MARCH – MAY 2021 • MCI (P) 003/10/2020

Starting the conversation End-of-life: Start at the beginning It’s never too early to make your final wishes known

PLUS The value of Advance Care Planning

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THE HOSPICE LINK • MARCH – MAY 2021 CHIEF EXECUTIVE’S NOTE Members’ Contacts Contents The Palliative Care Centre 378 Alexandra Road, S(159964) for Excellence in Research In the end, it’s not the years“ in your life that count. T: 6472 2000 F: 6379 4339 and Education (PalC) www.ah.com.sg PalC c/o Dover Park Hospice [email protected] 10 Jalan Tan Tock Seng, S(308436) It’s the life in your years.” T: 6500 7269 Assisi Hospice www.palc.org.sg 832 Thomson Road, S(574627) [email protected] ABRAHAM LINCOLN T: 6832 2650 F: 6253 5312 www.assisihospice.org.sg Ren Ci Hospital [email protected] 71 Irrawaddy Road, S(329562) T: 6385 0288 F: 6358 0900 ur legacy is vital and for Letting your family know your EASE OF MIND Buddhist Compassion Relief www.renci.org.sg Tzu Chi Foundation (Singapore) [email protected] that reason we should plans will enable them to carry Knowing that you have put your 9 Elias Road, S(519937) O live with a well-planned out your wishes and minimise any final affairs and arrangements T: 6582 9958 F: 6582 9952 Sengkang General Hospital life journey. There are financial burden on loved ones in in order will give you a sense of www.tzuchi.org.sg/en 110 Sengkang East Way, S(544886) T: 6930 6000 many who understood and saw the future. It is also among the most contentment and relief as you www.skh.com.sg the importance of making the right unselfish and loving things that one are aware that your options 2 Simei Street 3, S(529889) 8 decision to pre-plan for their final generation can do for another. will be honoured as planned. T: 6788 8833 F: 6788 0933 Cancer Society www.cgh.com.sg 15 Enggor Street, #04-01, wishes as it provides peace of mind. We are great planners only if our Pre-planning would make it Realty Centre, S(079716) 2 Members’ Contacts Ironically, talking about end-of-life plan includes our final wishes for: more affordable as the plans Dover Park Hospice T: 1800 727 3333 10 Jalan Tan Tock Seng, S(308436) www.singaporecancersociety.org.sg decisions and final wishes would will be locked within your T: 6500 7272 F: 6258 9007 [email protected] 3 Chief Executive’s Note probably never be ranked as the UNFORESEEN CIRCUMSTANCES means where it is cost-effective www.doverpark.org.sg [email protected] Singapore General Hospital most pleasurable or anticipated You never know what life has in and practical. Department of Internal Medicine, conversation. store and therefore it is sensible, It’s never too early to make HCA Hospice Care The Academia, Level 4, 4 Starting the 705 Serangoon Road, Block A #03-01 20 College Road, S(169856) conversation The peace-of-mind benefits will not necessary and timely to pre-plan your final wishes known as @Kwong Wai Shiu Hospital, S(328127) T: 6222 3322 be complete if it is not discussed with your end-of-life care and wishes. letting your loved ones know T: 6251 2561 F: 6291 1076 www.sgh.com.sg the relevant loved ones. Therefore, it’s This will enable your family to about your plans will relieve www.hca.org.sg [email protected] [email protected] 6 A life-affirming project essential to actualise that discussion be aware of your preferences or them from unnecessary SingHealth Community Hospitals even if you think your family may decisions, which will make it easier conflicts and stress about (, 90 Yishun Central, S(768828) Outram Community Hospital, 8 The value of Advance question or not be prepared to go for them to cope at a time of crisis making decisions during a T: 6555 8000 F: 6602 3700 Sengkang Community Hospital) through what you have decided. or loss. time of grief. www.ktph.com.sg 10 Hospital Boulevard, S(168582) Care Planning T: 6970 3000 KK Women’s and www..com.sg/SCH Children’s Hospital 10 It’s never too early Consider talking about your final wishes 100 Bukit Timah Road, S(229899) St. Andrew’s Community Hospital to plan for the end T: 6225 5554 F: 6293 7933 8 Simei Street 3, S(529895) with these professionals and anyone else www.kkh.com.sg T: 6586 1000 you believe will have an impact www.sach.org.sg Lien Centre for Palliative Care [email protected] 12 Advantages of early on your final arrangements: Lawyers Duke-NUS Advance Care Planning Medical School Singapore St Joseph’s Home 8 College Road 36 Jurong West St 24, S(648141) Level 4, S(169857) T: 6268 0482 F: 6268 4787 T: 6601 2034 / 6601 7424 [Education] www.stjh.org.sg 14 Never a better time T: 6601 5113 [Research] [email protected] than now Funeral Healthcare www.duke-nus.edu.sg/lcpc St Luke’s Hospital Directors Professionals Metta Hospice Care 2 Bukit Batok Street 11, S(659674) 32 Simei Street 1, T: 6563 2281 F: 6561 8205 16 Seize the moment Metta Building, S(529950) www.slh.org.sg T: 6580 4695 F: 6787 7542 [email protected] www.metta.org.sg 18 End-of-life [email protected] You should 11 Jalan Tan Tock Seng, S(308433) conversations: start at MWS Home Care & Home Hospice T: 6256 6011 the beginning speak to: 2 Kallang Avenue, www.ttsh.com.sg CT Hub #08-14, S(339407) T: 6435 0270 F: 6435 0274 Tsao Foundation 20 Immediate www.mws.sg/centre-location/ 298 Tiong Bahru Road A mother’s love Insurance mws-home-care-home-hospice/ Central Plaza, #15-01/06, S(168730) Family [email protected] T: 6593 9500 F: 6593 9505 Agents www.tsaofoundation.org 22 Get started on end-of- Members National Cancer [email protected] life care planning with Centre Singapore 11 Hospital Drive, S(169610) Woodlands Health Campus SHC resources! T: 6436 8000 F: 6225 6283 9 Maxwell Road, www.nccs.com.sg MND Complex Annex A, Caregivers #03-01A, S(069112) 24 Announcements / Ng Teng Fong General Hospital T: 6681 5999 1 Jurong East Street 21, S(609606) www.whc.sg Events calendar Ms Evelyn Leong T: 6716 2000 F: 6716 5500 Chief Executive www.ntfgh.com.sg Singapore Hospice Council [email protected]

