advance care planning in patients with advanced COPD

BackgroundAdvance care planning has become government policy in Scotland and England, and many health professionals are being trained to do it for all patients with advanced life-limiting disease. However there...

Behaviour Response and Ageing

<h3>Background</h3> Since its inception in 2011, ACP has steadily gained traction among healthcare providers in rapidly ageing Singapore. Efforts to implement ACP, beginning with public hospitals, are spearheaded by a National ACP Steering Committee, in collaboration with service providers and government agencies. However public awareness remains low. This poster examines the key thrusts, outcomes, and challenges in assimilating ACP in our system of care. <h3>Aim</h3> To share Singapore9s experience in implementing ACP nationally, with considerations such as its diverse cultural and ethnic composition, family structures that tend to place familial harmony over autonomy, and lack of communication on end of life matters. <h3>Methods</h3> ACP is implemented along 3 thrusts: (i) Increasing ACP awareness among healthcare professionals, community and religious leaders, and the public; (ii) Training more ACP facilitators in health and social care organisations to assist with ACP conversations; and (iii) Building and strengthening systems to support ACP implementation, including a national ACP IT system. <h3>Results</h3> Over 450 facilitators have been trained. Pilots are on-going in five public hospitals, in departments such as Palliative Medicine, Cardiology, Oncology and Respiratory Medicine. <h3>Discussion</h3> With plans to improve health and social support for aged persons in the community, greater emphasis must be placed on developing ACP services among providers of intermediate and long-term care. Community engagement, media advocacy and publicity also need to be in place to raise awareness and normalise conversations in care planning. <h3>Conclusion</h3> In tandem with the growth of ACP at acute and community settings, greater engagement and empowerment of providers and the public must also happen.