BackgroundNo previous evaluation was carried out to determine the satisfaction and knowledge of ACP among heart failure patients in Singapore.AimStudy the impact of ACP on heart failure patients using a pre and post survey in National Heart Centre Singapore (NHCS).MethodsPre survey with patients who consented to ACP discussion during screening and follow up with post survey via telephone by the ACP clinical coordinators two weeks after the first ACP discussion.ResultsPre-survey (N = 94), 82.4% never heard of ACP, 95.6% had no written documentations on their end-of-life preferences, 60.4% were comfortable to discuss end-of-life preferences, 34.1% had thought about their preferences.Post-survey (N = 88), 82.1% rated satisfied or very satisfied with the ACP discussion. 67.9% felt that it helped them reflect their personal values and identify end-of-life preferences. 71.4% had good understanding towards ACP and 74% had improved health knowledge after the discussion. 93.4% agreed that planning for end-of-life care preferences is important.DiscussionThe awareness of ACP is low among NHCS patients. Majority of patients believe that it is important to plan for their healthcare wishes but very few have initiated this conversation or documented their wishes with their healthcare providers or their family members.ConclusionMore publicity is needed to promote the literacy of this ACP Programme among Singaporeans, especially those with unpredictable disease trajectories. Findings show that the Programme is beneficial to patients who are ready for such discussion. A more proactive approach by healthcare stakeholders is needed to expand this Programme.
BackgroundLimited data on the factors affecting end-of-life (EOL) decisions faced by heart failure patients in a SEA population.AimIdentify attitudes and issues heart failure patients face with communication of EOL decisions in a SEA population.MethodsA qualitative study was conducted with five focus group sessions (N = 27), 5–6 heart failure per session, over a six month period.ResultsThe qualitative study revealed six themes representing the issues that heart failure patients faced: 1) physical and psychological symptoms; 2) financial concerns; 3) uncertainty and lack of knowledge about the disease; 4) difficulties in navigating the healthcare system; 5) EOL care concerns; and, 6) fear of being a burden to the family.DiscussionOut of the six themes raised, points 3, 5 and 6 are areas that can be addressed with Advance Care Planning (ACP). The results show that patients want autonomy and more information about their treatment options so as to resolve EOL care issues and reduce family burden. In contrast to those without ACP, patients who underwent ACP discussion were clearer on their treatment preferences and had discussion on EOL decisions with their physicians and family members.ConclusionThere is inadequate discussion between the healthcare providers and the patients regarding treatment plans, expected side effects and prognosis in our current healthcare system. Having an ACP program will facilitate a patient-centric and proactive approach towards engaging patients and their families on EOL issues.
BackgroundOur institution has initiated inpatient advance care planning (ACP) programme for heart failure patients in 2013. Enrollment rate has been low.AimExpansion of ACP programme to arrhythmia and myocardial infarction (MI) patients besides heart failure (HF) with support from nurse navigators to increase enrollment.MethodsPatients hospitalised for MI were approached by ACP trained nurse navigators from 1st October 2014 to 30th November 2014, while patients with arrhythmia were approached by ACP coordinators from 1st July 2014 to 30 November 2014. Heart failure patients were approached by ACP coordinators from 1st June 2013 to 30th November 2014.Results112 (5.8%) patients were enrolled from a total screening of 1943 patients. The mean age of patients was 63.9 years and majority was male (73.2%). Ethnic distribution: Chinese 83%, Malay 8%, Indians 7%. 7 out of 61 MI patients were enrolled by the nurse navigators. 8 out of 273 arrhythmia patients and 97 out of 1609 HF patients were enrolled by ACP coordinators. Enrollment rates for MI 11.5%, arrhythmia 2.9%, HF 6.0%.DiscussionThere is a significant increase in enrollment rate of ACP programme after the engagement of nurse navigators’ support. During the patient’s hospital stay, rapport and trusthave built up among the patient, caregiver and nurse navigator. This resulted in patient being more open and able to accept ACP when approached by nurse navigator.ConclusionHealthcare providers who have built up a rapport with patients play an important role in advocating ACP programme.
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