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THE HOSPICE LINK • MARCH – MAY 2021 THE HOSPICE LINK • MARCH – MAY 2021 COMPLETETAKE THE FIRSTHOME STEP CARE

Starting the Planning“ for EOL early allows you conversation to prepare for any Planning for end-of-life early empowers us to make the best decisions for unfinished business ourselves and also reassures our loved ones. HCA Senior Medical Social Worker to be completed, Yap Ching Sian shares some tips on reconcile with people beginning the end-of-life conversation. whom you might not At what age should I start planning for end-of-life? have spoken to for a Planning for your end-of-life (EOL) requires you to start thinking about how you would like to be cared for when you are diagnosed while and have proper with a life-threatening illness or when your Planning for end- of-life early enables prognosis is guarded. your loved ones time to say goodbye It also requires considerations to be given and medical team to understand and to who you want to appoint as a decision- act in accordance to maker, in the event that you lose your your wishes. to your loved ones.” mental capacity. These decisions include how your assets should be managed, funeral arrangements to be made and the legacy made under such circumstances would can begin spontaneously. For example, you These conversations can lead to powerful you want to leave behind. likely be ones that are thought through and your loved ones might have watched moments, where affirmations and words As these considerations require significant rationally and carefully. a TV programme, in which one of the of love and gratitude get conveyed and deliberation, it is advisable that you characters fell ill, or you and your loved expressed. These conversations sometimes only start to plan for EOL when you are Where do I start? ones might have visited someone at the become shared and precious experiences sufficiently mature. While there is no A good place to start is Advance Care hospital. These are good opportunities to for you and your loved ones, which can be specific age to start planning for one’s EOL, Planning (ACP). It involves the process of start having EOL conversations with your deeply moving, meaningful and life-giving. a good gauge is when one enters adulthood. planning for one’s future personal and loved ones in a more natural and less When planning your EOL, you must have health care. It requires you to identify a threatening way. What are the advantages of planning for a good understanding of your values and spokesperson to make medical decisions EOL early? preferences. on your behalf, while being guided by the What are some of the obstacles that I might Planning for EOL early allows you to prepare medical team, when you are unable to make encounter during the conversation? for any unfinished business to be completed, I am young and healthy. Why do I have to your own decisions. Your loved ones may not be ready for the reconcile with people whom you might not plan for EOL so soon? ACP also reflects your views on what gives topic due to many reasons. They may find have spoken to for a while and have proper Having a plan for your EOL is about being meaning to your life, elements of care that it inauspicious or taboo to be talking about time to say goodbye to your loved ones. prepared should unforeseen circumstances are important to you and how you would such topics. Others may find it difficult to It also gives you the chance for your arise. We often get emotionally like to be cared for in the event of an illness dive into the conversations as the fear and wishes regarding your care, financial overwhelmed when we find out about or injury. sadness of losing you are too much to bear. matters and funeral matters to be heard. In a major illness or when we meet with Care and consideration about your loved doing so, your loved ones will not feel the an accident. How do I include my loved ones in the ones’ readiness to have these conversations burden of having to make guesses about HCA HOSPICE CARE HCA HOSPICE Under these difficult situations, it would conversation? should be taken into account. However, your preferences. They can be empowered be challenging for us to think about EOL You would know your loved ones best. You getting your loved ones involved in your EOL and assured that they are carrying out your matters rationally. Hence, EOL plans are could start by asking questions to gauge conversations is equally important, as they preferences and can even take comfort ideally made when you are healthy and in a how far your loved ones can go with the get a chance to hear you out and also to knowing that things are being carried out in

good emotional and mental state. Decisions conversation. Sometimes, the conversation & PHOTO WORDS express their views about your EOL plans. accordance to your wishes.

