It's never too early to make your final wishes known - Starting the conversation End-of-life: Start at the beginning

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It's never too early to make your final wishes known - Starting the conversation End-of-life: Start at the beginning
MARCH – MAY 2021 • MCI (P) 003/10/2020

Starting the
conversation
End-of-life:
Start at the
beginning

It’s never too
early to make
your final
wishes known

                                                                        PLUS
                                                              The value of
                                                              Advance Care
                                                                Planning
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                                         T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1
It's never too early to make your final wishes known - Starting the conversation End-of-life: Start at the beginning
CHIEF EXECUTIVE’S NOTE

Members’ Contacts
Alexandra Hospital
378 Alexandra Road, S(159964)
T: 6472 2000 F: 6379 4339
www.ah.com.sg
AH_Enquiries@nuhs.edu.sg
                                                         The Palliative Care Centre
                                                         for Excellence in Research
                                                         and Education (PalC)
                                                         PalC c/o Dover Park Hospice
                                                         10 Jalan Tan Tock Seng, S(308436)
                                                                                                 Contents
                                                                                                                                                                                          “
                                                                                                                                               In the end, it’s not the years in your life that count.
                                                                                                                                                              It’s the life in your years.”
                                                         T: 6500 7269
Assisi Hospice                                           www.palc.org.sg
832 Thomson Road, S(574627)                              enquiries@palc.org.sg                                                                                                   ABRAHAM LINCOLN
T: 6832 2650 F: 6253 5312
www.assisihospice.org.sg                                 Ren Ci Hospital
assisi@assisihospice.org.sg                              71 Irrawaddy Road, S(329562)
                                                         T: 6385 0288 F: 6358 0900                                                            ur legacy is vital and for      Letting your family know your          EASE OF MIND

                                                                                                                                  O
Buddhist Compassion Relief                               www.renci.org.sg
                                                                                                                                              that reason we should        plans will enable them to carry           Knowing that you have put your

                                                                                                                           8
Tzu Chi Foundation (Singapore)                           renci@renci.org.sg
9 Elias Road, S(519937)                                                                                                                       live with a well-planned     out your wishes and minimise any          final affairs and arrangements
T: 6582 9958 F: 6582 9952                                Sengkang General Hospital                                                            life journey. There are      financial burden on loved ones in         in order will give you a sense of
www.tzuchi.org.sg/en                                     110 Sengkang East Way, S(544886)
                                                         T: 6930 6000                                                          many who understood and saw                 the future. It is also among the most     contentment and relief as you
Changi General Hospital                                  www.skh.com.sg                                                        the importance of making the right          unselfish and loving things that one      are aware that your options
2 Simei Street 3, S(529889)
T: 6788 8833 F: 6788 0933                                Singapore Cancer Society                                              decision to pre-plan for their final        generation can do for another.            will be honoured as planned.
www.cgh.com.sg                                           15 Enggor Street, #04-01,                                             wishes as it provides peace of mind.           We are great planners only if our      Pre-planning would make it
                                                         Realty Centre, S(079716)                2 Members’ Contacts           Ironically, talking about end-of-life       plan includes our final wishes for:       more affordable as the plans
Dover Park Hospice                                       T: 1800 727 3333
10 Jalan Tan Tock Seng, S(308436)                        www.singaporecancersociety.org.sg                                     decisions and final wishes would                                                      will be locked within your
T: 6500 7272 F: 6258 9007                                hospice@singaporecancersociety.org.sg   3 Chief Executive’s Note      probably never be ranked as the             UNFORESEEN CIRCUMSTANCES                  means where it is cost-effective
www.doverpark.org.sg
info@doverpark.org.sg                                    Singapore General Hospital                                            most pleasurable or anticipated             You never know what life has in           and practical.
                                                         Department of Internal Medicine,                                      conversation.                               store and therefore it is sensible,          It’s never too early to make
HCA Hospice Care                                         The Academia, Level 4,                  4 Starting the
                                                                                                                                 The peace-of-mind benefits will not       necessary and timely to pre-plan          your final wishes known as
705 Serangoon Road, Block A #03-01                       20 College Road, S(169856)                conversation
@Kwong Wai Shiu Hospital, S(328127)                      T: 6222 3322                                                          be complete if it is not discussed with     your end-of-life care and wishes.         letting your loved ones know
T: 6251 2561 F: 6291 1076                                www.sgh.com.sg                                                        the relevant loved ones. Therefore, it’s    This will enable your family to           about your plans will relieve
www.hca.org.sg                                           sghfeedback@sgh.com.sg
contactus@hcahospicecare.org.sg
                                                                                                 6 A life-affirming project    essential to actualise that discussion      be aware of your preferences or           them from unnecessary
                                                         SingHealth Community Hospitals                                        even if you think your family may           decisions, which will make it easier      conflicts and stress about
Khoo Teck Puat Hospital                                  (Bright Vision Hospital,
90 Yishun Central, S(768828)                             Outram Community Hospital,              8 The value of Advance        question or not be prepared to go           for them to cope at a time of crisis      making decisions during a
T: 6555 8000 F: 6602 3700                                Sengkang Community Hospital)              Care Planning               through what you have decided.              or loss.                                  time of grief.
www.ktph.com.sg                                          10 Hospital Boulevard, S(168582)
                                                         T: 6970 3000
KK Women’s and                                           www.singhealth.com.sg/SCH
Children’s Hospital                                                                              10 It’s never too early       Consider talking about your final wishes
100 Bukit Timah Road, S(229899)                          St. Andrew’s Community Hospital            to plan for the end
T: 6225 5554 F: 6293 7933                                8 Simei Street 3, S(529895)                                           with these professionals and anyone else
www.kkh.com.sg                                           T: 6586 1000                                                          you believe will have an impact
                                                         www.sach.org.sg
Lien Centre for Palliative Care                          general@sach.org.sg                     12 Advantages of early        on your final arrangements:                             Lawyers
Duke-NUS
Medical School Singapore                                 St Joseph’s Home
                                                                                                    Advance Care Planning
8 College Road                                           36 Jurong West St 24, S(648141)
Level 4, S(169857)                                       T: 6268 0482 F: 6268 4787
T: 6601 2034 / 6601 7424 [Education]                     www.stjh.org.sg                         14 Never a better time
T: 6601 5113 [Research]                                  general@stjh.org.sg                        than now                                               Funeral                                             Healthcare
www.duke-nus.edu.sg/lcpc
                                                         St Luke’s Hospital                                                                               Directors                                           Professionals
Metta Hospice Care                                       2 Bukit Batok Street 11, S(659674)
32 Simei Street 1,                                       T: 6563 2281 F: 6561 8205               16 Seize the moment
Metta Building, S(529950)                                www.slh.org.sg
T: 6580 4695 F: 6787 7542                                referral@stluke.org.sg
www.metta.org.sg
hhospice@metta.org.sg                                    Tan Tock Seng Hospital
                                                                                                 18 End-of-life                                                                   You should
                                                                                                    conversations: start at
MWS Home Care & Home Hospice
                                                         11 Jalan Tan Tock Seng, S(308433)
                                                         T: 6256 6011                               the beginning                                                                  speak to:
2 Kallang Avenue,                                        www.ttsh.com.sg
CT Hub #08-14, S(339407)
T: 6435 0270 F: 6435 0274                                Tsao Foundation                         20 A mother’s love                                       Immediate
www.mws.sg/centre-location/                              298 Tiong Bahru Road                                                                                                                                      Insurance
mws-home-care-home-hospice/                              Central Plaza, #15-01/06, S(168730)                                                                Family
MWShh@mws.sg                                             T: 6593 9500 F: 6593 9505                                                                                                                                  Agents
                                                         www.tsaofoundation.org                  22 Get started on end-of-                                 Members
National Cancer                                          info@tsaofoundation.org                    life care planning with
Centre Singapore
11 Hospital Drive, S(169610)                             Woodlands Health Campus                    SHC resources!
T: 6436 8000 F: 6225 6283                                9 Maxwell Road,
www.nccs.com.sg                                          MND Complex Annex A,                                                                                                        Caregivers
Ng Teng Fong General Hospital
                                                         #03-01A, S(069112)
                                                         T: 6681 5999
                                                                                                 24 Announcements /
1 Jurong East Street 21, S(609606)                       www.whc.sg                                 Events calendar                                                                                                  Ms Evelyn Leong
T: 6716 2000 F: 6716 5500                                                                                                                                                                                            Chief Executive
www.ntfgh.com.sg                                                                                                                                                                                                     Singapore Hospice Council
enquiries@juronghealth.com.sg

