Increasing the Uptake of Advanced Directives in SingHealth Polyclinics
Condition: Advanced Medical Directive, a Legal Document Signed in Advance to State Healthcare Preferences
Study type: Interventional

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.
    

Intervention name(s): standardised face-to-face counselling session; advanced medical directive pamphlet
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 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.; A standardised pamphlet containing information about the Advanced Medical Directive produced by the Ministry of Health, Singapore.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 3-arm, randomised control trial
Active Intervention group (n=65) Counselling provided Pamphlet given
Passive Intervention group (n=65) Pamphlet given
Control group (n=65) Neither counselling nor pamphlet given
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research