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THE HOSPICE LINK • MARCH – MAY 2021 THE HOSPICE LINK • MARCH – MAY 2021 SEIZE THE OPPORTUNITY A life-affirming project Despite an ongoing pandemic, St. Andrew’s Community Hospital’s successful initiative saw the extension of Advance Care Planning beyond the Palliative Care ward to the Rehabilitation ward.

ave for a rainy day, or surgery, and require some time they reach the end of their lives and prepare for our future, to regain or improve their functional to share what is important to them. S what would you like state. They prove to be a captive Our multidisciplinary team was to do when you grow audience between therapy sessions! really thrilled that this little project up, what are your retirement plans. ACP influencers, who are staff yielded very encouraging results. These are some commonly heard such as nurses, pastors and Over 30 patients in just one ward sayings as we go through life in therapists, were trained to reach managed to complete an ACP Singapore. We make many of out to patients and their families discussion with a facilitator over a such preparations but what about to raise awareness of ACP. Using span of six months. Families have our health? materials such as videos, brochures expressed gratitude towards the We can also make plans for our and workbooks from the Agency of ACP team, as now they know more future health. Integrated Care, the team found that about what their loved ones would Due to restrictions as a result of the there was interest among patients in like for their future and will not feel COVID-19 pandemic, I found myself attending ACP awareness sessions. guilty at making a wrong decision. serving in St. Andrew’s Community During one such session, a patient They are thankful that these Hospital (SACH) for six months longer raised his hand to show interest discussions bring the family closer than I had anticipated. Harbouring in having the discussion in the together. Our staff awareness has a passion for Advance Care Planning hospital. Another heard how we also increased through this initiative (ACP), my initial efforts to learn more engaged another patient on ACP and and they are now more capable of about this work blossomed into a said he too wanted to do it all along carrying out an ACP discussion. full-fledged effort to introduce ACP but did not have the time, and “this We aim to eventually roll out this into the Rehabilitation ward of SACH. is the best time for me to do so while initiative to the rest of the wards A Quality Improvement Initiative was being an inpatient”. Some patients in SACH. started in July after discussions with who live alone felt assured that they This year may have bought great team members during the Circuit have been given the opportunity to disruption to the world. Amidst Breaker. Patients admitted into the think and discuss their end-of-life this, I was glad for the opportunity ward are usually elderly and have care plans. This only goes to show to carry out this life-affirming suffered a health-related setback that many do wish to talk about initiative and leave a legacy for such as a stroke, a serious infection how they wish to be cared for when others to build on. ST. ANDREW’S COMMUNITY HOSPITAL ANDREW’S COMMUNITY ST. PHOTO

The team members of the Quality Improvement Initiative are (left to right): Tabitha Low (Senior Executive, Healthcare Performance Office), Marcia Chung (Principal Medical Social Worker), Dr Ng

Han Xian (Medical Officer), Leong Peiyu (Associate Chaplain, Pastoral Care Services), Dr Melissa ANDREW’S DR NG HAN XIAN, MEDICAL OFFICER, ST. Abamonga (Resident Physician) and Dr Kyi Theint Theint Thu (Principal Resident Physician) COMMUNITY HOSPITAL HOSPITAL COMMUNITY WORDS WORDS

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THE HOSPICE LINK • MARCH – MAY 2021 THE HOSPICE LINK • MARCH – MAY 2021 PLAN FOR FINAL DIGNITY

Far left: Senior Staff Nurse Hasnah bte Abdullah with Nurse Clinician Sahnan bin Rahim work together on ACP outreach; Below: SSN Hasnah guides ACP sessions with relevant materials

experience an ACP discussion. Attorney (LPA) and to draw up death to be in a hospice. I guided Mr L was initially very angry; he felt a will. him and his sister with information that he did not get much time with However, he was still very much about the signs of active dying, The value of Advance doctors and had many unanswered in denial about his life-limiting what the final hours might be like, questions. Although he was a soft- illness. After that initial discussion, and how his sister should take care spoken and respectful man, he got he subsequently underwent of herself after her brother’s death. so agitated that we had to calm aggressive chemotherapy and Both Mr L and his sister were very Care Planning him down. We assured him that we many medical interventions. The open to hearing this. They were would help him where we could. next time I saw him was one year thankful for the information as it Changi General Hospital Senior Staff Nurse Hasnah bte Abdullah shares He soon became very appreciative later. He was admitted and again prepared them for the end through the importance of making your final wishes known through a case study. of the time we spent talking to referred to me. This time, he was knowing what to expect. him. He finally felt heard and much weaker, wheelchair-bound, Relevant information provided at taken seriously. and appeared to have accepted a pace suited to both Mr L and his As a single 68-year-old man, that further treatment was not family meant that he could make ontrary to popular ACP discussions include talking Let me share this through Mr L’s main concern was not to going to reverse the course of his decisions that prioritised what was

perception, Advance about preparation for end-of- a memorable meeting with UNSPLASH.COM CHANGI GENERAL HOSPITAL, burden his siblings with his care. disease. It had progressed to a important to him. It might have C Care Planning (ACP) life care and death, dealing with Mr L, who was referred to me in I explained that the ACP is an very advanced stage and he was seemed premature to talk about is much more about unfinished business, avoiding November 2019. Mr L had received ongoing discussion that can be given a prognosis of less than end-of-life care right at the start PHOTOS life than death. It is about helping unnecessary prolongation of bad news of metastatic cancer revisited anytime. At the end of the three months. He was seen by the of the disease, but it got him to people live out the final stage of life dying, strengthening of personal and limited prognosis from a discussion, referrals were made palliative team and referred to carry out certain important actions as fully as possible and to make the relationships, and relieving urologist. He was devastated, at a to a psychiatrist, medical social Assisi Hospice. early, such as appointing an LPA, most of each remaining moment. In burdens placed on family. They loss, anxious, angry, and in denial. worker and a private nursing I revisited his ACP with his before he was not able to do so. The the end, when the time comes, ACP are a key step towards provision I was asked to see him as soon as service provider to meet the needs sister who was the nominated discussions respected his desire

is a means to help people die with of care that is in line with a I could. CARE PLANNING NURSE, ADVANCE NURSE HASNAH BTE ABDULLAH, SENIOR STAFF he had described. As a result of healthcare spokesperson. During not to burden his siblings and dignity in the place and manner of person’s wishes, at a time when it I went to see him with two other the discussion, he also agreed that discussion, Mr L made the facilitated his eventual death in a CHANGI GENERAL HOSPITAL CHANGI GENERAL HOSPITAL their choice. matters most. senior nurses who wanted to WORDS to nominate a Lasting Power of decision for his preferred place of place of his choice.

