Increasing the Uptake of Advanced Directives in SingHealth Polyclinics

Not Applicable

Completed

• Conditions: Advanced Medical Directive, a Legal Document Signed in Advance to State Healthcare Preferences
• Interventions: Behavioral: standardised face-to-face counselling session; Behavioral: advanced medical directive pamphlet

• Registration Number: NCT03499847
• Lead Sponsor: SingHealth Polyclinics

Brief Summary

An Advanced Medical Directive (AMD) is a legal document in Singapore that allows one to inform their medical practitioner that they do not want any life-sustaining treatment should they become unconscious and terminally ill where death is imminent. Despite the AMD act being passed in Singapore Parliament in 1996, uptake remains low among the population. Several intervention studies have shown that education and communication can be effective in promoting end-of-life discussion and planning. In this study, we aim to compare the effectiveness of counselling sessions together with pamphlets, versus pamphlets alone, versus current care, in increasing the completion rates of the AMD in the Singapore Polyclinic setting.

Detailed Description

An Advanced Medical Directive (AMD) is a legal document in Singapore that allows one to inform their medical practitioner that they do not want any life-sustaining treatment should they become unconscious and terminally ill where death is imminent. It may be completed by any person, of sound mind, aged 21 years and above.The AMD Act was passed in the Singapore Parliament in May 1996.

A cross-sectional, community-based study surveyed 1200 selected households in Singapore. Only 37.9% of the sample population had heard of the AMD prior to the study, though when approached, 60.6% were willing to sign an AMD. As of 2017, less than 25,000 people (0.45%) in Singapore have opted to sign an AMD.

Past studies have shown that end of life discussions reduce stress, anxiety, and depression in surviving relatives. A local study in 2010 revealed a 33% patient-surrogate discrepancy in end-of-life decision making.

There are a lack of intervention studies regarding AMD in Singapore. In this study, we aim to compare the effectiveness of counselling sessions together with pamphlets, versus pamphlets alone, versus current care, in increasing the completion rates of the AMD in the Singapore Polyclinic setting.

Study Timeline

• Study Start: 2018-03-29
• Study First Submitted: 2018-04-08
• Study First Submitted QC: 2018-04-14
• Study First Posted: 2018-04-17
• Primary Completion: 2018-12-19
• Study Completion: 2018-12-19
• Status Verified: 2019-09
• Last Update Submitted: 2019-09-23
• Last Update Posted: 2019-09-24

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 189

Inclusion Criteria

• Age > 40
• Patient who seeks medical consultation at Singhealth Polyclinics (Bedok, Marine Parade, Outram, Tampines)

Read More

Exclusion Criteria

• History of dementia
• History of depression
• Known diagnosis of terminal illness
• Signed Advanced Medical Directive/Advanced Care Plan previously

Read More

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Active Intervention	standardised face-to-face counselling session	subjects will be given a pamphlet about the advanced medical directive, and a standardized face-to-face counselling session will be conducted with their healthcare provider
Active Intervention	advanced medical directive pamphlet	subjects will be given a pamphlet about the advanced medical directive, and a standardized face-to-face counselling session will be conducted with their healthcare provider
Passive Intervention	advanced medical directive pamphlet	subjects will be given a pamphlet about the advanced medical directive

Primary Outcome Measures

Name	Time	Method
Number of patients who completed the Advanced Medical Directive	4 months
Number of patient who expressed interest to complete the Advanced Medical Directive	4 months

Secondary Outcome Measures

Name	Time	Method
Barriers to completion of the Advanced Medical Directive	4 months

Trial Locations

Locations (4)

Outram Polyclinic; 🇸🇬 Singapore, Singapore

Marine Parade Polyclinic; 🇸🇬 Singapore, Singapore

Bedok Polyclinic; 🇸🇬 Singapore, Singapore

Tampines Polyclinic; 🇸🇬 Singapore, Singapore