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T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1                                                                                                                                                                T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1
It's never too early to make your final wishes known - Starting the conversation End-of-life: Start at the beginning
COMPLETE
           TAKE THE FIRST
                    HOMESTEP
                          CARE

Starting the                                                                                                                                                                                                “
                                                                                                                                                                                                            Planning for EOL
conversation                                                                                                                                                                                                early allows you
                                                                                                                                                                                                            to prepare for any
Planning for end-of-life early empowers
us to make the best decisions for                                                                                                                                                                           unfinished business
ourselves and also reassures our loved
ones. HCA Senior Medical Social Worker                                                                                                                                                                      to be completed,
Yap Ching Sian shares some tips on
beginning the end-of-life conversation.
                                                                                                                                                                                                            reconcile with people
                                                                                                                                                                                                            whom you might not
At what age should I start planning for
end-of-life?                                                                                                                                                                                                have spoken to for a
Planning for your end-of-life (EOL) requires
you to start thinking about how you would
like to be cared for when you are diagnosed
                                                                                                                                                                                                            while and have proper
                                                         Planning for end-
with a life-threatening illness or when your
prognosis is guarded.
   It also requires considerations to be given
                                                         of-life early enables
                                                         your loved ones
                                                         and medical team
                                                                                                                                                                                                            time to say goodbye
                                                         to understand and
to who you want to appoint as a decision-
maker, in the event that you lose your
                                                         act in accordance to
                                                         your wishes.                                                                                                                                       to your loved ones.”
mental capacity. These decisions include
how your assets should be managed, funeral
arrangements to be made and the legacy                   made under such circumstances would                                                can begin spontaneously. For example, you        These conversations can lead to powerful
you want to leave behind.                                likely be ones that are thought through                                            and your loved ones might have watched         moments, where affirmations and words
   As these considerations require significant           rationally and carefully.                                                          a TV programme, in which one of the            of love and gratitude get conveyed and
deliberation, it is advisable that you                                                                                                      characters fell ill, or you and your loved     expressed. These conversations sometimes
only start to plan for EOL when you are                  Where do I start?                                                                  ones might have visited someone at the         become shared and precious experiences
sufficiently mature. While there is no                   A good place to start is Advance Care                                              hospital. These are good opportunities to      for you and your loved ones, which can be
specific age to start planning for one’s EOL,            Planning (ACP). It involves the process of                                         start having EOL conversations with your       deeply moving, meaningful and life-giving.
a good gauge is when one enters adulthood.               planning for one’s future personal and                                             loved ones in a more natural and less
When planning your EOL, you must have                    health care. It requires you to identify a                                         threatening way.                               What are the advantages of planning for
a good understanding of your values and                  spokesperson to make medical decisions                                                                                            EOL early?
preferences.                                             on your behalf, while being guided by the                                          What are some of the obstacles that I might    Planning for EOL early allows you to prepare
                                                         medical team, when you are unable to make                                          encounter during the conversation?             for any unfinished business to be completed,
I am young and healthy. Why do I have to                 your own decisions.                                                                Your loved ones may not be ready for the       reconcile with people whom you might not
plan for EOL so soon?                                       ACP also reflects your views on what gives                                      topic due to many reasons. They may find       have spoken to for a while and have proper
Having a plan for your EOL is about being                meaning to your life, elements of care that                                        it inauspicious or taboo to be talking about   time to say goodbye to your loved ones.
                                                                                                           WORDS & PHOTO HCA HOSPICE CARE

prepared should unforeseen circumstances                 are important to you and how you would                                             such topics. Others may find it difficult to     It also gives you the chance for your
arise. We often get emotionally                          like to be cared for in the event of an illness                                    dive into the conversations as the fear and    wishes regarding your care, financial
overwhelmed when we find out about                       or injury.                                                                         sadness of losing you are too much to bear.    matters and funeral matters to be heard. In
a major illness or when we meet with                                                                                                           Care and consideration about your loved     doing so, your loved ones will not feel the
an accident.                                             How do I include my loved ones in the                                              ones’ readiness to have these conversations    burden of having to make guesses about
   Under these difficult situations, it would            conversation?                                                                      should be taken into account. However,         your preferences. They can be empowered
be challenging for us to think about EOL                 You would know your loved ones best. You                                           getting your loved ones involved in your EOL   and assured that they are carrying out your
matters rationally. Hence, EOL plans are                 could start by asking questions to gauge                                           conversations is equally important, as they    preferences and can even take comfort
ideally made when you are healthy and in a               how far your loved ones can go with the                                            get a chance to hear you out and also to       knowing that things are being carried out in
good emotional and mental state. Decisions               conversation. Sometimes, the conversation                                          express their views about your EOL plans.      accordance to your wishes.

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T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1                                                                                                                                                                T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1
It's never too early to make your final wishes known - Starting the conversation End-of-life: Start at the beginning
SEIZE THE OPPORTUNITY

     A life-affirming project
                    Despite an ongoing pandemic, St. Andrew’s Community Hospital’s
                    successful initiative saw the extension of Advance Care Planning
                       beyond the Palliative Care ward to the Rehabilitation ward.

               ave for a rainy day,                           or surgery, and require some time             they reach the end of their lives and

       S       prepare for our future,
               what would you like
               to do when you grow
                                                              to regain or improve their functional
                                                              state. They prove to be a captive
                                                              audience between therapy sessions!
                                                                                                            to share what is important to them.
                                                                                                               Our multidisciplinary team was
                                                                                                            really thrilled that this little project
up, what are your retirement plans.                              ACP influencers, who are staff             yielded very encouraging results.
These are some commonly heard                                 such as nurses, pastors and                   Over 30 patients in just one ward
sayings as we go through life in                              therapists, were trained to reach             managed to complete an ACP
Singapore. We make many of                                    out to patients and their families            discussion with a facilitator over a
such preparations but what about                              to raise awareness of ACP. Using              span of six months. Families have
our health?                                                   materials such as videos, brochures           expressed gratitude towards the
  We can also make plans for our                              and workbooks from the Agency of              ACP team, as now they know more
future health.                                                Integrated Care, the team found that          about what their loved ones would
  Due to restrictions as a result of the                      there was interest among patients in          like for their future and will not feel
COVID-19 pandemic, I found myself                             attending ACP awareness sessions.             guilty at making a wrong decision.
serving in St. Andrew’s Community                                During one such session, a patient         They are thankful that these
Hospital (SACH) for six months longer                         raised his hand to show interest              discussions bring the family closer
than I had anticipated. Harbouring                            in having the discussion in the               together. Our staff awareness has
a passion for Advance Care Planning                           hospital. Another heard how we                also increased through this initiative
(ACP), my initial efforts to learn more                       engaged another patient on ACP and            and they are now more capable of
about this work blossomed into a                              said he too wanted to do it all along         carrying out an ACP discussion.
full-fledged effort to introduce ACP                          but did not have the time, and “this             We aim to eventually roll out this
into the Rehabilitation ward of SACH.                         is the best time for me to do so while        initiative to the rest of the wards
A Quality Improvement Initiative was                          being an inpatient”. Some patients            in SACH.
started in July after discussions with                        who live alone felt assured that they            This year may have bought great
team members during the Circuit                               have been given the opportunity to            disruption to the world. Amidst
Breaker. Patients admitted into the                           think and discuss their end-of-life           this, I was glad for the opportunity
ward are usually elderly and have                             care plans. This only goes to show            to carry out this life-affirming
suffered a health-related setback                             that many do wish to talk about               initiative and leave a legacy for
such as a stroke, a serious infection                         how they wish to be cared for when            others to build on.