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THE HOSPICE LINK • MARCH – MAY 2021 THE HOSPICE LINK • MARCH – MAY 2021 COMPLETEA YOUTHFUL HOME EXAMPLE CARE

was in a lot of pain and could not and have one of them join the reflect on what is truly important communicate his wishes to my session. After all, an ACP is a to them. This is then a chance for mother and her sister. Both of them piece of document. What matters them to make choices that are could not come to an agreement more is the conversation, where congruent with their values. Life on whether to prolong his life or to we have a nominated healthcare and death are two sides of the It’s never too early let him go. I am bringing this story spokesperson listen to you and same coin; in planning for their up to illustrate that these difficult respect your wishes. death, they also plan how they decisions may have been easier if want to live. they had talked about it before it Did you encourage your family to plan for the end became too late. and/or friend(s) to do their ACP It always seems too early, until it’s as well? too late. How would you encourage Hilda sat down and did her Advance Care Plan at the tender age What made you decide to finally do Yes, I shared about my experience young adults like yourself to of 23. We find out more about her motivations. your ACP? during my volunteering work start planning for their future I had wanted to try it myself and and if I sense that my friends are healthcare preferences, while they use the experience to persuade my interested, I would encourage them are still healthy? parents to get their ACP done as to get their ACP done. However, I I understand that thinking about well — it’s still a work in progress. do not rush people into it. I rather your own mortality can be scary, t always seems too early As I am an only child, I worry about trust that they will do it when they and that is normal. In your youth, until it is too late. not knowing what to do when my are ready. you want to savour your own I Advance Care Planning parents pass away. We do not talk vitality, to feel alive and delay (ACP) is for everyone, about end-of-life matters as they What do you think is one major adult responsibilities for as long as including healthy adults, and does are resistant to it. advantage of having an ACP done? you can. Having an ACP done does not need to be done only in our senior ACP covers a broad range of not mean that you have everything years. More often than not, it usually Did you discuss with your family questions beyond healthcare figured out. It also does not mean takes a major illness to prompt such and/or friend(s) while considering preferences. For example: “What that you must be fearless of your discussions with our loved ones. to get your ACP done? makes each day meaningful?”, own death. You simply accept that However, it is always better to plan No. I simply did a search online “What are the important aspects death is inevitable; it will come to for our future healthcare preferences on where I could get my ACP done about your well-being?”, “Who everyone eventually. Hence, what when we are still well. In this way, it without charge, then proceeded to or what helps you face serious we can do is really to prepare as allows our needs and wishes to be make an appointment for myself. challenges in life?”. Thinking about much as we can. Starting your ACP met should we be unable to speak or On hindsight, it may be more the answers to these questions conversation early will bring you communicate for ourselves and relieves effective to talk to my parents gives one the opportunity to comfort in the future. our loved ones of having to make these difficult decisions. Hilda (as she wants to be known) at 23 years old is one of the many It is never too early to who had their ACP done with an ACP start a conversation Facilitator at Khoo Teck Puat Hospital. about Advance Care Planning. Opposite The hospital hopes more young adults page: Hilda having a will consider having their ACP done. tele-ACP discussion with the ACP Facilitator

How did you first know about ACP? “Having an ACP done does I found out about it at a volunteer training on ACP in August 2018. not mean that you have Was there any past experience, e.g. from a loved one, that contributed to everything figured out. It also your decision of doing an ACP? No. However, months after I got my ACP done, I had my first experience of

does not mean that you must death in the family. It does not feel real PIXABAY HOSPITAL, PUAT KHOO TECK that someone I knew for my whole life is now gone. When I was a child, I was be fearless of your own death. PHOTOS close to my grandfather who taught me watercolour painting. We grew You simply accept that death distant as I got older because it became harder for us to communicate due to is inevitable; it will come to my limited vocabulary and his hearing loss. Upon knowing about his death, I CARE PLANNING, ADVANCE EXECUTIVE, TRICIA TAN, did not know how to react. In the days KHOO TECK PUAT HOSPITAL HOSPITAL PUAT KHOO TECK everyone eventually.” leading to my grandfather’s death, he WORDS

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THE HOSPICE LINK • MARCH – MAY 2021 THE HOSPICE LINK • MARCH – MAY 2021 LEAVING CLEAR DIRECTIONS

Opposite page: Assisi Hospice’s Senior Medical Social Worker/ Counsellor Ms Ivee Tee (left) facilitates Advance Care Planning discussions with patients and their caregivers

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.

Why ACP?

