Background While older age is associated with better emotional well-being, it is unclear whether such age advantages remain during a pandemic. This study examined differences in mental health, adaptive behaviours, social support, perceived stress, digital media usage, and perceived change in circumstances between younger and older adults during the circuit breaker period (partial lockdown) in Singapore. Methods A door-to-door survey was administered to a nationally representative sample of 602 younger (n = 302) and older (n = 300) adults aged 21–89 years from Singapore from 17 October to 27 November 2020. All participants self-reported their depression, anxiety, stress, adaptive behaviours, social support, perceived stress, change in circumstances, and digital media usage during the partial lockdown period. Results Older adults were found to report significantly lower levels of depression, anxiety, and stress as compared to younger adults. Although older adults were less able to perform essential activities during the lockdown, they were more adaptable psycho-socially. Logistic regression analyses revealed that for older age group, adaptability and health status significantly predicted better mental health. Older adults had higher odds of low depression scores [odds ratio (OR) 1.81, 95% confidence intervals (CI) 1.07–3.08], anxiety scores (OR 1.80, 95% CI 1.05–3.08), and stress scores (OR 3.05, 95% CI 1.72–5.41). In addition, adaptability was found to moderate the relationship between age and mental health with detrimental effects of low adaptability stronger for younger adults than older adults. Conclusions During the lockdown period, older adults in Singapore had better mental health, perceived less stress-related concerns and were more adaptable psycho-socially as compared to younger adults. This study’s findings extend current evidence that age-related advantages in emotional well-being persisted in the wake of the COVID-19 pandemic.

Background ENABLE (Educate, Nurture, Advise, Before Life Ends) is a nurse coach-led, early palliative care model for patients with advanced cancer and their family caregivers. Content covered includes problem-solving, advance care planning, symptom management and self-care. The aim was to evaluate the cultural acceptability of ENABLE among patients with advanced cancer and their caregivers in Singapore and identify modifications for an adapted ENABLE-SG model. Methods Qualitative formative evaluation with a thematic analysis approach in two hospitals in Singapore, involving patients (n = 10), family caregivers (n = 11) and healthcare professionals (n = 10) who care for patients with advanced cancer. Semi-structured interviews were conducted to explore (i) the main needs and challenges facing individuals with advanced cancer and their family caregivers; (ii) patient involvement in healthcare decision making; and (iii) content and delivery of ENABLE. Results While physical needs were largely well met, participants expressed that psychosocial care was delivered too late in the illness trajectory. Healthcare decision making approaches varied from a patient-centred shared decision-making model to a family-centred model where patients may not know their cancer diagnosis and prognosis. The content was considered to be relevant, comprehensive and practical; financial assistance, adjustment to body image, and evaluation of complementary therapy were also recommended. Face-to-face rather than telephone sessions were preferred to facilitate rapport building. Conclusions ENABLE was broadly acceptable with some modifications, including adjusting the content to ensure it can be delivered even if the patient is not fully aware of cancer diagnosis and delivering the first session face-to-face with flexibility for subsequent sessions.

ObjectiveTo define clinical empathy from the perspective of healthcare workers and patients from a multicultural setting.DesignGrounded theory approach using focus group discussions.SettingA health cluster in Singapore consisting of an acute hospital, a community hospital, ambulatory care teams, a medical school and a nursing school.Participants69 participants including doctors, nurses, medical students, nursing students, patients and allied health workers.Main outcome measuresA robust definition of clinical empathy.ResultsThe construct of clinical empathy is consistent across doctors, nurses, students, allied health and students. Medical empathy consists of an inner sense of empathy (imaginative, affective and cognitive), empathy behaviour (genuine concern and empathic communication) and a sense of connection (trust and rapport). This construct of clinical empathy is similar to definitions by neuroscientists but challenges a common definition of clinical empathy as a cognitive process with emotional detachment.ConclusionsThis paper has defined clinical empathy as ‘a sense of connection between the healthcare worker and the patient as a result of perspective taking arising from imaginative, affective and cognitive processes, which are expressed through behaviours and good communication skills that convey genuine concern’. A clear and multidimensional definition of clinical empathy will improve future education and research efforts in the application and impact of clinical empathy.

Introduction: The COVID-19 pandemic has brought about multiple losses to various groups, namely patients, families and healthcare professionals. Grief, which is the reaction to these losses, could cause strain on these individuals’ physical and mental health if not identified and managed early. This scoping review analysed loss, grief and how they were managed among these groups during the pandemic. Method: This scoping review utilised the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute framework for scoping reviews. Only qualitative studies relating to loss and grief and their management were included. Of 166 studies screened, 69 were included in the study. Qualitative analysis and data coding of each record were conducted through qualitative data analysis software. Results: Losses included the death of family members, patients, colleagues and others. They also included the loss of usual routines, lifestyles and physical health. The grief experienced was multidimensional, affecting mainly the emotional, physical, social and existential realms. Anger, guilt and fear resulted from unsatisfactory farewells, issues with funerals, social isolation, financial strain and stigmatisation. Management strategies could be categorised into 5 themes: communication, finance, counselling, education and spiritual care. Conclusion: Loss and grief identification and management among patients, family members and healthcare professionals are critically important during this COVID-19 pandemic. Current operating guidelines have proven insufficient in managing loss and grief. Innovative strategies are essential to tackle the many dimensions of loss and grief. Nevertheless, further research is necessary to better understand the effectiveness of implemented policies. Keywords: Bereavement, death, mourning, outbreak, palliative care

Background COVID-19 is an infectious disease caused by the SARS-CoV-2 virus that has caused substantial impact on population health, healthcare, and social and economic systems around the world. Several vaccines have been developed to control the pandemic with varying effectiveness and safety profiles. One of the biggest obstacles to implementing successful vaccination programmes is vaccine hesitancy stemming from concerns about effectiveness and safety. This review aims to identify the factors influencing COVID-19 vaccine hesitancy and acceptance and to organize the factors using the social ecological framework. Methods We adopted the five-stage methodological framework developed by Arksey and O’Malley to guide this scoping review. Selection criteria was based on the PICo (Population, Phenomenon of interest and Context) framework. Factors associated with acceptance and hesitancy were grouped into the following: intrapersonal, interpersonal, institutional, community, and public policy factors using the social ecological framework. Results Fifty-one studies fulfilled this review’s inclusion criteria. Most studies were conducted in Europe and North America, followed by Asia and the Middle East. COVID-19 vaccine acceptance and hesitancy rates varied across countries. Some common demographic factors associated with hesitancy were younger age, being female, having lower than college education, and having a lower income level. Most of the barriers and facilitators to acceptance of the COVID-19 vaccines were intrapersonal factors, such as personal characteristics and preferences, concerns with COVID-19 vaccines, history/perception of general vaccination, and knowledge of COVID-19 and health. The remaining interpersonal, institution, community, and public policy factors were grouped into factors identified as barriers and facilitators. Conclusion Our review identified barriers and facilitators of vaccine acceptance and hesitancy and organised them using the social ecological framework. While some barriers and facilitators such as vaccine safety are universal, differentiated barriers might exist for different target groups, which need to be understood if they are to be addressed to maximize vaccine acceptance.