Enhancing Patient Empowerment in Home Palliative Care

In Singapore’s rapidly ageing society, engaging in Preferred Plan of Care (PPC) discussions as part of Advance Care Planning (ACP) is crucial for pre-planning and supporting home palliative care patients. 

However, many patients referred to MWS Home Care & Home Hospice (HCHH) lack documented PPC at the point of admission, making it challenging for the team to provide clinical advice that aligns with their care preferences. 

To enhance PPC documentation rates for MWS HCHH patients, the team (comprising Chong Yan Chew, Poh Chu Xiang, Yeo Chee Wei, and Dr Andy Lee), with support from MWS’ Research, Innovation & Training Academy (RITA), conducted a study to explore improvement strategies. They identified that adding an automated reminder to the primary nurse’s task list was the most effective intervention. Implemented between November 2022 and April 2023, this initiative increased the PPC documentation rate to approximately 88.1%. 

This best practice serves as a crucial first step in benefitting the broader ecosystem of healthcare and community partners. By advocating for the uploading of PPCs into the National Electronic Health Record (NEHR), it ensures that all healthcare providers in Singapore have seamless access to patients’ documented care preferences, enabling timely interventions and quality care. 

Their study, titled ‘Improving Advance Care Planning-Preferred Plan of Care Documentation Rate in Home Palliative Service’, was presented at the Transforming Community and Home-based Care in an Ageing World conference on 18-20 April 2024. The conference was organised by Tsao Foundation and the International Home Care Nurses Organization.