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Sustainable implementation of advance care planning in Asia: An interpretive-systemic framework for national development

Published online by Cambridge University Press:  03 August 2020

Andy Hau Yan Ho Open the ORCID record for Andy Hau Yan Ho [Opens in a new window] ,
Priya Lall Open the ORCID record for Priya Lall [Opens in a new window] ,
Woan Shin Tan Open the ORCID record for Woan Shin Tan [Opens in a new window] ,
Paul Victor Patinadan Open the ORCID record for Paul Victor Patinadan [Opens in a new window] ,
Lok Hang Wong ,
Oindrila Dutta Open the ORCID record for Oindrila Dutta [Opens in a new window] ,
Weng Sun Pang ,
Chan Kee Low  and
Josip Car Open the ORCID record for Josip Car [Opens in a new window]
Andy Hau Yan Ho*
Affiliation:
Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore The Palliative Care Centre for Excellence in Education and Research (PalC), Singapore
Priya Lall
Affiliation:
College of Social Science, University of Lincoln, Lincoln, UK
Woan Shin Tan
Affiliation:
Health Services & Outcomes Research Department, National Healthcare Group, Singapore
Paul Victor Patinadan
Affiliation:
Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore
Lok Hang Wong
Affiliation:
Tan Tock Seng Hospital, Clinical Epidemiology, Singapore
Oindrila Dutta
Affiliation:
Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore
Weng Sun Pang
Affiliation:
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
Chan Kee Low
Affiliation:
Economics Program, School of Social Sciences, Nanyang Technological University, Singapore
Josip Car
Affiliation:
Centre for Population Health Sciences (CePHaS), Nanyang Technological University, Singapore
*
Author for correspondence: Andy Hau Yan Ho, Nanyang Technological University, 48 Nanyang Avenue, SHHKB-04-03, Singapore 639818. E-mail: [email protected]
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Abstract

Objectives

A qualitative interpretive-systemic focus group study was conducted to examine the developmental and implementational underpinnings of Asia's first national Advance Care Planning (ACP) programme constituted in Singapore.

Methods

63 physicians, nurses, medical social workers, and allied health workers who actively rendered ACP were purposively recruited across seven major public hospitals and specialist centers.

Results

Framework analysis revealed 19 themes, organized into 5 categories including Life and Death Culture, ACP Coordination, ACP Administration, ACP Outcomes, and Sustainability Shift. These categories and themes formed an Interpretive-Systemic Framework of Sustainable ACP, which reflects the socio-cultural, socio-political, and socio-spiritual contexts that influence ACP provision, highlighting the need to adopt a public health strategy for enhancing societal readiness for end-of-life conversations.

Significance of results

The Interpretive-Systemic Framework of Sustainable ACP underscores the importance of health policy, organizational structure, social discourse, and shared meaning in ACP planning and delivery so as to support and empower care decision-making among terminally ill Asian patients and their families facing mortality.