                                                                                                                                                       COMMUNITY HOSPITAL PHOTO ST. ANDREW’S COMMUNITY HOSPITAL
                                                                                                                                                       WORDS DR NG HAN XIAN, MEDICAL OFFICER, ST. ANDREW’S

         The team members of the Quality Improvement Initiative are (left to right): Tabitha Low (Senior
         Executive, Healthcare Performance Office), Marcia Chung (Principal Medical Social Worker), Dr Ng
         Han Xian (Medical Officer), Leong Peiyu (Associate Chaplain, Pastoral Care Services), Dr Melissa
         Abamonga (Resident Physician) and Dr Kyi Theint Theint Thu (Principal Resident Physician)

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T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1                                                                                                                                                            T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1
It's never too early to make your final wishes known - Starting the conversation End-of-life: Start at the beginning
PLAN FOR FINAL DIGNITY

                                                                                                                                                                                                                                                                                                     Far left: Senior Staff
                                                                                                                                                                                                                                                                                                     Nurse Hasnah bte
                                                                                                                                                                                                                                                                                                     Abdullah with Nurse
                                                                                                                                                                                                                                                                                                     Clinician Sahnan bin
                                                                                                                                                                                                                                                                                                     Rahim work together
                                                                                                                                                                                                                                                                                                     on ACP outreach;
                                                                                                                                                                                                                                                                                                     Below: SSN Hasnah
                                                                                                                                                                                                                                                                                                     guides ACP sessions
                                                                                                                                                                                                                                                                                                     with relevant materials

                                                                                                                                                                                                                  experience an ACP discussion.            Attorney (LPA) and to draw up                  death to be in a hospice. I guided

         The value of Advance                                                                                                                                                                                     Mr L was initially very angry; he felt
                                                                                                                                                                                                                  that he did not get much time with
                                                                                                                                                                                                                                                           a will.
                                                                                                                                                                                                                                                              However, he was still very much
                                                                                                                                                                                                                                                                                                          him and his sister with information
                                                                                                                                                                                                                                                                                                          about the signs of active dying,

                                                                                                                                     WORDS SENIOR STAFF NURSE HASNAH BTE ABDULLAH, ADVANCE CARE PLANNING NURSE,
                                                                                                                                                                                                                  doctors and had many unanswered          in denial about his life-limiting              what the final hours might be like,

                                                                                                                                     CHANGI GENERAL HOSPITAL PHOTOS CHANGI GENERAL HOSPITAL, UNSPLASH.COM
            Care Planning
                                                                                                                                                                                                                  questions. Although he was a soft-       illness. After that initial discussion,        and how his sister should take care
                                                                                                                                                                                                                  spoken and respectful man, he got        he subsequently underwent                      of herself after her brother’s death.
                                                                                                                                                                                                                  so agitated that we had to calm          aggressive chemotherapy and                    Both Mr L and his sister were very
                                                                                                                                                                                                                  him down. We assured him that we         many medical interventions. The                open to hearing this. They were
                                                                                                                                                                                                                  would help him where we could.           next time I saw him was one year               thankful for the information as it
          Changi General Hospital Senior Staff Nurse Hasnah bte Abdullah shares                                                                                                                                   He soon became very appreciative         later. He was admitted and again               prepared them for the end through
         the importance of making your final wishes known through a case study.                                                                                                                                   of the time we spent talking to          referred to me. This time, he was              knowing what to expect.
                                                                                                                                                                                                                  him. He finally felt heard and           much weaker, wheelchair-bound,                   Relevant information provided at
                                                                                                                                                                                                                  taken seriously.                         and appeared to have accepted                  a pace suited to both Mr L and his
                                                                                                                                                                                                                     As a single 68-year-old man,          that further treatment was not                 family meant that he could make
              ontrary to popular                            ACP discussions include talking      Let me share this through                                                                                        Mr L’s main concern was not to           going to reverse the course of his             decisions that prioritised what was

     C        perception, Advance
              Care Planning (ACP)
              is much more about
                                                         about preparation for end-of-
                                                         life care and death, dealing with
                                                         unfinished business, avoiding
                                                                                              a memorable meeting with
                                                                                              Mr L, who was referred to me in
                                                                                              November 2019. Mr L had received
                                                                                                                                                                                                                  burden his siblings with his care.
                                                                                                                                                                                                                  I explained that the ACP is an
                                                                                                                                                                                                                  ongoing discussion that can be
                                                                                                                                                                                                                                                           disease. It had progressed to a
                                                                                                                                                                                                                                                           very advanced stage and he was
                                                                                                                                                                                                                                                           given a prognosis of less than
                                                                                                                                                                                                                                                                                                          important to him. It might have
                                                                                                                                                                                                                                                                                                          seemed premature to talk about
                                                                                                                                                                                                                                                                                                          end-of-life care right at the start
life than death. It is about helping                     unnecessary prolongation of          bad news of metastatic cancer                                                                                       revisited anytime. At the end of the     three months. He was seen by the               of the disease, but it got him to
people live out the final stage of life                  dying, strengthening of personal     and limited prognosis from a                                                                                        discussion, referrals were made          palliative team and referred to                carry out certain important actions
as fully as possible and to make the                     relationships, and relieving         urologist. He was devastated, at a                                                                                  to a psychiatrist, medical social        Assisi Hospice.                                early, such as appointing an LPA,
most of each remaining moment. In                        burdens placed on family. They       loss, anxious, angry, and in denial.                                                                                worker and a private nursing                I revisited his ACP with his                before he was not able to do so. The
the end, when the time comes, ACP                        are a key step towards provision     I was asked to see him as soon as                                                                                   service provider to meet the needs       sister who was the nominated                   discussions respected his desire
is a means to help people die with                       of care that is in line with a       I could.                                                                                                            he had described. As a result of         healthcare spokesperson. During                not to burden his siblings and
dignity in the place and manner of                       person’s wishes, at a time when it      I went to see him with two other                                                                                 the discussion, he also agreed           that discussion, Mr L made the                 facilitated his eventual death in a
their choice.                                            matters most.                        senior nurses who wanted to                                                                                         to nominate a Lasting Power of           decision for his preferred place of            place of his choice.

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T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1                                                                                                                                                                                                                                                      T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1
It's never too early to make your final wishes known - Starting the conversation End-of-life: Start at the beginning
COMPLETE
          A YOUTHFUL
                   HOME
                     EXAMPLE
                        CARE

                                                                                                                                                                        was in a lot of pain and could not      and have one of them join the          reflect on what is truly important
                                                                                                                                                                        communicate his wishes to my            session. After all, an ACP is a        to them. This is then a chance for
                                                                                                                                                                        mother and her sister. Both of them     piece of document. What matters        them to make choices that are

It’s never too early
                                                                                                                                                                        could not come to an agreement          more is the conversation, where        congruent with their values. Life
                                                                                                                                                                        on whether to prolong his life or to    we have a nominated healthcare         and death are two sides of the
                                                                                                                                                                        let him go. I am bringing this story    spokesperson listen to you and         same coin; in planning for their

to plan for the end
                                                                                                                                                                        up to illustrate that these difficult   respect your wishes.                   death, they also plan how they
                                                                                                                                                                        decisions may have been easier if                                              want to live.
                                                                                                                                                                        they had talked about it before it      Did you encourage your family
                                                                                                                                                                        became too late.                        and/or friend(s) to do their ACP       It always seems too early, until it’s
                                                                                                                                                                                                                as well?                               too late. How would you encourage
Hilda sat down and did her Advance Care Plan at the tender age                                                                                                          What made you decide to finally do      Yes, I shared about my experience      young adults like yourself to
                                                                                                                                                                        your ACP?                               during my volunteering work            start planning for their future
of 23. We find out more about her motivations.
                                                                                                                                                                        I had wanted to try it myself and       and if I sense that my friends are     healthcare preferences, while they
                                                                                                                                                                        use the experience to persuade my       interested, I would encourage them     are still healthy?
                                                                                                                                                                        parents to get their ACP done as        to get their ACP done. However, I      I understand that thinking about
                                                                                                                                                                        well — it’s still a work in progress.   do not rush people into it. I rather   your own mortality can be scary,
                                                                       t always seems too early                                                                         As I am an only child, I worry about    trust that they will do it when they   and that is normal. In your youth,

                                                              I        until it is too late.
                                                                          Advance Care Planning
                                                                       (ACP) is for everyone,
                                                                                                                                                                        not knowing what to do when my
                                                                                                                                                                        parents pass away. We do not talk
                                                                                                                                                                        about end-of-life matters as they
                                                                                                                                                                                                                are ready.

