The Straits Times (27 June 2019)
More patients at Tan Tock Seng
Hospital (TTSH) have been making
plans for their future care.
In 2011, the hospital introduced
its advance care planning (ACP)
system, which documents a person’s
future healthcare preferences
so that his family members and doctor
can use this information when,
in case of a medical emergency, a
patient cannot speak for himself.
New figures show that 1,279 patients
had signed up to the system
last year, up from 415 in 2013.
But Dr Adeline Lam, who is leading
the initiative, thinks that even
more patients can take up the discussion
to plan for their future
health and personal care, including
those who currently do not have
any medical conditions.
The scheme was initiated by the
Singapore Government in 2011,
modelled on the Respecting
Choices programme in the United
States.
Before 2011, TTSH staff would
discuss ACP with patients on an ad
hoc basis, which was one of the reasons
for the low take-up rate.
“It is not an easy discussion, especially
in Asia where there is a lot of
taboo and superstition about
death,” said Dr Lam, who is a consultant
in the general medicine department.
“Some relatives feel that
by having this discussion, they are
taking hope away.”
Other factors that have stalled
these discussions are people having
a lack of time or not knowing
much about ACP.
The hospital has since used a
three-pronged approach to bump
up numbers: spreading public
awareness of ACP; training general
medicine doctors about it; and asking
patients who are in their 60s
and 70s – and have more serious
medical conditions – about making
such plans.
Last year, 594 TTSH staff were
trained in ACP, up from 142 in 2013.
Madam Wee Ah Miow, 87, is one
patient who made plans in 2017 after
the new system was up and running.
While the stroke survivor had
frequent conversations with her
children about how she preferred
not to have surgery for her medical
conditions, her plans were not formally
documented.
“I don’t want to trouble people
and be dependent on them,” said
Madam Wee. “I’d rather go if I become
bedridden.”
It also helped that the planning
was done with her doctor of 11
years – Dr Lam.
ACP sessions take about an hour
and while they are free at some
places, others charge around $30,
said Dr Lam.
ACP facilitators can be found at
other hospitals and medical centres,
such as National University
Hospital, Alexandra Hospital,
Khoo Teck Puat Hospital (KTPH),
Singapore General Hospital, National
Heart Centre Singapore and
Changi General Hospital.
At KTPH, the number of advance
care plans has jumped from 196 in
2013 when the programme was piloted,
to 515 last year.