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Increasing the Uptake of Advanced Directives in SingHealth Polyclinics

S

SingHealth Polyclinics

Status

Completed

Conditions

Advanced Medical Directive, a Legal Document Signed in Advance to State Healthcare Preferences

Treatments

Behavioral: standardised face-to-face counselling session
Behavioral: advanced medical directive pamphlet

Study type

Interventional

Funder types

Other

Identifiers

NCT03499847
Polyclinics AMD Intervention

Details and patient eligibility

About

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.

Full 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.

Enrollment

189 patients

Sex

All

Ages

41 to 100 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

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

Exclusion criteria

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

Trial design

Primary purpose

Health Services Research

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

Single Blind

189 participants in 3 patient groups

Active Intervention
Active Comparator group
Description:
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
Treatment:
Behavioral: standardised face-to-face counselling session
Behavioral: advanced medical directive pamphlet
Passive Intervention
Active Comparator group
Description:
subjects will be given a pamphlet about the advanced medical directive
Treatment:
Behavioral: advanced medical directive pamphlet
Control
No Intervention group

Trial contacts and locations

4

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Data sourced from clinicaltrials.gov

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