                                                                                                                                                                                                                What do you think is one major
                                                                                                                                                                                                                                                       you want to savour your own
                                                                                                                                                                                                                                                       vitality, to feel alive and delay
                                                                                                                                                                                                                                                       adult responsibilities for as long as
                                                         including healthy adults, and does                                                                             are resistant to it.                    advantage of having an ACP done?       you can. Having an ACP done does
                                                         not need to be done only in our senior                                                                                                                 ACP covers a broad range of            not mean that you have everything
                                                         years. More often than not, it usually                                                                         Did you discuss with your family        questions beyond healthcare            figured out. It also does not mean
                                                         takes a major illness to prompt such                                                                           and/or friend(s) while considering      preferences. For example: “What        that you must be fearless of your
                                                         discussions with our loved ones.                                                                               to get your ACP done?                   makes each day meaningful?”,           own death. You simply accept that
                                                         However, it is always better to plan                                                                           No. I simply did a search online        “What are the important aspects        death is inevitable; it will come to
                                                         for our future healthcare preferences                                                                          on where I could get my ACP done        about your well-being?”, “Who          everyone eventually. Hence, what
                                                         when we are still well. In this way, it                                                                        without charge, then proceeded to       or what helps you face serious         we can do is really to prepare as
                                                         allows our needs and wishes to be                                                                              make an appointment for myself.         challenges in life?”. Thinking about   much as we can. Starting your ACP
                                                         met should we be unable to speak or                                                                            On hindsight, it may be more            the answers to these questions         conversation early will bring you
                                                         communicate for ourselves and relieves                                                                         effective to talk to my parents         gives one the opportunity to           comfort in the future.
                                                         our loved ones of having to make these
                                                         difficult decisions.
                                                           Hilda (as she wants to be known)
                                                         at 23 years old is one of the many

“
                                                                                                                                                                           It is never too early to
                                                         who had their ACP done with an ACP                                                                                start a conversation
                                                         Facilitator at Khoo Teck Puat Hospital.                                                                           about Advance Care
                                                                                                                                                                           Planning. Opposite
                                                         The hospital hopes more young adults                                                                              page: Hilda having a
                                                         will consider having their ACP done.                                                                              tele-ACP discussion
                                                                                                                                                                           with the ACP Facilitator

                                                                                                      KHOO TECK PUAT HOSPITAL PHOTOS KHOO TECK PUAT HOSPITAL, PIXABAY
                                                         How did you first know about ACP?
Having an ACP done does                                  I found out about it at a volunteer
                                                         training on ACP in August 2018.

not mean that you have
                                                                                                      WORDS TRICIA TAN, EXECUTIVE, ADVANCE CARE PLANNING,

                                                         Was there any past experience, e.g.
                                                         from a loved one, that contributed to
everything figured out. It also                          your decision of doing an ACP?
                                                         No. However, months after I got my

does not mean that you must                              ACP done, I had my first experience of
                                                         death in the family. It does not feel real
                                                         that someone I knew for my whole life
be fearless of your own death.                           is now gone. When I was a child, I was
                                                         close to my grandfather who taught
                                                         me watercolour painting. We grew
You simply accept that death                             distant as I got older because it became
                                                         harder for us to communicate due to

is inevitable; it will come to                           my limited vocabulary and his hearing
                                                         loss. Upon knowing about his death, I
                                                         did not know how to react. In the days
everyone eventually.”                                    leading to my grandfather’s death, he

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T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1                                                                                                                                                                                                  T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1
It's never too early to make your final wishes known - Starting the conversation End-of-life: Start at the beginning
LEAVING CLEAR DIRECTIONS

                                                                                                                                                                                                              Opposite page: Assisi
                                                                                                                                                                                                              Hospice’s Senior
                                                                                                                                                                                                              Medical Social Worker/
                                                                                                                                                                                                              Counsellor Ms Ivee
                                                                                                                                                                                                              Tee (left) facilitates
                                                                                                                                                                                                              Advance Care Planning
                                                                                                                                                                                                              discussions with patients
                                                                                                                                                                                                              and their caregivers

                                                                                                                                                                                                              Mr Tan’s wife’s worries
                                                                                                                                                                                                              were addressed and
                                                                                                                                                                                                              eased with assurance of
                                                                                                                                                                                                              the available resources,
                                                                                                                                                                                                              decreasing her sense
                                                                                                                                                                                                              of uncertainty over her
                                                                                                                                                                                                              caregiving journey.

                                                                                                                                                                                                                                          Why ACP?

Advantages of early                                                                                                                                                                                                Why should we do ACP early?
                                                                                                                                                                                                                   • Illness can strike any time
                                                                                                                                                                                                                   • It reduces the pressure of decision-making on our

Advance Care Planning                                                                                                                                                                                                loved ones

                                                                                                                                                                                                                   What should the conversation cover?
                                                                                                                                                                                                                   • Sharing of your values and beliefs
Assisi Hospice’s Senior Medical Social Worker/Counsellor                                                                                                                                                           • Exploring how your values and beliefs affect your
Ms Ivee Tee shares a patient’s case study.                                                                                                                had thought through their decisions, the MSW               medical/care decisions when you are seriously ill
                                                                                                                                                          proceeded to discuss the details with them.              • Choosing one or more spokesperson(s) who can
                                                                                                                                                            Mr Tan’s wife did not really want to talk about
                                                                                                                                                                                                                     represent you when you are unable to express your wishes
              ixty-four-year-old Mr Tan (name            in his direct care, and they were not on good                                                    end-of-life initially as she had been grieving

      S       has been changed) was diagnosed            terms with his wife.                                                                             due to his illness. The ACP conversation gave
                                                                                                            WORDS ASSISI HOSPICE IMAGES ASSISI HOSPICE,

              with cancer and referred to Assisi            Assisi Hospice’s MSW visited Mr Tan and his                                                   the couple a platform to talk about Mr Tan’s             Should I and how do I document my ACP?
              Hospice for palliative care and            wife twice to discuss ACP. During the MSW’s                                                      wishes for his care openly and helped his wife to        • Though ACP is not a legal document in Singapore,
symptom management in July 2020. Even                    first visit, she identified and brought to his                                                   understand what he wanted. This also gave her              documenting it would enable your loved ones and the
though Mr Tan could still care for himself at that       attention the family dynamics and possible                                                       more time to prepare herself mentally in caring            medical team to provide care according to your wishes
point in time, he decided to discuss Advance             challenges his wife might face regarding his                                                     for Mr Tan. Her worries were addressed and
                                                                                                            PIXABAY.COM & PEXELS.COM

                                                                                                                                                                                                                     when you lose your mental capacity.
Care Planning (ACP) with Assisi Hospice’s Medical        end-of-life care. She then introduced ACP to                                                     eased with assurance of the available resources,
Social Worker (MSW) as he was concerned that             him and his wife, engaging them in a series                                                      decreasing her sense of uncertainty over her
                                                                                                                                                                                                                   • You can use your own ways to document it and share with
his wife, who was his sole caregiver, would              of discussions to understand their values                                                        caregiving journey.                                        your loved ones.
be confronted with disagreements with his                and wishes regarding the various important                                                         Mr Tan conveyed his decision to his siblings.          • You may also document your plans in the ACP workbook
siblings regarding his decisions on his care plan        elements of care, including preferences relating                                                 They respected it and gave their full support to           available at www.livingmatters.sg
at his end-of-life. Mr Tan’s siblings visited him        to resuscitation, care and treatment, place                                                      his wife.
regularly even though they were not involved             of care and death. After Mr Tan and his wife                                                       Mr Tan passed on in September 2020.