Why should we do ACP early? • Illness can strike any time Advantages of early • It reduces the pressure of decision-making on our loved ones

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

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THE HOSPICE LINK • MARCH – MAY 2021 THE HOSPICE LINK • MARCH – MAY 2021 COMPLETEPREPARING HOME FOR CRISIS CARE Never a better time than now COVID-19 is a clarion call for Advance Care Planning, highlighting how an unexpected and sudden health crisis increases the urgency of making our care preferences known.

he COVID-19 pandemic we cannot hide from death. Every we have witnessed how this has irrevocably changed day, we receive news on the rising uncertainty causes significant T our lives — how we caseloads and death tolls worldwide. stress to the family members who work, how we socialise, COVID-19 is a stark reminder of struggle to make decisions on their and even how we eat. The global what we have always known but do loved one’s care. This is why we spread and impact of the virus have not openly acknowledge — anyone are calling for people, even those demonstrated that we humans are can suddenly fall seriously ill. who are young and well, to do not as invulnerable as we think we In a serious illness, healthcare their Advance Care Planning (ACP). Everyone should take the are, despite the many advancements decisions are complicated, with ACP is a series of conversations time to talk to their families and loved ones about what of modern medicine. The COVID-19 no single best answer. With the where a person’s values and they value in terms of virus has afflicted young and old, rich advice of the healthcare team, the preferences are shared with their health and lives and poor, and brought many of us, patient can then make a choice their loved ones and healthcare perhaps for the first time, face to face after weighing the benefits and providers. These values and with our mortality. risks of various treatments, based preferences are what shape an In pre-COVID times, acute serious on their own personal values and individual’s healthcare decisions. illnesses could happen to anyone goals. But when someone becomes They are unique to each and the risks, benefits and trade- 1. What are the things in life that and telemedicine consultations at any time as well — a sudden seriously ill and is unable to individual and allow for person- offs of various treatment options. give me meaning and purpose? right now on how to conduct bout of acute pancreatitis triggered make decisions for themselves, it centred care. These conversations The Circuit Breaker period 2. How would I like my loved ones and implement ACP. In Singapore, by previously silent gallstones, an becomes very challenging for their are documented and used to created many challenges and even to remember me? while there are some fledgling

insidious skin infection in the leg healthcare team. Without knowing guide both family members SHUTTERSTOCK a certain degree of suffering for 3. What would I be most fearful of tele-health efforts to help people from poorly controlled diabetes a patient’s unique preferences and and healthcare teams when the some, but it also brought great should I become seriously ill? do their ACP, we think there resulting in septic shock, a road traffic values, healthcare teams default patient cannot make decisions PHOTO clarity. We began to appreciate 4. If I should become dependent needs to be a louder call to accident causing severe irreversible to choosing treatments that aim to for themselves during serious what we used to take for granted — and require a full-time caregiver, promote ACP in our population brain injury. But these incidents of prolong life as much as possible, illness. When you are well and the freedom to simply sit outdoors what are my concerns and and systemically entrench it in human vulnerability and mortality as well as consult patients’ families have the time and mental space and have a conversation with a preferences? our healthcare system. We need were largely kept away from public or loved ones to make decisions on to think about what matters most loved one, to hug a friend, or share 5. How do I feel about the use of to change, en masse, our attitude view, contained by the healthcare treatment options. to you, do your ACP; it allows you a meal with extended family. We life-support machines? towards talking about death and teams in hospitals; the resulting grief However, in our experience, most to achieve a clear understanding learned that living well is more 6. Who knows me best and would dying, and embrace having these and loss, no less painful, leaving their family members are uncertain as of what your health journey than just being physically alive. As be able to share my values with important conversations early indelible marks on individual families this topic has never been discussed may look like, the potential we move forward as a country, we the doctors, to make healthcare with our families and healthcare rather than whole nations. Now, before. In the face of time pressures, complications that may occur, should not lose sight of this clarity. decisions for me? practitioners. We should take the time to talk ACP is not to a panacea for the (JAN-MAR2021), AN NHG PUBLICATION AN NHG PUBLICATION (JAN-MAR2021), to our families and our loved ones We plan for everything in life: our pain and suffering one might about what we value in terms studies, our career, vacations, whom face when one is seriously ill. But

LIFEWISE of our health and lives. By doing we marry, how many kids we it can be very helpful — for you, We need to change, en masse, our attitude our ACP, we could empower them want, and our retirement. However, your family, and your healthcare with the right information so that studies have shown that the large team. Most importantly, the ACP is towards talking about death and dying, if we cannot make decisions for majority of us do not plan for not cast in stone. As an on-going ourselves, our loved ones will be serious illness or share our values conversation, it provides a way for able to have certainty and peace of and preferences on our care with us to talk about our fiercest loves and embrace having these important mind to make healthcare decisions our families. and our deepest fears and allows on our behalf. This public health crisis could our loved ones to make difficult conversations early with our families To help you get started, here be an impetus for us to turn the decisions should they be called DR EUNICE CHUA, CONSULTANT, DEPARTMENT OF GENERAL MEDICINE & CLINICAL CO-LEAD FOR ACP, TAN TAN FOR ACP, OF GENERAL MEDICINE & CLINICAL CO-LEAD DEPARTMENT CONSULTANT, DR EUNICE CHUA, are some questions that you can tide for ACP. In some countries, upon. Rather than thinking about think about and discuss with your such as the US and Australia, there this as taboo, embrace it as a gift of TOCK SENG HOSPITAL & DR RAYMOND NG, SENIOR CONSULTANT & HEAD, PALLIATIVE MEDICINE, WOODLANDS HEALTH HEALTH WOODLANDS MEDICINE, PALLIATIVE & HEAD, SENIOR CONSULTANT NG, & DR RAYMOND SENG HOSPITAL TOCK FIRST APPEARED IN CAMPUS THIS ARTICLE and healthcare practitioners. WORDS loved ones: are COVID-specific advisories love to those you care about.

