BackgroundNHCS Heart Failure team and Medical Social Workers (MSW) spearheaded the implementation of ACP in August 2012. The programme now incorporates a component of intra-institution education of HCWs, specifically with cardiac nurses and physicians.AimTo provide on-going education and address misconceptions of ACP amongst HCWs in a SEA acute hospital setting, in view that discussion of patients’ crucial end-of-life treatment preferences is an avoided topic amongst HCWs in their daily frontline patient interactions and care.MethodsNHCS ACP model was enhanced to include sub-clinical teams for education. Education on ACP was disseminated via interactive lecture-style presentations by the MSW team, with the support from key NHCS Senior Management.Results122 registered and enrolled nurses attended 3 one-hour lectures.About 40 Cardiologists and medical officers attended a 30-minute lecture.DiscussionFrontline HCWs tend to perceive ACP as a sensitive topic and are uncomfortable bringing it up in their patient care, despite perceiving ACP as an essential discussion framework to minimise conflict or dilemma during medical emergencies.ConclusionTo garner support from essential healthcare stakeholders and help them appreciate ACP as part of standard patient care, ongoing education for HCWs is necessary to overcome the cultural barriers and to shift perceptions on ACP. Further development of a skills-based education programme may be necessary to equip HCW with the soft skills of introducing ACP as standard patient care in NHCS.
BackgroundOur institution has implemented advance care planning (ACP) for cardiac inpatients since 2013.AimTo explore main contributing factors influencing patients’ choice of end-of-life (EOL) care options.MethodsPatients hospitalised for heart failure, arrhythmia, myocardial infarction were enrolled from 1st June 2013 to 30th November 2014.Results112 patients were enrolled from a screening of 1943 patients. Out of 112 patients, 69 (61.6%) had completed ACP discussions. 57 (82.6%) patients chose comfort care (CC) whereas 12 (17.4%) chose life-sustaining treatments (LST) for their EOL care. Mean age for CC patients is 62.3 and mean age for LST patients is 59.7. 86.0% patients who chose CC stay with their family compared to 91.7% patients in LST. 49.1% of CC patients are unemployed whereas 83.3% of LST patients are unemployed. 68.4% of CC patients are married compared to 58.3% of LST patients. 10.5% of CC patients had no education compared to 25% of LST patients. 19.3% of CC patients had no religion compared to 8.3% of LST patients. No difference in gender distribution (77.2% for CC patients vs 75.0% for LST patients). More Chinese patients opted for CC (96.5% vs 75.0% in LST patients).DiscussionPatients who chose CC are generally older, employed, married, educated, Chinese race compared to LST. Majority of CC group prefer quality of life to quantity of life, and do not want to burden family due to length, cost of treatments and emotion endurance.ConclusionPatient’s EOL care options are contributed by multiple factors like age, education, race, employment status and marital status.
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