12                                                                                                                                                                                                                                                                                              13

T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1                                                                                                                                                                                       T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1
It's never too early to make your final wishes known - Starting the conversation End-of-life: Start at the beginning
COMPLETE
          PREPARINGHOME
                   FOR CRISIS
                        CARE

                                 Never a better
                                 time than now
                         COVID-19 is a clarion call for Advance Care Planning,
                       highlighting how an unexpected and sudden health crisis
                     increases the urgency of making our care preferences known.

              he COVID-19 pandemic                       we cannot hide from death. Every         we have witnessed how this

      T       has irrevocably changed
              our lives — how we
              work, how we socialise,
                                                         day, we receive news on the rising
                                                         caseloads and death tolls worldwide.
                                                         COVID-19 is a stark reminder of
                                                                                                  uncertainty causes significant
                                                                                                  stress to the family members who
                                                                                                  struggle to make decisions on their
and even how we eat. The global                          what we have always known but do         loved one’s care. This is why we
spread and impact of the virus have                      not openly acknowledge — anyone          are calling for people, even those
demonstrated that we humans are                          can suddenly fall seriously ill.         who are young and well, to do
not as invulnerable as we think we                         In a serious illness, healthcare       their Advance Care Planning (ACP).                                                                                                                                                                                                                       Everyone should take the
are, despite the many advancements                       decisions are complicated, with             ACP is a series of conversations                                                                                                                                                                                                                    time to talk to their families
                                                                                                                                                                                                                                                                                                                                                          and loved ones about what
of modern medicine. The COVID-19                         no single best answer. With the          where a person’s values and                                                                                                                                                                                                                                  they value in terms of
virus has afflicted young and old, rich                  advice of the healthcare team, the       preferences are shared with                                                                                                                                                                                                                                   their health and lives
and poor, and brought many of us,                        patient can then make a choice           their loved ones and healthcare
perhaps for the first time, face to face                 after weighing the benefits and          providers. These values and
with our mortality.                                      risks of various treatments, based       preferences are what shape an
   In pre-COVID times, acute serious                     on their own personal values and         individual’s healthcare decisions.

                                                                                                                                        TOCK SENG HOSPITAL & DR RAYMOND NG, SENIOR CONSULTANT & HEAD, PALLIATIVE MEDICINE, WOODLANDS HEALTH
illnesses could happen to anyone                         goals. But when someone becomes          They are unique to each                                                                                                                     and the risks, benefits and trade-       1. What are the things in life that     and telemedicine consultations

                                                                                                                                        CAMPUS THIS ARTICLE FIRST APPEARED IN LIFEWISE (JAN-MAR2021), AN NHG PUBLICATION PHOTO SHUTTERSTOCK
                                                                                                                                        WORDS DR EUNICE CHUA, CONSULTANT, DEPARTMENT OF GENERAL MEDICINE & CLINICAL CO-LEAD FOR ACP, TAN
at any time as well — a sudden                           seriously ill and is unable to           individual and allow for person-                                                                                                            offs of various treatment options.          give me meaning and purpose?         right now on how to conduct
bout of acute pancreatitis triggered                     make decisions for themselves, it        centred care. These conversations                                                                                                              The Circuit Breaker period            2. How would I like my loved ones       and implement ACP. In Singapore,
by previously silent gallstones, an                      becomes very challenging for their       are documented and used to                                                                                                                  created many challenges and even            to remember me?                      while there are some fledgling
insidious skin infection in the leg                      healthcare team. Without knowing         guide both family members                                                                                                                   a certain degree of suffering for        3. What would I be most fearful of      tele-health efforts to help people
from poorly controlled diabetes                          a patient’s unique preferences and       and healthcare teams when the                                                                                                               some, but it also brought great             should I become seriously ill?       do their ACP, we think there
resulting in septic shock, a road traffic                values, healthcare teams default         patient cannot make decisions                                                                                                               clarity. We began to appreciate          4. If I should become dependent         needs to be a louder call to
accident causing severe irreversible                     to choosing treatments that aim to       for themselves during serious                                                                                                               what we used to take for granted —          and require a full-time caregiver,   promote ACP in our population
brain injury. But these incidents of                     prolong life as much as possible,        illness. When you are well and                                                                                                              the freedom to simply sit outdoors          what are my concerns and             and systemically entrench it in
human vulnerability and mortality                        as well as consult patients’ families    have the time and mental space                                                                                                              and have a conversation with a              preferences?                         our healthcare system. We need
were largely kept away from public                       or loved ones to make decisions on       to think about what matters most                                                                                                            loved one, to hug a friend, or share     5. How do I feel about the use of       to change, en masse, our attitude
view, contained by the healthcare                        treatment options.                       to you, do your ACP; it allows you                                                                                                          a meal with extended family. We             life-support machines?               towards talking about death and
teams in hospitals; the resulting grief                    However, in our experience, most       to achieve a clear understanding                                                                                                            learned that living well is more         6. Who knows me best and would          dying, and embrace having these
and loss, no less painful, leaving their                 family members are uncertain as          of what your health journey                                                                                                                 than just being physically alive. As        be able to share my values with      important conversations early
indelible marks on individual families                   this topic has never been discussed      may look like, the potential                                                                                                                we move forward as a country, we            the doctors, to make healthcare      with our families and healthcare
rather than whole nations. Now,                          before. In the face of time pressures,   complications that may occur,                                                                                                               should not lose sight of this clarity.      decisions for me?                    practitioners.
                                                                                                                                                                                                                                                 We should take the time to talk                                                  ACP is not to a panacea for the
                                                                                                                                                                                                                                              to our families and our loved ones         We plan for everything in life: our   pain and suffering one might
                                                                                                                                                                                                                                              about what we value in terms             studies, our career, vacations, whom    face when one is seriously ill. But

                    We need to change, en masse, our attitude                                                                                                                                                                                 of our health and lives. By doing
                                                                                                                                                                                                                                              our ACP, we could empower them
                                                                                                                                                                                                                                                                                       we marry, how many kids we
                                                                                                                                                                                                                                                                                       want, and our retirement. However,
                                                                                                                                                                                                                                                                                                                               it can be very helpful — for you,
                                                                                                                                                                                                                                                                                                                               your family, and your healthcare
                                                                                                                                                                                                                                              with the right information so that       studies have shown that the large       team. Most importantly, the ACP is
                     towards talking about death and dying,                                                                                                                                                                                   if we cannot make decisions for
                                                                                                                                                                                                                                              ourselves, our loved ones will be
                                                                                                                                                                                                                                                                                       majority of us do not plan for
                                                                                                                                                                                                                                                                                       serious illness or share our values
                                                                                                                                                                                                                                                                                                                               not cast in stone. As an on-going
                                                                                                                                                                                                                                                                                                                               conversation, it provides a way for

                      and embrace having these important                                                                                                                                                                                      able to have certainty and peace of
                                                                                                                                                                                                                                              mind to make healthcare decisions
                                                                                                                                                                                                                                                                                       and preferences on our care with
                                                                                                                                                                                                                                                                                       our families.
                                                                                                                                                                                                                                                                                                                               us to talk about our fiercest loves
                                                                                                                                                                                                                                                                                                                               and our deepest fears and allows
                                                                                                                                                                                                                                              on our behalf.                             This public health crisis could       our loved ones to make difficult
                       conversations early with our families                                                                                                                                                                                     To help you get started, here
                                                                                                                                                                                                                                              are some questions that you can
                                                                                                                                                                                                                                                                                       be an impetus for us to turn the
                                                                                                                                                                                                                                                                                       tide for ACP. In some countries,
                                                                                                                                                                                                                                                                                                                               decisions should they be called
                                                                                                                                                                                                                                                                                                                               upon. Rather than thinking about
                                                                                                                                                                                                                                              think about and discuss with your        such as the US and Australia, there     this as taboo, embrace it as a gift of
                          and healthcare practitioners.                                                                                                                                                                                       loved ones:                              are COVID-specific advisories           love to those you care about.

14                                                                                                                                                                                                                                                                                                                                                                                  15

T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1                                                                                                                                                                                                                                                                          T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1
It's never too early to make your final wishes known - Starting the conversation End-of-life: Start at the beginning
ENGAGING WITH SENIORS

                                                                                                                                                                                                                            Carrying on

        Seize the                                                                                                                                                                                                         the conversation
                                                                                                                                                                                                                    Once you’ve started the conversation, what can you

        moment
                                                                                                                                                                                                                      talk about? Here are three ideas to consider.