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THE HOSPICE LINK • MARCH – MAY 2021 THE HOSPICE LINK • MARCH – MAY 2021 ENGAGING WITH SENIORS

Carrying on the conversation Seize the Once you’ve started the conversation, what can you talk about? Here are three ideas to consider.

Providing companionship moment If your loved one is home-bound and living alone, there is a high chance that he or she is feeling lonely. With seniors being more The rapid pace at which the world is moving may also susceptible to the adverse effects add to the feeling of being isolated or left behind. Palliative home care, which provides a range of of COVID-19, it may be time to get services, may be an option. At MWS Home Care & the conversation going with your Home Hospice, there are teams of doctors, nurses and medical social workers who make regular home visits loved one sooner rather than later. and provide round-the-clock support. Many seniors actually look forward to the visits even when they are well because of the companionship and camaraderie.

Getting care according to their wishes While you may be focused on curative treatment to treat your loved one’s condition, he or she may have other thoughts about the care they want. Hence, it may be a good time to bring up Advance Care Planning (ACP), which promotes care that is consistent with his or her values and preferences. It guides you and the healthcare team to make decisions in your loved one’s best interests should he or she lose the mental capacity to do so. One tool that often complements ACP is the Advance Medical Directive, which informs the doctor treating your loved one to An MWS Home stop aggressive life-prolonging treatments should this Care & Home Hospice patient be what he or she wishes. This helps to avoid disputes receives holistic care between family members when the time comes for critical medical decisions to be made.

Having a better quality of life hile the COVID-19 situation According to a press release issued by who are in short supply as many have returned We all want our loved ones to be comfortable, not has improved in Singapore, the Ministry of Health, Singapore*, seniors home and there are travel restrictions for their suffering towards the end. Yet, more often than not, especially with the vaccine aged 60 and above form at least 80% of all replacements. This results in them not being able W the curative treatment route may cause pain and side now available, it is widely COVID-19 deaths. The number is even higher in to receive the optimal care required. Many are effects. This makes it important to talk about palliative acknowledged that the crisis has been Singapore, where seniors made up 95% of all also more emotionally distressed due to myriad particularly hard on seniors. From being COVID-19 deaths. The statistics also indicated reasons, such as having to adhere to strict safe care, which gives him or her the option for pain and more susceptible to dying from the virus that nearly 1 in 6 or 16% developed severe distancing guidelines and juggling the needs of symptom management, as well as a higher quality to experiencing adverse effects of various symptoms and required intensive care in the other family members. In addition, they may of life by meeting their physical, psychological and containment measures, seniors have borne hospital compared to just 0.2% of non-seniors. be experiencing a higher level of anxiety when spiritual needs. Giving your loved ones better control the brunt of the impact. Although the various measures to safeguard visiting hospitals and polyclinics for fear of over their pain and symptoms will also enable them This makes it more important than ever to the health and well-being of seniors may getting infected by the virus. to spend their remaining time in a more meaningful METHODIST WELFARE SERVICES SERVICES METHODIST WELFARE start that end-of-life conversation with your have kept the death toll low, these may have manner. Palliative care could also be helpful for those loved one as soon as possible. One way to resulted in undesirable effects. *Ministry of Health, Support Measures for Seniors who are struggling with the emotional distress and broach the topic could be to share about the At MWS Home Care & Home Hospice, many During COVID-19, 8 May 2020. Retrieved from anxiety brought on by the COVID-19 situation. COVID-19 situation and its serious impact patients are facing limited access to care https://www.moh.gov.sg/news-highlights/details/

on seniors. resources, such as foreign domestic workers & PHOTO WORDS support-measures-for-seniors-during-covid-19.

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THE HOSPICE LINK • MARCH – MAY 2021 THE HOSPICE LINK • MARCH – MAY 2021 LEAVING MEMORIES

Caption for the nurse here Caption for the End-of-life nurse here Caption for the nurse here Caption for the nurse here Caption for the conversations: start nurse here at the beginning

Patients and their caregivers can use the recently published A Family Dignity Intervention Journey: Our Lasting Legacy to create their own legacy document.

