"I decide myself"- A qualitative exploration of end of life decision making processes of patients and caregivers through Advance Care Planning.

Background: The Singapore national Advance Care Planning (ACP) programme was launched in 2011 with the purpose of ensuring that healthcare professionals are fully aware of patients' treatment preferences. There is little research assessing the performance of such programmes in ethnically diverse Asian countries; hence, the purpose of this study was to qualitatively examine patients and caregivers' experiences with the ACP programme.

Method: We conducted interviews with 28 participants, thirteen of whom identified as proxy decision makers (PDMs) and the remainder as patients.

Competing expectations: Advance care planning from the perspectives of doctors and nurses in the South-East Asian context.

This study qualitatively examines the perspectives of doctors and nurses on the implementation of the Advance Care Planning program in Singapore. Findings suggest that a combination of structural and conceptual factors hindered the performance of ACP. Themes on structural factors indicated that low awareness of ACP among senior staff resulted overall lack of buy-in and incorrect implementation of the program due to misconceptions.

Sustainable implementation of advance care planning in Asia: An interpretive-systemic framework for national development.

Objectives: A qualitative interpretive-systemic focus group study was conducted to examine the developmental and implementational underpinnings of Asia's first national Advance Care Planning (ACP) programme constituted in Singapore.

Methods: 63 physicians, nurses, medical social workers, and allied health workers who actively rendered ACP were purposively recruited across seven major public hospitals and specialist centers.

Results: Framework analysis revealed 19 themes, organized into 5 categories including Life and Death Culture, ACP Coordination, ACP Administration, ACP Outcomes, and Sustainability Shift.

Patient autonomy and participation in end-of-life decision-making: An interpretive-systemic focus group study on perspectives of Asian healthcare professionals.

Objectives: Asia's first national advance care planning (ACP) program was established in Singapore in 2011 to enhance patient autonomy and self-determination in end-of-life (EoL) care decision-making. However, no known study has examined the extent to which ACP in Singapore successfully met its aims. The purpose of the current study was to examine the attitudes of local healthcare professionals on patients' autonomy in decision-making at the EoL since they strongly influence the extent to which patient and family wishes are fulfilled.

Individual, clinical and system factors associated with the place of death: A linked national database study.

Background: Many middle- and high-income countries face the challenge of meeting preferences for home deaths. A better understanding of associated factors could support the design and implementation of policies and practices to enable dying at home. This study aims to identify factors associated with the place of death in Singapore, a country with a strong sense of filial piety.

Implementing Advance Care Planning in Acute Hospitals: Leading the Transformation of Norms.

Background: Despite being simply defined as a process to further one's understanding about future medical care, the process of implementing advance care planning (ACP) within acute hospital settings can be complex.

Aim: We describe different ACP service models adopted in Singapore, and the facilitators for, and barriers to, its effective implementation.

Design: Qualitative focus group study with thematic analysis.

Retrospective cohort analysis of real-life decisions about end-of-life care preferences in a Southeast Asian country.

Objective: To describe the end-of-life care preferences of individuals, and to examine the influence of age and gender on these preferences.

Design, Setting And Participants: A retrospective cohort study was conducted. Participants included all adults (≥21 years old) (n=3380) who had completed a statement of their preferences as part of a national Advance Care Planning (ACP) programme in Singapore.

Using Routinely Collected Data to Ascertain Concordance With Advance Care Planning Preferences.

Context: One of the key outcomes of advance care planning is whether patients had received care that was consistent with their expressed goals and preferences.

Objectives: The aims of this study were to illustrate the feasibility of using routinely collected health care data that include hospital procedural codes, diagnosis-related codes, health services utilization, and death registry data and to ascertain the level of concordance between care received and the stated goals.

Methods: In this retrospective cohort study, medical treatments were ascertained using a combination of hospital procedural codes and diagnosis-related codes.

State of advance care planning research: A descriptive overview of systematic reviews.

Objective: To provide an overview of the current state of research of advance care planning (ACP), highlighting most studied topics, publication time, quality of studies and reported outcomes, and to identify gaps to improve ACP receptivity, utilization, implementation, and outcomes.

Method: Cochrane methodology for conducting overviews of systematic reviews. Study quality was assessed using a modified version of the Assessing the Methodological Quality of Systematic Reviews tool.

Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons.

Background: Advance care planning (ACP) involves important decision making about future medical needs. The high-volume and disparate nature of ACP research makes it difficult to grasp the evidence and derive clear policy lessons for policymakers and clinicians.

Aim: The aim of this study was to synthesize ACP research evidence and identify relevant contextual elements, program features, implementation principles, and impacted outcomes to inform policy and practice.