                                                                                                                                                                                                                  Providing companionship
                                                                                                                                                                                                                  If your loved one is home-bound and living alone,
                                                                                                                                                                                                                  there is a high chance that he or she is feeling lonely.
        With seniors being more                                                                                                                                                                                   The rapid pace at which the world is moving may also
        susceptible to the adverse effects                                                                                                                                                                        add to the feeling of being isolated or left behind.
                                                                                                                                                                                                                  Palliative home care, which provides a range of
        of COVID-19, it may be time to get                                                                                                                                                                        services, may be an option. At MWS Home Care &
        the conversation going with your                                                                                                                                                                          Home Hospice, there are teams of doctors, nurses and
                                                                                                                                                                                                                  medical social workers who make regular home visits
        loved one sooner rather than later.                                                                                                                                                                       and provide round-the-clock support. Many seniors
                                                                                                                                                                                                                  actually look forward to the visits even when they are
                                                                                                                                                                                                                  well because of the companionship and camaraderie.

                                                                                                                                                                                                                  Getting care according to their wishes
                                                                                                                                                                                                                  While you may be focused on curative treatment
                                                                                                                                                                                                                  to treat your loved one’s condition, he or she may
                                                                                                                                                                                                                  have other thoughts about the care they want.
                                                                                                                                                                                                                  Hence, it may be a good time to bring up Advance
                                                                                                                                                                                                                  Care Planning (ACP), which promotes care that is
                                                                                                                                                                                                                  consistent with his or her values and preferences. It
                                                                                                                                                                                                                  guides you and the healthcare team to make decisions
                                                                                                                                                                                                                  in your loved one’s best interests should he or she
                                                                                                                                                                                                                  lose the mental capacity to do so. One tool that often
                                                                                                                                                                                                                  complements ACP is the Advance Medical Directive,
                                                                                                                                                                                                                  which informs the doctor treating your loved one to
                                                                                                                                                                                             An MWS Home          stop aggressive life-prolonging treatments should this
                                                                                                                                                                                                Care & Home
                                                                                                                                                                                             Hospice patient      be what he or she wishes. This helps to avoid disputes
                                                                                                                                                                                         receives holistic care
                                                                                                                                                                                                                  between family members when the time comes for
                                                                                                                                                                                                                  critical medical decisions to be made.

                                                                                                                                                                                                                  Having a better quality of life
               hile the COVID-19 situation                 According to a press release issued by                                                    who are in short supply as many have returned                We all want our loved ones to be comfortable, not

      W        has improved in Singapore,
               especially with the vaccine
                                                         the Ministry of Health, Singapore*, seniors
                                                         aged 60 and above form at least 80% of all
                                                                                                                                                     home and there are travel restrictions for their
                                                                                                                                                     replacements. This results in them not being able
                                                                                                                                                                                                                  suffering towards the end. Yet, more often than not,
                                                                                                                                                                                                                  the curative treatment route may cause pain and side
                                                                                                          WORDS & PHOTO METHODIST WELFARE SERVICES

               now available, it is widely               COVID-19 deaths. The number is even higher in                                               to receive the optimal care required. Many are
                                                                                                                                                                                                                  effects. This makes it important to talk about palliative
acknowledged that the crisis has been                    Singapore, where seniors made up 95% of all                                                 also more emotionally distressed due to myriad
particularly hard on seniors. From being                 COVID-19 deaths. The statistics also indicated                                              reasons, such as having to adhere to strict safe
                                                                                                                                                                                                                  care, which gives him or her the option for pain and
more susceptible to dying from the virus                 that nearly 1 in 6 or 16% developed severe                                                  distancing guidelines and juggling the needs of              symptom management, as well as a higher quality
to experiencing adverse effects of various               symptoms and required intensive care in the                                                 other family members. In addition, they may                  of life by meeting their physical, psychological and
containment measures, seniors have borne                 hospital compared to just 0.2% of non-seniors.                                              be experiencing a higher level of anxiety when               spiritual needs. Giving your loved ones better control
the brunt of the impact.                                   Although the various measures to safeguard                                                visiting hospitals and polyclinics for fear of               over their pain and symptoms will also enable them
  This makes it more important than ever to              the health and well-being of seniors may                                                    getting infected by the virus.                               to spend their remaining time in a more meaningful
start that end-of-life conversation with your            have kept the death toll low, these may have                                                                                                             manner. Palliative care could also be helpful for those
loved one as soon as possible. One way to                resulted in undesirable effects.                                                            *Ministry of Health, Support Measures for Seniors            who are struggling with the emotional distress and
broach the topic could be to share about the               At MWS Home Care & Home Hospice, many                                                     During COVID-19, 8 May 2020. Retrieved from                  anxiety brought on by the COVID-19 situation.
COVID-19 situation and its serious impact                patients are facing limited access to care                                                  https://www.moh.gov.sg/news-highlights/details/
on seniors.                                              resources, such as foreign domestic workers                                                 support-measures-for-seniors-during-covid-19.

16                                                                                                                                                                                                                                                                                         17

T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1                                                                                                                                                                                  T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1
It's never too early to make your final wishes known - Starting the conversation End-of-life: Start at the beginning
LEAVING MEMORIES

                   End-of-life                                                                                                                                                                                                Caption for the nurse
                                                                                                                                                                                                                              here Caption for the
                                                                                                                                                                                                                              nurse here Caption

               conversations: start
                                                                                                                                                                                                                              for the nurse here
                                                                                                                                                                                                                              Caption for the nurse
                                                                                                                                                                                                                              here Caption for the
                                                                                                                                                                                                                              nurse here

                at the beginning
                        Patients and their caregivers can use the recently published
                           A Family Dignity Intervention Journey: Our Lasting
                               Legacy to create their own legacy document.

               id you know that the                         But we are not just ‘the patient’.   caregivers, with the goal of

     D         most important and
               meaningful stories in
               our lives are actually
                                                         We are not just ‘the caregiver’.
                                                            We are unique individuals with
                                                         wonderful stories to tell. We are
                                                                                                 deepening emotional connections,
                                                                                                 creating lasting legacies and paving
                                                                                                 the way for end-of-life discussions.
our own? The ones that were                              spouses, children, siblings, parents    The FDI is conducted by a trained                                                                                                                                                                                                                 Senior counsellor
created since the day we were born,                      and friends. We have loved and lost,    therapist who delves into an                                                                                                                                                                                                                 Geraldine Tan-Ho and
                                                                                                                                                                                                                                                                                                                                           Associate Professor Andy
continued as we walk through life,                       given and received, dreamed and         exploration of recollections, life                                                                                                                                                                                                        Ho with their publication
and shared with special people we                        accomplished, failed and learned.       accomplishments, words of wisdom                                                                                                                                                                                                                  A Family Dignity
                                                                                                                                                                                                                                                                                                                                              Intervention Journey:
meet along the way.                                      Most importantly, we have shared        and expressions of appreciation                                                                                                                                                                                                                Our Lasting Legacy
   Sometimes, painful events such                        these precious experiences and          between patients and their
as the diagnosis of a serious illness                    memories with some special people       family caregiver. This interview
can seem to consume our entire                           in our lives. All of these cannot be    is later transformed into a ‘legacy
lives. As patients, we may feel                          undermined by the presence of a         document’ — an edited and

                                                                                                                                        SINGAPORE AND A MEMBER OF SHC’S COMMUNITY ENGAGEMENT & COMMUNICATIONS COMMITTEE
overwhelmed by the daily physical                        life-threatening illness.               personalised copy of the interview                                                                                          “When they have the opportunity      we should always remember to start          8. What are your hopes and

                                                                                                                                        PHOTOS NANYANG TECHNOLOGICAL UNIVERSITY SINGAPORE CORPORATE COMMUNICATIONS
discomfort, and the emotional                                                                    transcript that is designed like                                                                                         to first recall shared memories from    at the beginning. Based on the FDI             dreams for yourself, and