id you know that the But we are not just ‘the patient’. caregivers, with the goal of most important and We are not just ‘the caregiver’. deepening emotional connections, D meaningful stories in We are unique individuals with creating lasting legacies and paving our lives are actually wonderful stories to tell. We are the way for end-of-life discussions. our own? The ones that were spouses, children, siblings, parents The FDI is conducted by a trained Senior counsellor created since the day we were born, and friends. We have loved and lost, therapist who delves into an Geraldine Tan-Ho and Associate Professor Andy continued as we walk through life, given and received, dreamed and exploration of recollections, life Ho with their publication and shared with special people we accomplished, failed and learned. accomplishments, words of wisdom A Family Dignity Intervention Journey: meet along the way. Most importantly, we have shared and expressions of appreciation Our Lasting Legacy Sometimes, painful events such these precious experiences and between patients and their as the diagnosis of a serious illness memories with some special people family caregiver. This interview can seem to consume our entire in our lives. All of these cannot be is later transformed into a ‘legacy lives. As patients, we may feel undermined by the presence of a document’ — an edited and overwhelmed by the daily physical life-threatening illness. personalised copy of the interview “When they have the opportunity we should always remember to start 8. What are your hopes and discomfort, and the emotional transcript that is designed like to first recall shared memories from at the beginning. Based on the FDI dreams for yourself, and rollercoaster of uncertainty, hope FAMILY DIGNITY INTERVENTION – an autobiography — and given to childhood to adulthood and think interview, patients, family caregivers your loved ones? and fear that accompany our CREATING LASTING LEGACIES patients and their families. Last about what they have accomplished and healthcare professionals can 9. What are some things you illnesses. As family caregivers, we Associate Professor Andy Ho and year, the team published A Family and learned in life, they begin to embark on a meaningful storytelling would want your loved one may feel completely absorbed by his team at the Action Research Dignity Intervention Journey: reflect also on what they would journey with such questions: to know about you, or to our caregiving responsibilities, for Community Health (ARCH) Our Lasting Legacy, a book with like for themselves and their loved remember about you? while coping with the tiredness Lab designed the Family Dignity activities based on the FDI for ones in the future. The FDI provides 1. Tell me about your childhood. that comes with our devoted acts Intervention (FDI) in 2017 to patients and caregivers to create a gentle and empowering way of What are some of the important In bringing back old of caregiving. On top of all these, facilitate valuable conversations their own legacy document. This inviting patients and caregivers and memorable times in memories, new and cherished we are asked to participate in end- between patients and family book has been distributed to local into these difficult but crucial your life? ones are made. In expressing of-life care conversations, such as hospices, hospital palliative care conversations.” 2. How has your relationship appreciation and love, family Advance Care Planning or units and intermediate long-term with your loved one influenced bonds are rekindled. In Lasting Power of Attorney, care facilities (ILTC) such as START AT THE BEGINNING your life? talking about our lives, we something many of us nursing homes. An interactive Mr. Ahmed*, a patient who had 3. What do you think are your most pave the way to reflections had never even thought web version of the book is received Family Dignity Intervention, meaningful accomplishments about our death. The end- about before the also underway. once wisely declared, “If someone in life? of-life conversation must be illness. Suddenly, our A/Prof Andy Ho observes does not ask about your life, how 4. What do you think your loved dignifying, empowering and present lives seem to that a significant feature can they ask about your death?” one is most proud of you for? meaningful; perhaps a lasting revolve solely around of the FDI is that while the Indeed, end-of-life care 5. What do you appreciate most legacy and a story in itself. the illness and its interview questions did not conversations must begin from about your loved one? After all, life is a gift to us, and repercussions; the ask about end-of-life care a place of love and concern, and 6. What would you like to thank sharing our life stories can be ‘good old days’ feel like planning, many patients and not simply from a place of urgent your loved one for? our gift to the ones we love. NANYANG TECHNOLOGICAL UNIVERSITY SINGAPORE CORPORATE COMMUNICATIONS UNIVERSITY SINGAPORE CORPORATE TECHNOLOGICAL NANYANG a distant memory, or caregivers brought up these UNIVERSITY TECHNOLOGICAL NANYANG SENIOR COUNSELLOR, GERALDINE TAN-HO, necessity. Whether or not we are in 7. Are there any words of wisdom even a figment of our topics organically during a hurry to acquire or convey final or advice that you would like to *Name has been changed PHOTOS PHOTOS SINGAPORE AND A MEMBER OF SHC’S COMMUNITY ENGAGEMENT & COMMUNICATIONS COMMITTEE & COMMUNICATIONS ENGAGEMENT SINGAPORE AND A MEMBER OF SHC’S COMMUNITY imagination. the interview. WORDS wishes and plans for the very end, offer to your family? for confidentiality

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THE HOSPICE LINK • MARCH – MAY 2021 THE HOSPICE LINK • MARCH – MAY 2021 AN HEIRLOOM TO TREASURE

Left: The ties bound by A lifetime of love and shared food memories memories are wrapped are unbreakable and a up in the legacy strong legacy. Below: works left behind for This recipe book patients’ families will help Mdm Wee’s children continue the tradition of cooking for the family.

The Medical Social Services (MSS) team on the other hand provided psycho-emotional support for her to complete the project. But the process was not as easy as the team thought it would be. Madam Wee was lethargic and needed rest most of the time due to her condition. To help her complete her wish, the Rehabilitation team focused on getting one recipe done at a time. They broke down the tasks into smaller steps and completed them day by day. For example, the team would start with getting the list of ingredients followed by recording the methods the next day. “ Once they have gotten all the information, Some examples of legacy they began to decorate the recipe book based on Madam Wee’s instructions. There was also the work are conducting a life language barrier that the team had to overcome. The team had to enlist the help of Teochew- speaking colleagues so they could understand review, creating a recipe Madam Wee’s wishes. With all the help from the team, Madam Wee was book, written or audio letters, finally able to complete her recipe book. She passed away three months later in August 2020 in her late 80s, but not without leaving something very or photograph albums to valuable behind. Madam Wee’s legacy work taught many staff and A mother’s love family members.” patients about a mother’s unconditional love. She To most, it’s merely a cookbook. But for one palliative patient at Sengkang was able to be a part of her children’s life despite her illness, continuing to celebrate their birthdays Community Hospital, the collection of recipes was part of her legacy that PRABHA D/O TECHNA MITI, whenever her recipes are recreated in the kitchen allowed her to live out the remainder of her life meaningfully. SKCH SENIOR MEDICAL SOCIAL WORKER she left behind.

