Assisi Hospice’s Senior Medical Social Worker/Counsellor Ms Ivee Tee shares a patient’s case study.
Sixty-four-year-old Mr Tan (name has been changed) was diagnosed with cancer and referred to Assisi Hospice for palliative care and symptom management in July 2020. Even though Mr Tan could still care for himself at that point in time, he decided to discuss Advance Care Planning (ACP) with Assisi Hospice’s Medical Social Worker (MSW) as he was concerned that his wife, who was his sole caregiver, would be confronted with disagreements with his siblings regarding his decisions on his care plan at his end-of-life. Mr Tan’s siblings visited him regularly even though they were not involved in his direct care, and they were not on good terms with his wife.
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.
Assisi Hospice’s MSW visited Mr Tan and his wife twice to discuss ACP. During the MSW’s first visit, she identified and brought to his attention the family dynamics and possible challenges his wife might face regarding his end-of-life care. She then introduced ACP to him and his wife, engaging them in a series of discussions to understand their values and wishes regarding the various important elements of care, including preferences relating to resuscitation, care and treatment, place of care and death. After Mr Tan and his wife had thought through their decisions, the MSW proceeded to discuss the details with them.
Mr Tan’s wife did not really want to talk about end-of-life initially as she had been grieving due to his illness. The ACP conversation gave the couple a platform to talk about Mr Tan’s wishes for his care openly and helped his wife to understand what he wanted. This also gave her more time to prepare herself mentally in caring for Mr Tan. Her worries were addressed and eased with assurance of the available resources, decreasing her sense of uncertainty over her caregiving journey.
Mr Tan conveyed his decision to his siblings. They respected it and gave their full support to his wife.
Mr Tan passed on in September 2020.
Why ACP
Why should we do ACP early?
• Illness can strike any time
• It reduces the pressure of decision-making on our
loved ones
What should the conversation cover?
• Sharing of your values and beliefs
• Exploring how your values and beliefs affect your medical/care decisions when you are seriously ill
• Choosing one or more spokesperson(s) who can represent you when you are unable to express your wishes
Should I and how do I document my ACP?
• Though ACP is not a legal document in Singapore, documenting it would enable your loved ones and the medical team to provide care according to your wishes when you lose your mental capacity.
• You can use your own ways to document it and share with your loved ones.
• You may also document your plans in the ACP workbook available at www.livingmatters.sg
