1 AIC HOME Programme Advance Care Planning Lawrence Wong Senior Counsellor / Assistant Manager AIC...
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1 AIC HOME Programme Advance Care Planning Lawrence Wong Senior Counsellor / Assistant Manager AIC HOME Programme ACP Master Trainer (US) Appointed member of National ACP Expert Panel
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Transcript of 1 AIC HOME Programme Advance Care Planning Lawrence Wong Senior Counsellor / Assistant Manager AIC...
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AIC HOME Programme
Advance Care Planning
Lawrence WongSenior Counsellor / Assistant Manager
AIC HOME ProgrammeACP Master Trainer (US)
Appointed member of National ACP Expert Panel
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Case study of an elderly man
WishesSuffered years of torment from illnesses
Warded into ICU eventually
Reconciled to his lot
Expressed he is much fearful of pain/suffering than death
Hoped he could die in peace with minimal suffering
Made clear to nurse of do not resuscitate in event of life threatening situations
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Case study of an elderly man
Instead… Sons consulted Fortune teller with father’s birth
date
Never allow father to pass on before the time of a specific date
Else, fortune of descendants will be diminished
Instead…Instead…
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Case study of an elderly man
OutcomesFrail elderly man could not sustain any longer
“Passed on” 5~6 times before the auspicious time
Was resuscitated each time from death with:
Long needle of cardiac stimulant pierced directly into his heart
Most rib bones crushed under CPR
Skin burned due to defibrillation
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What is Advance Care Planning?
Process of discussion between patient, family and healthcare team on future care issues and end-of-life preferences
Making plans now about how patient wishes to be cared for in the future
Expressing patient’s wishes when he/she is still capable of making decisions
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Discussion topics in ACP
Understanding of illness and it’s progression
Life support measures
Resuscitation
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Discussion topics in ACP
Substitute Decision Maker(s)
Religious or spiritual beliefs
Preferred place of care and death
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Outcome of ACP discussion
Can be instructed orally or in written form
Can be changed at any time
Aim to honour and respect patient’s life and wishes
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Why is ACP important?
Video Clip illustration
Extracted from China TV drama series<<我的青春谁做主 >>
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Why is ACP important?
Should we continue injecting the pressor drug? We need to seek the family’s opinion.
Patient did not express or make clear of his preferences. Doctor turned to family
members for opinion.
Is there a need to ask? Of course! Continue until he
is well!
Patient did not state clear of his preferences. Family decided treatment on his behalf. But is that what patient wants?
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Why is ACP important?
Mum! To
continue or not?
Dr. Zhang, stop the injection!
It is not easy for family to decide when patient did not make clear of
his preferences
A tough decision!
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Why is ACP important?
Let him go peacefully with dignity!
Guilt and emotional burden may be lightened for the loved ones who need to make tough medical decision on patient’s
behalf if patient had made clear of his own medical/care preferences in advance.
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Why is ACP important?
Express patient’s end-of-life preferences
Allow family and medical team to know patient’s preferences and to prepare in advance
Clarify expectations, choices between patient and his/her loved one
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Why is ACP important?
Empower patient and family in decision making
Give patient a peace of mind
Reassure patient’s loved ones that they are carrying out what patient wants
Maintain quality of life
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Is ACP compulsory?
ACP is not compulsory. An individual decides to do ACP or not
An individual expresses his/her wishes or appoints a decision maker
No legal requirement
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Who are Involved?
Patient, his/her loved ones and significant others
Medical team/Allied Health professionals if appropriate
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When is ACP initiated?
Diagnosis of illness is made known. Ideally is when one is still mentally able
Readiness to discuss
Desire to plan ahead
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Where to initiate ACP?
A comfortable environment with no pressure, such as our own home
With sufficient time and conducted at an appropriate place, a discussion can be purposeful with well coverage of
intended agenda and issues of concern.
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HOME ProgrammeA palliative homecare programme for end-stage
heart, lung & renal failure
• Patients’ sharing of preferred choices
• Photographs of Honour andStatements of Remembrance
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AIC HOME Programme
Thank You
On how to start an advance care planning discussion, you can go to www.livingmatters.sg for further information