                                                                                                                                        WORDS GERALDINE TAN-HO, SENIOR COUNSELLOR, NANYANG TECHNOLOGICAL UNIVERSITY
rollercoaster of uncertainty, hope                       FAMILY DIGNITY INTERVENTION –           an autobiography — and given to                                                                                          childhood to adulthood and think        interview, patients, family caregivers         your loved ones?
and fear that accompany our                              CREATING LASTING LEGACIES               patients and their families. Last                                                                                        about what they have accomplished       and healthcare professionals can            9. What are some things you
illnesses. As family caregivers, we                      Associate Professor Andy Ho and         year, the team published A Family                                                                                        and learned in life, they begin to      embark on a meaningful storytelling            would want your loved one
may feel completely absorbed by                          his team at the Action Research         Dignity Intervention Journey:                                                                                            reflect also on what they would         journey with such questions:                   to know about you, or to
our caregiving responsibilities,                         for Community Health (ARCH)             Our Lasting Legacy, a book with                                                                                          like for themselves and their loved                                                    remember about you?
while coping with the tiredness                          Lab designed the Family Dignity         activities based on the FDI for                                                                                          ones in the future. The FDI provides    1. Tell me about your childhood.
that comes with our devoted acts                         Intervention (FDI) in 2017 to           patients and caregivers to create                                                                                        a gentle and empowering way of             What are some of the important             In bringing back old
of caregiving. On top of all these,                      facilitate valuable conversations       their own legacy document. This                                                                                          inviting patients and caregivers           and memorable times in                   memories, new and cherished
we are asked to participate in end-                      between patients and family             book has been distributed to local                                                                                       into these difficult but crucial           your life?                               ones are made. In expressing
of-life care conversations, such as                                                              hospices, hospital palliative care                                                                                       conversations.”                         2. How has your relationship                appreciation and love, family
Advance Care Planning or                                                                         units and intermediate long-term                                                                                                                                    with your loved one influenced           bonds are rekindled. In
Lasting Power of Attorney,                                                                         care facilities (ILTC) such as                                                                                         START AT THE BEGINNING                     your life?                               talking about our lives, we
something many of us                                                                                 nursing homes. An interactive                                                                                        Mr. Ahmed*, a patient who had           3. What do you think are your most          pave the way to reflections
had never even thought                                                                                 web version of the book is                                                                                         received Family Dignity Intervention,      meaningful accomplishments               about our death. The end-
about before the                                                                                         also underway.                                                                                                   once wisely declared, “If someone          in life?                                 of-life conversation must be
illness. Suddenly, our                                                                                     A/Prof Andy Ho observes                                                                                        does not ask about your life, how       4. What do you think your loved             dignifying, empowering and
present lives seem to                                                                                   that a significant feature                                                                                        can they ask about your death?”            one is most proud of you for?            meaningful; perhaps a lasting
revolve solely around                                                                                    of the FDI is that while the                                                                                       Indeed, end-of-life care              5. What do you appreciate most              legacy and a story in itself.
the illness and its                                                                                       interview questions did not                                                                                     conversations must begin from              about your loved one?                      After all, life is a gift to us, and
repercussions; the                                                                                        ask about end-of-life care                                                                                      a place of love and concern, and        6. What would you like to thank             sharing our life stories can be
‘good old days’ feel like                                                                                 planning, many patients and                                                                                     not simply from a place of urgent          your loved one for?                      our gift to the ones we love.
a distant memory, or                                                                                    caregivers brought up these                                                                                       necessity. Whether or not we are in     7. Are there any words of wisdom
even a figment of our                                                                                   topics organically during                                                                                         a hurry to acquire or convey final         or advice that you would like to         *Name has been changed
imagination.                                                                                           the interview.                                                                                                     wishes and plans for the very end,         offer to your family?                    for confidentiality

18                                                                                                                                                                                                                                                                                                                                                            19

T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1                                                                                                                                                                                                                                                     T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1
AN HEIRLOOM TO TREASURE

                                                                                                                                                                                                                                Left: The ties bound by
     A lifetime of love and                                                                                                                                                                                                     shared food memories
     memories are wrapped                                                                                                                                                                                                       are unbreakable and a
     up in the legacy                                                                                                                                                                                                           strong legacy. Below:
     works left behind for                                                                                                                                                                                                      This recipe book
     patients’ families                                                                                                                                                                                                         will help Mdm Wee’s
                                                                                                                                                                                                                                children continue the
                                                                                                                                                                                                                                tradition of cooking
                                                                                                                                                                                                                                for the family.

                                                                                                                                                                                                                                   The Medical Social Services (MSS) team on the
                                                                                                                                                                                                                                other hand provided psycho-emotional support for
                                                                                                                                                                                                                                her to complete the project.
                                                                                                                                                                                                                                   But the process was not as easy as the team
                                                                                                                                                                                                                                thought it would be. Madam Wee was lethargic and
                                                                                                                                                                                                                                needed rest most of the time due to her condition.

                                                                                                                                                                    “
                                                                                                                                                                                                                                   To help her complete her wish, the Rehabilitation
                                                                                                                                                                                                                                team focused on getting one recipe done at a time.
                                                                                                                                                                                                                                They broke down the tasks into smaller steps and
                                                                                                                                                                                                                                completed them day by day. For example, the team
                                                                                                                                                                                                                                would start with getting the list of ingredients
                                                                                                                                                                                                                                followed by recording the methods the next day.

                                                                                                                                                                    Some examples of legacy                                        Once they have gotten all the information,
                                                                                                                                                                                                                                they began to decorate the recipe book based on
                                                                                                                                                                                                                                Madam Wee’s instructions. There was also the
                                                                                                                                                                    work are conducting a life                                  language barrier that the team had to overcome.
                                                                                                                                                                                                                                The team had to enlist the help of Teochew-

                                                                                                                                                                    review, creating a recipe                                   speaking colleagues so they could understand
                                                                                                                                                                                                                                Madam Wee’s wishes.
                                                                                                                                                                                                                                   With all the help from the team, Madam Wee was
                                                                                                                                                                    book, written or audio letters,                             finally able to complete her recipe book. She passed
                                                                                                                                                                                                                                away three months later in August 2020 in her

A mother’s love
                                                                                                                                                                                                                                late 80s, but not without leaving something very
                                                                                                                                                                    or photograph albums to                                     valuable behind.
                                                                                                                                                                                                                                   Madam Wee’s legacy work taught many staff and

To most, it’s merely a cookbook. But for one palliative patient at Sengkang
                                                                                                                                                                    family members.”                                            patients about a mother’s unconditional love. She
                                                                                                                                                                                                                                was able to be a part of her children’s life despite
                                                                                                                                                                                                                                her illness, continuing to celebrate their birthdays
Community Hospital, the collection of recipes was part of her legacy that                                                                                           PRABHA D/O TECHNA MITI,                                     whenever her recipes are recreated in the kitchen
                                                                                                                                                                    SKCH SENIOR MEDICAL SOCIAL WORKER                           she left behind.
allowed her to live out the remainder of her life meaningfully.

             adam Julie Wee’s life was not always          She envisioned the book to be filled with

     M       smooth sailing. Ever since her
             husband passed away many years
                                                         traditional dishes that she used to make for their
                                                         birthday celebrations. A part of her will stay with
                                                                                                                                                                          Starting legacy work
                                                                                                                                                                          Legacy works help patients to reflect and initiate
                                                                                                                PHOTOS SINGHEALTH COMMUNITY HOSPITALS, PEXELS.COM

             ago, she worked hard to raise her           them as memories and remind them how she
three children on her own. It was tough being a          used to prepare their favourite dishes on those
                                                                                                                                                                           a review of their life experiences and document
single parent, but her love for them was far greater     special occasions.                                                                                                it as a tangible item so that their stories can be
than anything else.                                        It will also help her children to continue with                                                                        passed on to the future generations.
                                                                                                                WORDS SINGHEALTH COMMUNITY HOSPITALS

                                                         the tradition of cooking for the family at home.
HER LAST WISH                                              The Rehabilitation team then initiated                                                                     Some questions that can be asked are:
Madam Wee was known by her fellow patients and           this piece of legacy work — something that                                                                   • What activities are meaningful to them to create a
the hospital staff to be a reserved person. She only     allowed palliative patients to reflect on what’s                                                               tangible memory?
opened up and shared about her life experiences          important to them, and motivate them to have a                                                               • What are some tips or life experiences that they
when spoken to in the Teochew dialect.                   dignified rest-of-their-lives during their stay in a                                                           would like to share with others?
  The fluent Teochew speaker knew that time              community hospital.                                                                                          • What would they want their family to remember
was not on her side. She could feel her condition          “The Rehabilitation team provided her with                                                                   them for?
worsening each day and so, expressed her wish            different art materials to create her cards and                                                              • What would they like to leave behind for their
to write a card for each of her children and             recipe book. She would request for what she                                                                    loved ones?
also to create a recipe book that contained their        needed and the designs she wanted,” shared
favourite dishes.                                        Tricia Ng, SKCH Senior Occupational Therapist.

