To explore the importance of factors influencing the end-of-life care decision making of health care professionals (HCPs) in Singapore.
Methods:
This cross-sectional survey encompassed facets of patient, family, and HCP-related care considerations. In total, 187 questionnaires were distributed to physicians and nurses and had a response rate of 78.6%.
Results:
The respondents rated patients’ wishes (96.6%), their clinical symptoms (93.9%), and patients’ beliefs (91.1%) very high. In all, 94.6% of the HCPs would respect a competent patient’s wishes over the family’s wishes when goals conflict. However, 59.9% of HCPs would abide by the family’s wishes when the patient loses capacity even if the patient’s previously expressed wishes are known.
Conclusion:
End-of-life care decision making by HCPs appears largely patient centered, although familial determination still wields significant influence with implications for advance care planning.
HuijerMWiddershovenG.Desires in palliative medicine. Five models of the physician-patient interaction on palliative treatments related to Hellenistic therapies of desire. Ethical Theory Moral Pract. 2001;4(2):143-159.
2.
KappMB. Medical decision-making for incapacitated elders: a “therapeutic interests” standard. Int J Law Psychiatry. 2010;33(2010):369–374. doi: 10.1016/j.ijlp.2010.09.008.
3.
LevackWMSiegertRJDeanSGMcPhersonKM. Goal planning for adults with acquired brain injury: how clinicians talk about involving family. Brain Inj. 2009;23(3):192–202.
4.
McKinlayJBPotterDAFeldmanHA. Non-medical influences on medical decision-making. Soc Sci Med.1996;42(5):769–776.
5.
LowYYS. ‘Who is responsible for this patient?’: a case study analysis of conflicting interests between patient, family and doctor in a Singaporean context. Asian Bioethics Review.2011;3(3):261–271.
6.
PhuaJKeeACTanA. End-of-life care in the general wards of a Singaporean hospital: an Asian perspective. J Palliat Med.2011;14(12):1296–1301.
7.
TanJOAChinJJLKaanTSHChanTE. What doctors say about care of the dying. Lien Foundation 2011, Singapore.
8.
OngJKBackMFLuJJ. Cultural attitudes to cancer management in traditional South East Asian patients. Australas Radiol. 2002;46(4):370–374.
9.
KrishnaL. The position of the family of palliative care patients within the decision making process at the end of life in Singapore. Ethics Med. 2011;27(3):183–190.
10.
OhDYKimJELeeCH. Discrepancies among patients, family members and physicians in Korea in terms values regarding the withholding of treatment from cancer patients with terminal malignancies. Cancer. 2004;100(9):1961–1966.
11.
ChiuTYHuWYHuangHLYaoCAChenCY. Prevailing ethical dilemmas in terminal care for patients with cancer in Taiwan. J Clin Oncol. 2009;27(24):3964–3968.
12.
PangMC. Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. J Med Ethics. 1999;25(3):247–253.
13.
LowJAKiowSLMainN. Reducing collusion between family members and clinicians of patients referred to the palliative care team. Perm J. 2009;13(4):11–15.
14.
KimSH. Confucian bioethics and cross-cultural considerations in health care decision-making. J Nurs Law. 2005;10(3):161–166.
15.
HoA. Relational autonomy or undue pressure? Family’s role in medical decision-making. Scand J Caring Sci. 2008;22(1):128–135.
16.
HoZJRadha KrishnaLKYeeCP. Chinese familial tradition and Western influences: a case study in Singapore on decision making at the end of life. J Pain Symptom Manage. 2010;40(6):932–936.
17.
BackMFHuakCY. Family centred decision making and non-disclosure of diagnosis in a South East Asian oncology practice. Psychooncology. 2005;14(12):1052–1059.
18.
FanR.Reconsidering surrogate decision making: Aristotelianism and Confucianism on ideal human relations. Philos East West. 2002;52(3):346–372.
19.
SilveiraMJKimSYLangaKM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med. 2010;362(13):1211–1218.
20.
LowJANgWCYapKBChanKM.End-of-life issues- preferences and choices of a group of elderly Chinese subjects attending a day care centre in Singapore. Ann Acad Med Singapore. 2000;29(1):50–56.
21.
TohHC. Providing hope in terminal cancer: when is it appropriate and when is not?Ann Acad Med Singapore. 2011;40(1):50–56.
22.
TanTKTeoFCWongKLimHL. Cancer: To tell or not to tell?Singapore M J. 1993;34(3):202–203.
23.
KrishnaL. Decision making at the end of life: a Singaporean perspective. Asian Bioethics Review. 2011;3(2):118–126.
24.
ChanHM. Sharing death and dying: advance directives, autonomy and the family. Bioethics. 2004;18(2):87–103.
25.
ShalowitzDIGarrett-MayerEWendlerD. The accuracy of surrogate decision makers: a systematic review. Arch Intern Med. 2006;166(5):493–497.
26.
WendlerDRidA. Systematic review: the effect on surrogates of making treatment decisions for others. Ann Inter Med. 2011;154(5):336–346.
27.
PhuaJKeeACTanA. End-of-life care in the general wards of a Singaporean hospital: an Asian perspective. J Palliat Med. 2011;14(12):1296–1301.
28.
WinzelbergGSHansonLCTulskyJA. Beyond autonomy: diversifying end-of-life decision-making approaches to serve patients and families. J Am Geriatr Soc. 2005;53(6):1046–1050.
