Discussion on advance care planning ‘not an easy conversation to have’ but important, say experts

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SINGAPORE: Advance care planning (ACP), which is part of the process of end-of-life planning, may make for difficult conversation, but it is still important, experts said.

ACP is the process of planning for future healthcare with family and doctors.

In an ACP discussion, patients are guided to understand, reflect upon, and discuss their goals, values and beliefs. They are also led to indicate their preferences regarding future healthcare treatments.

ACP also involves nominating a “substitute decision-maker” who can make decisions on the patient’s behalf. The documented discussion, while not legally binding, provides guidance for the medical team in making decisions when the patient no longer can communicate.

“The conversation around advanced care planning and being able to express our values, beliefs, and preferences in terms of the care that we would like to have at the end of our life, particularly when we lose the mental capacity to do so, is really important,” Agency for Integrated Care (AIC) CEO Tan Kwang Cheak said.

“But we acknowledge that it is not an easy conversation to have, which is why we have been working really hard on advance care planning services to actually enable and also encourage our Singaporeans to come forward.”


One way to make the conversation easier is to have a facilitator, said Dr Adeline Lam, co-lead for Advance Care Planning initiative at Tan Tock Seng Hospital.

“Most of the time, when the facilitator is in that conversation, the facilitator becomes a mediator and navigates through the sometimes difficult conversation and it's very useful,” said Dr Lam, who is also senior consultant in the general medicine department.

She gave the example of a patient who brought 10 family members, including her children and her in-laws for an ACP discussion. Her family were focused on what she was saying, she said.

“It was a way to hear what (their) mum has to say, but not directly because it's sometimes a little bit difficult for families to talk about this, but with a facilitator, it gets a little bit easier,” she said.

Dr Lam said ACP is useful throughout life, and preferences can be reviewed through differe...

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