Advance Care Planning

Advance Care Planning (ACP) is a process of planning for your future health and personal care.

• It is for you to share your wishes in advance so that your doctor(s) and loved ones understand your treatment decisions and preferences if you have a serious illness and are unable to express your wishes then (e.g. if you are unconscious).

• It should ideally start early on when you can still discuss these matters with your loved ones and have it documented in a way that is accessible and retrievable should the need arise.

• It should be reviewed periodically and refined or amended accordingly as your health status changes or if there are other life events.

It involves:

1. An understanding of what is important to you in order to LIVE WELL.

• Your relationships
• Your lifestyle
• Your religious or personal beliefs

These shape and determine what you consider important. Through this process, you are making a value statement.

2. Making decisions on your healthcare choices based on what you consider important (your values).

• Is living as long as possible more important than the quality of life?
• What kind of life is considered unacceptable for you in order to live well?
• Where would you want to spend your last days?

Your preferences may often be influenced by healthcare experiences which may be:

• Your own
• What you witness in other people’s healthcare experiences

3. Letting others know about it.
By letting people know about your wishes you may have an opportunity to discuss your views with those close to you. This has been known to strengthen bonds and deepen relationships.

• It is important that you let at least one trusted person know about your advance care plan. This will allow him/her to make decisions for you according to what is important for you.

• Though it is not essential to have your advance care plans documented, doing so helps the healthcare professionals involved in your care, your nominated person and loved ones know your wishes and preferences. Using the ACP workbook available at https://www.aic.sg/care-services/simple-steps-for-acp is a start.

• If you have an ACP discussion with a certified ACP facilitator, he/she will help ensure that this is documented and accessible to healthcare workers should they require this information.

• It is a good idea to give a copy of your ACP to everyone who needs to know. Remember to keep your own copy safe. There are now electronic apps available to help with this.

• If you have made an advance decision to decline specific treatment you must be sure that the people involved in your care know this. Some proceed to have an Advance Medical Directive signed, although a well-articulated ACP would usually suffice.

NB: Your ACP is only taken into consideration when you are terminally ill and unconscious or lose mental capacity such that you are no longer able to express your preferences or make decisions. However, making your preferences known ahead also helps your healthcare team to work together with you to ensure that the care is appropriate according to your values and preferences.

1. Peace of mind for your loved ones

In a medical emergency where you become very ill and lose the ability to speak for yourself, the healthcare team may turn to your loved ones to learn more about your values in order to make decisions in line with your preferences.

These decisions may be hard to make if they do not know you well enough to know what you would have wanted.

By communicating your preferences in advance, you can prepare for the unexpected and help relieve some of the burden and stress your loved ones may experience.

Not all your loved ones may have the same degree of understanding of what is important to you. As such, it is important that you nominate at least one person who understands your values and preferences, and is able to share this information with the healthcare team on your behalf. This person is known as the Nominated Healthcare Spokesperson in the local version of the ACP process.

This person can also be appointed as a donee of a Lasting Power of Attorney. However, the donee (the person you appoint) is not allowed to make any decision with respect to carrying out or continuing life sustaining treatment on the donor or any other treatment necessary to prevent a serious deterioration. In such instances, the decision rests with the clinical team after due consideration of the options of treatment available and discussion with your Nominated Healthcare Spokesperson (usually the same person as the donee) on your previously stated preferences.

2. Greater satisfaction with life

Having had conversations with your healthcare team and loved ones about end-of-life care brings about higher satisfaction and better quality of life at the final stages of your life. You would be less likely to receive burdensome treatments and are more likely to receive care consistent with your values and wishes.

This should be part of routine healthcare. In general, it is more beneficial when ACP is introduced early as part of ongoing care rather than in reaction to a decline in condition or a crisis situation.

Some triggers for ACP discussions may be:

• A person who is concerned about current or future treatment goals
• A diagnosis of advanced cancer or end organ failure indicating a poor prognosis
• A diagnosis of early dementia or a disease which could result in a loss of decision-making ability
• After a catastrophic illness

If you or your loved one(s) have a complex health condition, you may benefit from having a trained healthcare worker facilitate your ACP discussion. Please check with your healthcare professionals who can refer you to an ACP faciitator.

1. You can refer to https://www.aic.sg/care-services/simple-steps-for-acp for a DIY ACP Workbook.

2. Refer to this service directory where you can make an ACP.

More information about Advance Care Planning can be found at https://www.aic.sg/care-services/advance-care-planning.