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More TTSH patients planning for future healthcare in the event they can't speak for themselves

Felicia Choo on 27 Jun 2019

The Straits Times


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More patients at Tan Tock Seng Hospital (TTSH) have been making plans for their future care.


In 2011, the hospital introduced its advance care planning (ACP) system, which documents a person's future healthcare preferences so that his family members and doctor can use this information when, in case of a medical emergency, a patient cannot speak for himself.


New figures show that 1,279 patients had signed up to the system last year, up from 415 in 2013.


But Dr Adeline Lam, who is leading the initiative, thinks that even more patients can take up the discussion to plan for their future health and personal care, including those who currently do not have any medical conditions.


The scheme was initiated by the Singapore Government in 2011, modelled on the Respecting Choices programme in the United States.


Before 2011, TTSH staff would discuss ACP with patients on an ad hoc basis, which was one of the reasons for the low take-up rate.


"It is not an easy discussion, especially in Asia where there is a lot of taboo and superstition about death," said Dr Lam, who is a consultant in the general medicine department. "Some relatives feel that by having this discussion, they are taking hope away."


Other factors that have stalled these discussions are people having a lack of time or not knowing much about ACP.


The hospital has since used a three-pronged approach to bump up numbers: spreading public awareness of ACP; training general medicine doctors about it; and asking patients who are in their 60s and 70s - and have more serious medical conditions - about making such plans.


Last year, 594 TTSH staff were trained in ACP, up from 142 in 2013.


Madam Wee Ah Miow, 87, is one patient who made plans in 2017 after the new system was up and running. While the stroke survivor had frequent conversations with her children about how she preferred not to have surgery for her medical conditions, her plans were not formally documented.


"I don't want to trouble people and be dependent on them," said Madam Wee. "I'd rather go if I become bedridden."


It also helped that the planning was done with her doctor of 11 years - Dr Lam.


ACP sessions take about an hour and while they are free at some places, others charge around $30, said Dr Lam.


ACP facilitators can be found at other hospitals and medical centres, such as National University Hospital, Alexandra Hospital, Khoo Teck Puat Hospital (KTPH), Singapore General Hospital, National Heart Centre Singapore and Changi General Hospital.


At KTPH, the number of advance care plans has jumped from 196 in 2013 when the programme was piloted, to 515 last year.


Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.



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