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Planning for future medical care with Advance Care Plan (ACP)

What is Advance Care Plan?

Advance Care Plan (ACP) is a voluntary process to discuss and share your health-care preferences with your family and healthcare providers. The ACP process guides physicians, patients and their loved ones in making decisions based on the patient’s values, beliefs, wishes and personal goals of care.

Why make an ACP?

Similarly to Advance Medical Directive, it is about planning for future medical care in case one is unable to make one’s own decisions. It is important to start the conversation early as it is difficult to predict when a medical catastrophe might happen.

Who decides what treatment you get?

Your doctor considers what treatment to offer you based on your state of health at the time, the availability of treatment and the benefit you will get from the treatment, balanced with the risk of possible harm or side-effects.

You will then have the choice to agree or refuse the treatment. By completing an ACP, you are voicing out how you feel or you will have enabled a trusted friend or family member to speak on your behalf when you cannot. Your doctors will be clear about what you want. You will always be entitled to “comfort care” that respects your body, mind and spirit.

If you reach the point where you no longer want life-saving care, medical treatment and nursing care are always given to keep you comfortable, such as

  • Pain-relieving and symptom control medicines and treatments
  •  Antibiotics
  • Medication to ease breathing difficulties
  • Surgery to control pain (such as the repair of a broken hip)

Making an ACP

An ACP is for anyone, regardless of age or health. It includes:

  • Sharing your personal values, beliefs and goals for care with your loved ones and healthcare providers.
  • Exploring your healthcare preferences in difficult medical situations, which could include circumstances at the end-of-life.
  • ACP Facilitators can be engaged to assist in the conversation.
  • Appointing a Nominated Healthcare Spokesperson (NHS) to represent your voice and make your preferred medical decision should you be unable to speak for yourself one day. This can be formally appointed using Lasting Power of Attorney (LPA)
  • Document and retain a copy of your Advance Care Plan
  • Review your Advance Care Plan when you change your mind, or when your medical conditions or circumstances change

Also read: Lasting Power of Attorney (LPA) 

Different Types of ACP

Types Who is it for? Contents
General ACP For relatively well and healthy individuals 1) Appoint NHS
2) Decision on goal of care if one is to be rendered severely mentally impaired with low chance of recovery
Disease-Specific ACP (DSACP) For patients with progressive, life-limiting illness with frequent complications 1) Appoint NHS
2) Statement of treatment preference in 3 clinical scenarios:
a. serious complications with a low chance of survival
b. serious complications with a low chance of recovery of physical function or ability to communicate and will require total nursing care
c. serious complications with a high chance of mental incapacity and will require total nursing care
3) Specific disease-related care
Preferred Plan of Care (PPC) For patients with more advanced illness whom one will not be surprised if they pass away within 12 months. 1) Appoint NHS
2) Care options on CPR
3) Care goals for medical intervention when one suffers a potentially life-threatening crisis
4) Preference on place of care
5) Preference on place of death

When does it take effect?

It is an on-going conversation with your family and healthcare providers, by sharing one’s choices and health-care preferences.

Cancelling an ACP

You can change, review and update your Advance Care Plan at any time throughout your life.

Who can be my Nominated Healthcare Spokesperson (NHS)?

The NHS should be above 21 years old, be willing to speak on your behalf even under a stressful situation. It is important that your NHS knows you well and understand your wishes and concerns, inform the doctors about the care you would like to receive, and follow through with your care preferences.

Limitations of ACP

A person’s preference is vague or non-specific, which may also change with health status, life circumstances and change goals. A family may disagree with patient’s decisions. Hence, it is important to engage in a conversation with your family, review your plans regularly and communicate any changes as soon as possible. In times of emergencies when your Advance Care Plan and decision-makers are not available, your health professional may begin life-saving treatments but then stop these if they learn that it is not what you want.

To find out more

If you are a patient at any of the public hospitals, you may approach your doctor about ACP. For general inquiries, you may contact ACP National Office.

Organisation Contact details
ACP National Office
(Agency for Integrated Care)
No. 5 Maxwell Road, #10-00 Tower Block, MND Complex, Singapore 069110
Tel: 1800 650 6060
Email: livingmatters@aic.sg
Website: www.livingmatters.sg
Jurong Health Tel: 9622 5889
Email: JHCampus_ACP_Admin@nuhs.edu.sg
Khoo Teck Puat Hospital Tel: 6555 8000
Email: ktph.advancecareplanning@ktph.com.sg
Sengkang Health Tel: 6379 3370
Email: livingwellmatters@skh.com.sg
Singapore General Hospital Tel: 6576 2152
Email: livingmatters@sgh.com.sg
Tan Tock Seng Hospital Tel: 6359 6410
Email: acp@ttsh.com.sg

Also read: Advance Medical Directive

ACP is not just suitable for patients with advanced illness; it is suitable for everyone, in any state of health or illness. Even when one appears to be in the pink of health, one cannot predict when medical catastrophes might suddenly strike.

Updated on January 22, 2018

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