Increasing the Uptake of Advanced Directives in SingHealth Polyclinics

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

Official title:

Assessing the Effectiveness of Different Interventions in Increasing the Completion Rates of the Advanced Medical Directive in the Polyclinic Setting in Singapore - A Randomized Controlled Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03499847
• Other study ID #: Polyclinics AMD Intervention
• Status: Completed
• Phase: N/A
• Start date: March 29, 2018
• Est. completion date: December 19, 2018

Study information

• Verified date: September 2019
• Source: SingHealth Polyclinics
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 189
• Est. completion date: December 19, 2018
• Est. primary completion date: December 19, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 41 Years to 100 Years

Eligibility

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

Related Conditions & MeSH terms

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

Intervention

Behavioral:
• standardised face-to-face counselling session
the healthcare provider will conduct a standardised face-to-face counselling session guided with subjects guided by a check-list of topics to cover regarding the Advanced Medical Directive.
• advanced medical directive pamphlet
A standardised pamphlet containing information about the Advanced Medical Directive produced by the Ministry of Health, Singapore.

Locations

Country	Name	City	State
Singapore	Bedok Polyclinic	Singapore
Singapore	Marine Parade Polyclinic	Singapore
Singapore	Outram Polyclinic	Singapore
Singapore	Tampines Polyclinic	Singapore

Sponsors (1)

Lead Sponsor	Collaborator
SingHealth Polyclinics

Country where clinical trial is conducted

Singapore, 

References & Publications (6)

Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, Fassier T, Galliot R, Garrouste-Orgeas M, Goulenok C, Goldgran-Toledano D, Hayon J, Jourdain M, Kaidomar M, Laplace C, Larché J, Liotier J, Papazian L, Poisson C, Reignier J, Saidi F, Schlemmer B; FAMIREA Study Group. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med. 2005 May 1;171(9):987-94. Epub 2005 Jan 21. — View Citation

Foo AS, Lee TW, Soh CR. Discrepancies in end-of-life decisions between elderly patients and their named surrogates. Ann Acad Med Singapore. 2012 Apr;41(4):141-53. — View Citation

Houben CHM, Spruit MA, Groenen MTJ, Wouters EFM, Janssen DJA. Efficacy of advance care planning: a systematic review and meta-analysis. J Am Med Dir Assoc. 2014 Jul;15(7):477-489. doi: 10.1016/j.jamda.2014.01.008. Epub 2014 Mar 2. Review. — View Citation

Ramsaroop SD, Reid MC, Adelman RD. Completing an advance directive in the primary care setting: what do we need for success? J Am Geriatr Soc. 2007 Feb;55(2):277-83. Review. — View Citation

Tamayo-Velázquez MI, Simón-Lorda P, Villegas-Portero R, Higueras-Callejón C, García-Gutiérrez JF, Martínez-Pecino F, Barrio-Cantalejo IM. Interventions to promote the use of advance directives: an overview of systematic reviews. Patient Educ Couns. 2010 Jul;80(1):10-20. doi: 10.1016/j.pec.2009.09.027. Epub 2009 Oct 29. Review. — View Citation

Tay M, Chia SE, Sng J. Knowledge, attitudes and practices of the Advance Medical Directive in a residential estate in Singapore. Ann Acad Med Singapore. 2010 Jun;39(6):424-8. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of patients who completed the Advanced Medical Directive		4 months
Primary	Number of patient who expressed interest to complete the Advanced Medical Directive		4 months
Secondary	Barriers to completion of the Advanced Medical Directive		4 months

External Links

•   Singapore Ministry of Health - Advanced Medical Directives Information