Keywords

Advance care planningAsiaImplementation sciencePolicy makingQualitative research
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 1 , February 2021 , pp. 82 - 92
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Beck, E-R, McIlfatrick, S, Hasson, F, et al. (2017) Health care professionals’ perspectives of advance care planning for people with dementia living in long-term care settings: A narrative review of the literature. Dementia 16(4), 486–512. doi:10.1177/1471301215604997CrossRefGoogle ScholarPubMed
Chouchane, L, Mamtani, R, Dallol, A, et al. (2011) Personalized medicine: A patient-centered paradigm. Journal of Translational Medicine 9, 206. doi:10.1186/1479-5876-9-206CrossRefGoogle ScholarPubMed
Confucius (1997) The Analects of Confucius: A Literal Translation with an Introduction and Notes. Oxford: Oxford University Press.Google Scholar
De Lima, L and Pastrana, T (2016) Opportunities for palliative care in public health. Annual Review of Public Health 37, 357–374. doi:10.1146/annurev-publhealth-032315-021448CrossRefGoogle ScholarPubMed
Dickinson, GE (2006) Teaching end-of-life issues in US medical schools: 1975 to 2005. The American Journal of Hospice & Palliative Care 23(3), 197–204. doi:10.1177/1049909106289066CrossRefGoogle ScholarPubMed
Foo, JY (2017) Planning for death: Still not easy to talk about taboo issue. Retrieved July 1, 2017, from The New Paper. Available at: http://www.tnp.sg/news/singapore/planning-death-still-not-easy-talk-about-taboo-issueGoogle Scholar
Fuenmayor, R (1991) Truth and openness: An epistemology for interpretive systemology. Systems Practice 4(5). doi:10.1007/BF01104462CrossRefGoogle Scholar
Gibson, M. (2011). Death and community. In Conway, S (ed.), Governing Death and Loss: Empowerment, Involvement and Participation, pp. 15–26. Available at: https://market.android.com/details?id=book-0YlxHYRXfioCGoogle Scholar
Higginson, IJ and Koffman, J (2005) Public health and palliative care. Clinics in Geriatric Medicine 21(1), 45–55, viii. doi:10.1016/j.cger.2004.08.003CrossRefGoogle ScholarPubMed
Ho, AHY and Chan, CLW (2011) Liberating bereaved persons from the oppression of death and loss in Chinese societies: example of public health approaches. In Conway, S (ed.), Governing Death and Loss: Empowerment, Involvement and Participation, pp. 119–128. Available at: https://market.android.com/details?id=book-0YlxHYRXfioCGoogle Scholar
Ho, AHY and Tan-Ho, G (2016) A good death: Resolving the complexity of mortality. In Exploring Complexity: Vol. 2. Cultural Patterns and Neurocognitive Circuits, pp. 169–181. doi:10.1142/9789813147492_0009CrossRefGoogle Scholar
Ho, AHY, Chan, CLW, Chow, AYM, et al. (2010) Psychometric properties of the Chinese version (C-DAP-R) of the death attitude profile-revised. Illness, Crisis & Loss 18(2), 95–110. doi:10.2190/IL.18.2.bCrossRefGoogle Scholar
Ho, AHY, Dai, AAN, Lam, S-H, et al. (2016) Development and pilot evaluation of a novel dignity-conserving end-of-life (EoL) care model for nursing homes in Chinese societies. The Gerontologist 56(3), 578–589. doi:10.1093/geront/gnv037CrossRefGoogle ScholarPubMed
Houben, CHM, Spruit, MA, Groenen, MTJ, et al. (2014) Efficacy of advance care planning: a systematic review and meta-analysis. Journal of the American Medical Directors Association 15(7), 477–489. doi:10.1016/j.jamda.2014.01.008CrossRefGoogle ScholarPubMed
Illich, I (1976) Medical Nemesis: The Expropriation of Health. New York, NY: Pantheon Books.Google Scholar
Jimenez, G, Tan, WS, Virk, AK, et al. (2018a) Overview of systematic reviews of advance care planning: Summary of evidence and global lessons. Journal of Pain and Symptom Management 56(3), 436–459.e25. doi:10.1016/j.jpainsymman.2018.05.016CrossRefGoogle Scholar
Jimenez, G, Tan, WS, Virk, AK, et al. (2018b) State of advance care planning research: A descriptive overview of systematic reviews. Palliative & Supportive Care, 1–11. doi:10.1017/S1478951518000500Google Scholar
Johnson, S, Butow, P, Kerridge, I, et al. (2016) Advance care planning for cancer patients: A systematic review of perceptions and experiences of patients, families, and healthcare providers. Psycho-Oncology 25(4), 362–386. doi:10.1002/pon.3926CrossRefGoogle ScholarPubMed
Kamberelis, G and Dimitriadis, G (2005) Focus groups: Strategic articulations of pedagogy, politics, and inquiry. The Sage Handbook of Qualitative Research 3, 887–907. 3rd ed. Available at: https://psycnet.apa.org/fulltext/2005-07735-035.pdfGoogle Scholar
Kellehear, A (1999) Health Promoting Palliative Care. Available at: http://pdfvedotli.com/health-promoting-palliative-care-allan-kellehear-full-text-read-book.pdfGoogle Scholar
