Woan Shin Tan1,2,3, Josip Car2,4, Priya Lall5, Chan Kee Low6, Andy Hau Yan Ho2,7,8. 1. Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore. 2. Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. 3. Health Services and Outcomes Research Department, National Healthcare Group, Singapore, Singapore. 4. Global Digital Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom. 5. School of Geography, Queen Mary University of London, London, United Kingdom. 6. Economics Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore. 7. Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore. 8. Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore.
Abstract
BACKGROUND: Despite being simply defined as a process to further one's understanding about future medical care, the process of implementing advance care planning (ACP) within acute hospital settings can be complex. AIM: We describe different ACP service models adopted in Singapore, and the facilitators for, and barriers to, its effective implementation. DESIGN: Qualitative focus group study with thematic analysis. SETTINGS/PARTICIPANTS: We purposefully sampled four stakeholder groups involved in the implementation of ACP. Our sample included 63 participants, 12 physicians, 15 nurses, 24 medical social workers, and 12 ACP coordinators from seven public hospitals and one specialist center. RESULTS: We describe three different acute-care models adopted in Singapore, differentiated by leadership approach, target population, delivery process, and job roles. Our results revealed nine themes, organized into four categories, including: (1) hospital culture (curative norms, absence of preference-supportive culture), (2) organizational priority and leadership (low priority on hospital agenda, inappropriate leadership), (3) goals and distinction (lack of shared purpose and goals, no clear differentiation from existing practices), and (4) work practices (pigeonholing of ACP practice, inappropriate resourcing, accountability and feedback). CONCLUSION: We learned that to implement ACP effectively in an acute-care setting, there needs to be a cultural and behavioral transformation, led by committed and empowered leaders. Organizations that can create a shared purpose built on an ethos of honoring patients' preferences, and support this with systematic processes and adequate resourcing, will be more equipped to implement ACP effectively.
BACKGROUND: Despite being simply defined as a process to further one's understanding about future medical care, the process of implementing advance care planning (ACP) within acute hospital settings can be complex. AIM: We describe different ACP service models adopted in Singapore, and the facilitators for, and barriers to, its effective implementation. DESIGN: Qualitative focus group study with thematic analysis. SETTINGS/PARTICIPANTS: We purposefully sampled four stakeholder groups involved in the implementation of ACP. Our sample included 63 participants, 12 physicians, 15 nurses, 24 medical social workers, and 12 ACP coordinators from seven public hospitals and one specialist center. RESULTS: We describe three different acute-care models adopted in Singapore, differentiated by leadership approach, target population, delivery process, and job roles. Our results revealed nine themes, organized into four categories, including: (1) hospital culture (curative norms, absence of preference-supportive culture), (2) organizational priority and leadership (low priority on hospital agenda, inappropriate leadership), (3) goals and distinction (lack of shared purpose and goals, no clear differentiation from existing practices), and (4) work practices (pigeonholing of ACP practice, inappropriate resourcing, accountability and feedback). CONCLUSION: We learned that to implement ACP effectively in an acute-care setting, there needs to be a cultural and behavioral transformation, led by committed and empowered leaders. Organizations that can create a shared purpose built on an ethos of honoring patients' preferences, and support this with systematic processes and adequate resourcing, will be more equipped to implement ACP effectively.
Authors: Claire A Surr; Sahdia Parveen; Sarah J Smith; Michelle Drury; Cara Sass; Sarah Burden; Jan Oyebode Journal: BMC Health Serv Res Date: 2020-06-05 Impact factor: 2.655
Authors: Karen M Detering; Craig Sinclair; Kimberly Buck; Marcus Sellars; Ben P White; Helana Kelly; Linda Nolte Journal: BMC Health Serv Res Date: 2021-07-16 Impact factor: 2.655