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SHC COMMUNITY RESOURCES                                                                                                                                                                                 HAPPENINGS

                                Get started on
                           end-of-life care planning
                             with SHC resources!
                      Conversation Cards                                          Time Of My Life:
          It’s important to know your values, motivations, beliefs                Past Perfect,
          and life goals, and identify people in your life that could             The Journal of
          act as spokespersons in times of critical need. There are               Self-Discovery
          30 questions classified in three levels of complexity. Here
          are some examples you can try with your loved ones!                     The first step in creating a legacy
          1. Easy                                                                 and the beginning of important
             • What is one life lesson I have learnt from                         conversations with your loved ones is
                my grandparents?                                                  by sharing your own story, desires and
             • What is the most memorable                                         experiences. There are 10 chapters to
                event that has happened in                                        explore! Here are some questions from
                my life?                                                          the “Favourites” chapter, so you can
          2. Intermediate                                                         better care for your loved ones when
             • Who and/or what                                                    they are terminally ill.
                encourages or inspires                                            1. What is your favourite: colour,
                me most?                                                             country, TV show, radio station,
             • When am I most                                                        animal, celebrity?
                comfortable being myself?                                         2. What are your favourite childhood food or snacks?
          3. Advanced                                                             3. Where can you find your favourite dishes now?
             • What do I think about                                              4. What are your hobbies and favourite activities?
                death and dying?                                                  5. What is your memorable moment during your
             • Who can speak for me if I’m admitted to hospital?                     favourite public holiday?

                Palliative Care Communicator (PCC) online training course
                                      To get physical copies of these         Who Should Attend:
                                      resources in English and Mandarin,      Social workers, psychologists, counsellors, allied health
                                      which are part of SHC’s Community       professionals, education and social service practitioners,
                                       Engagement Kit, sign up for SHC’s      volunteers and general public. We invite social service
               le play
Participants ro on cards
                                       Palliative Care Communicator           agencies to organise the training course for their staff and
with conversati                         (PCC) online training course today!   volunteers, and members of the public to form a group of
                                                                              minimum three participants.
          Course Objectives:
                                                                                                                                                 For more details of the programme and to download the response form, please visit
          At the end of the two-hour free course, participants will:          Course Requirement:
                                                                                                                                                             https://singaporehospice.org.sg/events/charity-show-25
          • Gain knowledge to start conversations with their service          Each participant is required to use the Community
            recipients on palliative care and end-of-life care                Engagement Kit to have conversations with at least two
          • Develop skills in using the Community Engagement Kit              individuals and provide feedback of experience in a survey form.
            and to help the service recipients reflect on life and
            end-of-life matters                                               SHC will send a trained professional to
                                                                              conduct the training.
          Mode of Course Delivery:
          The course can be conducted in English or Mandarin.                 Sign up via the online form at
          It will be delivered through lecture, structured group              https://singaporehospice.org.sg/
                                                                                                                                                 Please complete the response form and email to rsvpshc@singaporehospice.org.sg.
          discussions, case studies and interactive role-plays.               training-courses/.

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ANNOUNCEMENTS

                SHC welcomes
                                                                                        Upcoming Events
             Ren Ci Hospital as our                                                     MARCH - MAY 2021
                                                                                        SHC “Live Well. Leave Well.”:
                 25th member                                                            All You Need To Know About Palliative Care Talk
                                                                                        Join us for an informative session to understand
                                                                                        palliative care and end-of-life matters. The session
                                                                                        also aims to increase awareness of the attitude
                                                                                        towards death and its impact on the willingness to
                                                                                        converse with family or loved ones. It also aims to
                                                                                        provide the participants with the suite of Community
                                                                                        Resources available for palliative care in Singapore.
                                                                                        Time: 2.00pm - 3.30pm
                                                                                        Venue: Online via Zoom
                                                                                        Contact: contact@singaporehospice.org.sg
          Ren Ci Hospital is a charity healthcare institution                           Registration*: https://tinyurl.com/shctalks21eng
              founded in 1994 with the primary mission                                  *Please indicate your interest in the link and we will
            of providing affordable medical, nursing and                                contact you via email.
           rehabilitative care services for the community,
           based on the principles of loving kindness and
                                                                                        23 MARCH 2021
                                                                                        SDSPCC-SHC Palliative Care MDF* –
             compassion, regardless of race, religion and                               Patient-Centred Outcomes That Matter
           background. Over the years, Ren Ci has played                                Speaker: Professor of Palliative Care Fliss Murtagh,
             an active role in the lives of a growing silver                            Hull York Medical School, UK
           population in Singapore through expanding its                                Time: 12:00pm – 1:00pm
           spectrum of services to support the healthcare                               Venue: Zoom Webinar
           needs of the senior community. Partnering the                                Registration: https://bit.ly/3cOTxoz
                                                                                        *SingHealth Duke-NUS Supportive and Palliative Care
          community remains pivotal to the sustainability
                                                                                        Centre - Singapore Hospice Council Palliative Care
            of our care delivery, providing those we serve                              Multidisciplinary Forum
          with the hope for quality and meaningful living.
                                                                                        20-28 MARCH 2021
                                                                                        Singapore Cancer Society –
                                                                                        TalkMed Relay For Life 2021
                                                                                        This event offers everyone a chance to celebrate
                                                                                        cancer survivors and caregivers’ triumphs against the
          EDITORIAL COMMITTEE                                                           disease, remember loved ones lost to cancer and fight
                                                                                        back against the disease. Participants can fundraise
                                                                                        for the cancer community by running / walking /
Editor                                                   Christina Wee
                                                                                        cycling / swimming or come up with their own
Associate Editor                                         Anne Loh
                                                                                        fundraising challenge to show cancer patients that
                                                                                        they are not alone in the fight against cancer.
Alexandra Hospital                                       Yvonne Lee                     Venue: Anywhere (Virtual Event)
Assisi Hospice                                           Angela Yeo                     Admission: Free
Buddhist Compassion Relief                               Tzu Chi Editorial Team         Registration: https://scsrelayforlife.sg/ (Registration
  Tzu Chi Foundation (Singapore)                                                        closes on 19 March 2021)
Changi General Hospital                                  Rasidah bte Alias
Dover Park Hospice                                       Jenny Goo                      1 APRIL 2021 - 31 MAY 2021
HCA Hospice Care                                         Toh Wei Shi                    SHC @ Ang Mo Kio Public Library
Khoo Teck Puat Hospital                                  Tricia Tan                     Explore and learn more about palliative care and
Lien Centre for Palliative Care                          Tang Swee Noi                  end-of-life care planning through stories and
Metta Hospice Care                                       Cecilia Soh                    printed resources!
MWS Home Care & Home Hospice                             Nicolette Yeo                  Venue: Level 1, 4300 Ang Mo Kio Avenue 6, S(569842)
Ren Ci Hospital                                          Sharon Tan
                                                                                        In view of the COVID-19 situation, please check our
                                                                                        website www.singaporehospice.org.sg for updates.
The Palliative Care Centre for                           Tan Li Kuan
  Excellence in Research and Education
Sengkang General Hospital                                Farah Rahman
Singapore Cancer Society                                 Kumudha Panneerchelvam
Singapore General Hospital                               Mavis Law
Singapore Hospice Council                                Sheena Koong
SingHealth Community Hospitals                           Muhammad Azhar bin
                                                         Abdul Rahim
St Andrew’s Community Hospital                           Peh Lay Koon
St Joseph’s Home                                         Shereen Ng                     1 Lorong 2 Toa Payoh #07-00, Braddell House, S (319637)
St Luke’s Hospital                                       Chua Hwee Leng                 T: 6538 2231 • E: secretariat@singaporehospice.org.sg
Tan Tock Seng Hospital                                   Candice Tan                    www.singaporehospice.org.sg
Tsao Foundation                                          Desiree Lim

Design                                                   Christian Subrata              Contents are not to be quoted or reproduced without the prior
Printer                                                  Yung Shung Printrade Pte Ltd   written permission of the Singapore Hospice Council.

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T H E H O S P I C E L I N K • M A R C H – M AY 2 0 2 1
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