Kellehear, A (2005) Compassionate Cities: Public Health and End of Life Care. Available at: https://www.taylorfrancis.com/books/9781134209200Google Scholar
Kelley, AS and Morrison, RS (2015) Palliative care for the seriously Ill. The New England Journal of Medicine 373(8), 747–755. doi:10.1056/NEJMra1404684CrossRefGoogle ScholarPubMed
Koh, V (2015) As Population Ages, More Are Confronting the Last Taboo. Available at: http://www.todayonline.com/singapore/big-read-population-ages-more-are-confronting-last-taboo (accessed July 1, 2017).Google Scholar
Lien Centre for Palliative Care, Duke-NUS Graduate Medical School. (2011). Report on the National Strategy for Palliative Care. Available at: https://www.singaporehospice.org.sg/en/wp-content/uploads/2018/08/Report_on_National_Strategy_for_Palliative_Care-5Jan2012.pdfGoogle Scholar
Meier, DE and Beresford, L (2007) Advocacy is essential to palliative care's future development. Journal of Palliative Medicine 10(4), 840–844. doi:10.1089/jpm.2007.9934CrossRefGoogle ScholarPubMed
Nyumba, TO, Wilson, K, Derrick, CJ, et al. (2018) The use of focus group discussion methodology: Insights from two decades of application in conservation. Methods in Ecology and Evolution 9(1), 20–32. doi:10.1111/2041-210X.12860CrossRefGoogle Scholar
Ochoa-Arias, AE (1998) An interpretive-systemic framework for the study of community organizations. Systemic Practice and Action Research 11(5), 543–562. doi:10.1023/A:1022460828246CrossRefGoogle Scholar
Proctor, E, Silmere, H, Raghavan, R, et al. (2011) Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health 38(2), 65–76. doi:10.1007/s10488-010-0319-7CrossRefGoogle ScholarPubMed
Ritchie, J and Spencer, E (1993) Qualitative data analysis for applied policy research. In Bryman, A and Burgess, B (eds.), Analyzing Qualitative Data, pp. 173–194. Available at: https://market.android.com/details?id=book-7mmKAgAAQBAJGoogle Scholar
Sabatino, CP (2010) The evolution of health care advance planning law and policy. The Milbank Quarterly 88(2), 211–239. doi:10.1111/j.1468-0009.2010.00596.xCrossRefGoogle ScholarPubMed
Sharp, T, Moran, E, Kuhn, I, et al. (2013) Do the elderly have a voice? Advance care planning discussions with frail and older individuals: A systematic literature review and narrative synthesis. The British Journal of General Practice: The Journal of the Royal College of General Practitioners 63(615), e657–e668. doi:10.3399/bjgp13X673667CrossRefGoogle ScholarPubMed
Silveira, MJ, Kim, SYH and Langa, KM (2010) Advance directives and outcomes of surrogate decision making before death. The New England Journal of Medicine 362(13), 1211–1218. doi:10.1056/NEJMsa0907901CrossRefGoogle ScholarPubMed
Singapore: Living Matters (2019). Living Matters Advance Care Planning. Available at: https://livingmatters.sg/ (accessed October 24).Google Scholar
Song, M-K, Kirchhoff, KT, Douglas, J, et al. (2005) A randomized, controlled trial to improve advance care planning among patients undergoing cardiac surgery. Medical Care 43(10), 1049–1053. doi:10.1097/01.mlr.0000178192.10283.b4CrossRefGoogle ScholarPubMed
Stjernswärd, J, Foley, KM and Ferris, FD (2007) The public health strategy for palliative care. Journal of Pain and Symptom Management 33(5), 486–493. doi:10.1016/j.jpainsymman.2007.02.016CrossRefGoogle ScholarPubMed
Sudore, RL, Lum, HD, You, JJ, et al. (2017) Defining advance care planning for adults: A consensus definition from a multidisciplinary Delphi Panel. Journal of Pain and Symptom Management 53(5), 821–832.e1. doi:10.1016/j.jpainsymman.2016.12.331CrossRefGoogle ScholarPubMed
The Economist Intelligence Unit (2015) The 2015 Quality of Death Index: Ranking Palliative Care Across the World. Available at: http://www.lienfoundation.org/sites/default/files/2015%20Quality%20of%20Death%20Report.pdf (accessed July 1, 2017).Google Scholar
Weathers, E, O'Caoimh, R, Cornally, N, et al. (2016) Advance care planning: A systematic review of randomised controlled trials conducted with older adults. Maturitas 91, 101–109. doi:10.1016/j.maturitas.2016.06.016CrossRefGoogle ScholarPubMed
Williams, M (2002) Generalization in interpretive research. In May, T (ed.), Qualitative Research in Action. London: Sage, pp. 126–143.Google Scholar
World Bank (2016) Live Long and Prosper: Aging in East Asia and Pacific. Available at: http://pubdocs.worldbank.org/en/165351470911396346/Live-Long-and-Prosper.pdfGoogle Scholar
Worldwide Palliative Care Alliance (2014) Global Atlas of Palliative Care at the End of Life. Geneva: World Health Organization.Google Scholar