Increasing the Uptake of Advanced Directives in SingHealth Polyclinics

NCT ID: NCT03499847

Last Updated: 2019-09-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

189 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-03-29

Study Completion Date

2018-12-19

Brief Summary

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An Advanced Medical Directive (AMD) is a legal document in Singapore that allows one to inform their medical practitioner that they do not want any life-sustaining treatment should they become unconscious and terminally ill where death is imminent. Despite the AMD act being passed in Singapore Parliament in 1996, uptake remains low among the population. Several intervention studies have shown that education and communication can be effective in promoting end-of-life discussion and planning. In this study, we aim to compare the effectiveness of counselling sessions together with pamphlets, versus pamphlets alone, versus current care, in increasing the completion rates of the AMD in the Singapore Polyclinic setting.

Detailed Description

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An Advanced Medical Directive (AMD) is a legal document in Singapore that allows one to inform their medical practitioner that they do not want any life-sustaining treatment should they become unconscious and terminally ill where death is imminent. It may be completed by any person, of sound mind, aged 21 years and above.The AMD Act was passed in the Singapore Parliament in May 1996.

A cross-sectional, community-based study surveyed 1200 selected households in Singapore. Only 37.9% of the sample population had heard of the AMD prior to the study, though when approached, 60.6% were willing to sign an AMD. As of 2017, less than 25,000 people (0.45%) in Singapore have opted to sign an AMD.

Past studies have shown that end of life discussions reduce stress, anxiety, and depression in surviving relatives. A local study in 2010 revealed a 33% patient-surrogate discrepancy in end-of-life decision making.

There are a lack of intervention studies regarding AMD in Singapore. In this study, we aim to compare the effectiveness of counselling sessions together with pamphlets, versus pamphlets alone, versus current care, in increasing the completion rates of the AMD in the Singapore Polyclinic setting.

Conditions

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Advanced Medical Directive, a Legal Document Signed in Advance to State Healthcare Preferences

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

3-arm, randomised control trial

1. Active Intervention group (n=65) Counselling provided Pamphlet given
2. Passive Intervention group (n=65) Pamphlet given
3. Control group (n=65) Neither counselling nor pamphlet given
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Outcome Assessors
subjects will be interviewed over the telephone 6 weeks after initial intervention by a blinded assessor to assess outcomes

Study Groups

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Active Intervention

subjects will be given a pamphlet about the advanced medical directive, and a standardized face-to-face counselling session will be conducted with their healthcare provider

Group Type ACTIVE_COMPARATOR

standardised face-to-face counselling session

Intervention Type BEHAVIORAL

the healthcare provider will conduct a standardised face-to-face counselling session guided with subjects guided by a check-list of topics to cover regarding the Advanced Medical Directive.

advanced medical directive pamphlet

Intervention Type BEHAVIORAL

A standardised pamphlet containing information about the Advanced Medical Directive produced by the Ministry of Health, Singapore.

Passive Intervention

subjects will be given a pamphlet about the advanced medical directive

Group Type ACTIVE_COMPARATOR

advanced medical directive pamphlet

Intervention Type BEHAVIORAL

A standardised pamphlet containing information about the Advanced Medical Directive produced by the Ministry of Health, Singapore.

Control

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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standardised face-to-face counselling session

the healthcare provider will conduct a standardised face-to-face counselling session guided with subjects guided by a check-list of topics to cover regarding the Advanced Medical Directive.

Intervention Type BEHAVIORAL

advanced medical directive pamphlet

A standardised pamphlet containing information about the Advanced Medical Directive produced by the Ministry of Health, Singapore.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Age \> 40
* Patient who seeks medical consultation at Singhealth Polyclinics (Bedok, Marine Parade, Outram, Tampines)

Exclusion Criteria

* History of dementia
* History of depression
* Known diagnosis of terminal illness
* Signed Advanced Medical Directive/Advanced Care Plan previously
Minimum Eligible Age

41 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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SingHealth Polyclinics

OTHER

Sponsor Role lead

Responsible Party

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Xu Cunzhi

Family Medicine Resident

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Lian Leng Low, MBBS

Role: PRINCIPAL_INVESTIGATOR

[email protected]

Locations

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Outram Polyclinic

Singapore, , Singapore

Site Status

Marine Parade Polyclinic

Singapore, , Singapore

Site Status

Bedok Polyclinic

Singapore, , Singapore

Site Status

Tampines Polyclinic

Singapore, , Singapore

Site Status

Countries

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Singapore

References

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Tay M, Chia SE, Sng J. Knowledge, attitudes and practices of the Advance Medical Directive in a residential estate in Singapore. Ann Acad Med Singap. 2010 Jun;39(6):424-8.

Reference Type BACKGROUND
PMID: 20625616 (View on PubMed)

Ramsaroop SD, Reid MC, Adelman RD. Completing an advance directive in the primary care setting: what do we need for success? J Am Geriatr Soc. 2007 Feb;55(2):277-83. doi: 10.1111/j.1532-5415.2007.01065.x.

Reference Type BACKGROUND
PMID: 17302667 (View on PubMed)

Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, Fassier T, Galliot R, Garrouste-Orgeas M, Goulenok C, Goldgran-Toledano D, Hayon J, Jourdain M, Kaidomar M, Laplace C, Larche J, Liotier J, Papazian L, Poisson C, Reignier J, Saidi F, Schlemmer B; FAMIREA Study Group. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med. 2005 May 1;171(9):987-94. doi: 10.1164/rccm.200409-1295OC. Epub 2005 Jan 21.

Reference Type BACKGROUND
PMID: 15665319 (View on PubMed)

Foo AS, Lee TW, Soh CR. Discrepancies in end-of-life decisions between elderly patients and their named surrogates. Ann Acad Med Singap. 2012 Apr;41(4):141-53.

Reference Type BACKGROUND
PMID: 22635278 (View on PubMed)

Houben CHM, Spruit MA, Groenen MTJ, Wouters EFM, Janssen DJA. Efficacy of advance care planning: a systematic review and meta-analysis. J Am Med Dir Assoc. 2014 Jul;15(7):477-489. doi: 10.1016/j.jamda.2014.01.008. Epub 2014 Mar 2.

Reference Type BACKGROUND
PMID: 24598477 (View on PubMed)

Tamayo-Velazquez MI, Simon-Lorda P, Villegas-Portero R, Higueras-Callejon C, Garcia-Gutierrez JF, Martinez-Pecino F, Barrio-Cantalejo IM. Interventions to promote the use of advance directives: an overview of systematic reviews. Patient Educ Couns. 2010 Jul;80(1):10-20. doi: 10.1016/j.pec.2009.09.027. Epub 2009 Oct 29.

Reference Type BACKGROUND
PMID: 19879090 (View on PubMed)

Xu C, Yan S, Chee J, Lee EP, Lim HW, Lim SWC, Low LL. Increasing the completion rate of the advance directives in primary care setting - a randomized controlled trial. BMC Fam Pract. 2021 Jun 18;22(1):115. doi: 10.1186/s12875-021-01473-1.

Reference Type DERIVED
PMID: 34144695 (View on PubMed)

Related Links

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https://www.moh.gov.sg/policies-and-legislation/advance-medical-directive

Singapore Ministry of Health - Advanced Medical Directives Information

Other Identifiers

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Polyclinics AMD Intervention

Identifier Type: -

Identifier Source: org_study_id

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