End-of-Life Care in the General Wards of a Singaporean Hospital: An Asian Perspective

Abstract

There was a lack of commitment by doctors on orders for DNR/CPR and to limit life-sustaining therapies, infrequent discussions with patients on end-of-life decisions, and excessive burdensome interventions with inadequate palliative care for the dying. These findings may reflect certain Asian cultural biases. More work is required to improve our quality of end-of-life care.

Understanding the Practice of Collusion on End of Life Care in Singapore

“…Local studies appear to confirm the practice of collusion and its unchanging nature over a 30-year period (Tan et al 1993, Low et al 2000, Krishna 2011a, Krishna 2011b, Phua et al 2011, Toh 2011, Foo et al 2012. A local study conducted in 1993 of a small sample (n=94) comprising of specialists, and general practitioners revealed that 90.4% would tell the family the diagnosis, 84% will accede to the family's request not to disclose the diagnosis to the patient and 23.4% would accede to the family's request not to tell the patient the diagnosis even if the patient insists on knowing it (Tan et al 1993).…”

“…The moderation or even the omission of information pertaining to a life threatening diagnosis is a common occurrence in Singaporean clinical practice (Tan et al 1993, Low et al 2000, Krishna 2011a, Krishna 2011b, Phua et al 2011, Toh 2011, Foo et al 2012. A patient's relatives will often act unilaterally and without the patient's knowledge to restrict the patient from learning about his or her diagnosis, and the medical and nursing teams may facilitate this deceptive collusion (Krishna 2011a, Krishna 2011b.…”

Dying in the Hospital: What Happens and What Matters, According to Bereaved Relatives

“…48 It has previously been shown that communication between physicians and patients or relatives about a poor prognosis and imminent death is often problematic. 7,12,49,50 Nevertheless, families of severely ill patients have been shown to need prognostic information, especially if the prognosis is poor. Respect, sensitivity, compassion, and frequent communication have been identified as important conditions to support such communication.…”

Not that way: Advance Care Planning

“…However, in the making of healthcare plans, they found that the family's preferences may sometimes be regarded higher than the patient's previously expressed wishes. (3,4) This suggests that ACP had yet to take root in our local community at the time of the survey. Ng et al listed some common barriers in exploring ACP, including it being culturally taboo to talk about end-of-life issues and a fear of destroying hope, especially for the older generations of Singaporeans.…”