Dealing with a novel viral epidemic creates spiritual and psychosocial issues similar to those encountered in a palliative care practice. Palliative care workers would do well to be aware of such issues and act proactively when such epidemics arise.

This study highlights the need for public education on the benefits and process of ACP in Singapore. In formulating an approach to ACP, there is a need to take into account cultural sensitivities towards ACP discussions and the importance of closely involving the family unit in the process.

Palliative social work is a growing specialty in healthcare social work and has seen significant milestones in development and growth in the past 10 years. Palliative social workers in Singapore possess a unique set of clinical skills to guide our work in a multiethnic and multicultural society. These include crucial elements such as leadership, supervision, mentoring, creativity in assessment, and interventions. In our society where family forms the basic unit of care, the assessment and interventions with patients occur within the context of families, including decision-making and truth-telling. In recent years, a lot of effort and focus had been on education and development, as well as enhancing collaboration and learning among social work practitioners across different settings providing palliative care.

In Singapore, most voluntary nursing homes(VNHs) residents with next-of-kins(NOKs) do not receive advance care planning(ACP). A local hospital embarked on a pilot program, Project CARE (PC), to conduct formal ACP and enable enhanced palliative care delivery in selected VNHs.This pilot cohort study of six VNHs residents included those with advanced medical conditions(UK Gold Standards Framework criteria) with Modified Shah Barthel Index score <30. Excluded are residents <65 years old (unless satisfied inclusion criteria), without NOKs and decision making capacity(DMC), or on police evaluation. ACP were initiated with documentation of preferences on cardiopulmonary resuscitation (CPR), medical intervention(comfort, limited intervention, full treatment) and place of death. Residents would be enrolled into PC when preferences were for comfort care/limited intervention in nursing home without or with further treatment at hospital. Hospital team would co-manage with VNHs during residents' deterioration. Outcomes are evaluated from program inception on September 2009 till January 2011.Of a total of 1464 residents, female(55.1%), Chinese(88.8%) and age ≥75 years old(61.7%) predominated. 54.4% of residents fulfilled criteria for possible ACP. Of this latter group, 51.2% completed ACP with 46.3% enrolled into PC. 4 NHs with minimum 6 months of patient reviews in PC framework were further evaluated with 153 deaths recorded. Success in honouring preferences on medical intervention and death place while in PC were 89.4% and 66% respectively. Mortality rate among eligible residents but without ACP yet, had ACP and in PC/not in PC were 24.6%, 25.8% and 24.2% respectively.Care preferences could be honoured under PC framework.