adam Julie Wee’s life was not always She envisioned the book to be filled with smooth sailing. Ever since her traditional dishes that she used to make for their Starting legacy work husband passed away many years birthday celebrations. A part of her will stay with M Legacy works help patients to reflect and initiate ago, she worked hard to raise her them as memories and remind them how she a review of their life experiences and document three children on her own. It was tough being a used to prepare their favourite dishes on those single parent, but her love for them was far greater special occasions. it as a tangible item so that their stories can be than anything else. It will also help her children to continue with passed on to the future generations. the tradition of cooking for the family at home. HER LAST WISH The Rehabilitation team then initiated Some questions that can be asked are: Madam Wee was known by her fellow patients and this piece of legacy work — something that • What activities are meaningful to them to create a the hospital staff to be a reserved person. She only allowed palliative patients to reflect on what’s tangible memory? opened up and shared about her life experiences important to them, and motivate them to have a • What are some tips or life experiences that they when spoken to in the Teochew dialect. dignified rest-of-their-lives during their stay in a would like to share with others? The fluent Teochew speaker knew that time community hospital. • What would they want their family to remember was not on her side. She could feel her condition “The Rehabilitation team provided her with them for? worsening each day and so, expressed her wish different art materials to create her cards and • What would they like to leave behind for their SINGHEALTH COMMUNITY HOSPITALS, PEXELS.COM HOSPITALS, COMMUNITY SINGHEALTH to write a card for each of her children and recipe book. She would request for what she HOSPITALS COMMUNITY SINGHEALTH loved ones? also to create a recipe book that contained their needed and the designs she wanted,” shared PHOTOS favourite dishes. Tricia Ng, SKCH Senior Occupational Therapist. WORDS

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THE HOSPICE LINK • MARCH – MAY 2021 THE HOSPICE LINK • MARCH – MAY 2021 SHC COMMUNITY RESOURCES HAPPENINGS Get started on end-of-life care planning with SHC resources!

Conversation Cards Time Of My Life: It’s important to know your values, motivations, beliefs Past Perfect, and life goals, and identify people in your life that could The Journal of act as spokespersons in times of critical need. There are Self-Discovery 30 questions classified in three levels of complexity. Here are some examples you can try with your loved ones! The first step in creating a legacy 1. Easy and the beginning of important • What is one life lesson I have learnt from conversations with your loved ones is my grandparents? by sharing your own story, desires and • What is the most memorable experiences. There are 10 chapters to event that has happened in explore! Here are some questions from my life? the “Favourites” chapter, so you can 2. Intermediate better care for your loved ones when • Who and/or what they are terminally ill. encourages or inspires 1. What is your favourite: colour, me most? country, TV show, radio station, • When am I most animal, celebrity? comfortable being myself? 2. What are your favourite childhood food or snacks? 3. Advanced 3. Where can you find your favourite dishes now? • What do I think about 4. What are your hobbies and favourite activities? death and dying? 5. What is your memorable moment during your • Who can speak for me if I’m admitted to hospital? favourite public holiday?

Palliative Care Communicator (PCC) online training course To get physical copies of these Who Should Attend: resources in English and Mandarin, Social workers, psychologists, counsellors, allied health which are part of SHC’s Community professionals, education and social service practitioners, Engagement Kit, sign up for SHC’s volunteers and general public. We invite social service

Participants role play Palliative Care Communicator agencies to organise the training course for their staff and with conversation cards (PCC) online training course today! volunteers, and members of the public to form a group of minimum three participants. Course Objectives: For more details of the programme and to download the response form, please visit At the end of the two-hour free course, participants will: Course Requirement: https://singaporehospice.org.sg/events/charity-show-25 • Gain knowledge to start conversations with their service Each participant is required to use the Community recipients on palliative care and end-of-life care Engagement Kit to have conversations with at least two • Develop skills in using the Community Engagement Kit individuals and provide feedback of experience in a survey form. and to help the service recipients reflect on life and end-of-life matters SHC will send a trained professional to conduct the training. Mode of Course Delivery: The course can be conducted in English or Mandarin. Sign up via the online form at It will be delivered through lecture, structured group https://singaporehospice.org.sg/ Please complete the response form and email to [email protected]. discussions, case studies and interactive role-plays. training-courses/.

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THE HOSPICE LINK • MARCH – MAY 2021 THE HOSPICE LINK • MARCH – MAY 2021 ANNOUNCEMENTS

SHC welcomes Upcoming Events MARCH - MAY 2021 Ren Ci Hospital as our SHC “Live Well. Leave Well.”: All You Need To Know About Palliative Care Talk 25th member Join us for an informative session to understand palliative care and end-of-life matters. The session also aims to increase awareness of the attitude towards death and its impact on the willingness to converse with family or loved ones. It also aims to provide the participants with the suite of Community Resources available for palliative care in Singapore. Time: 2.00pm - 3.30pm Venue: Online via Zoom Contact: [email protected] Ren Ci Hospital is a charity healthcare institution Registration*: https://tinyurl.com/shctalks21eng founded in 1994 with the primary mission *Please indicate your interest in the link and we will of providing affordable medical, nursing and contact you via email. rehabilitative care services for the community, 23 MARCH 2021 based on the principles of loving kindness and SDSPCC-SHC Palliative Care MDF* – compassion, regardless of race, religion and Patient-Centred Outcomes That Matter background. Over the years, Ren Ci has played Speaker: Professor of Palliative Care Fliss Murtagh, an active role in the lives of a growing silver Hull York Medical School, UK population in Singapore through expanding its Time: 12:00pm – 1:00pm spectrum of services to support the healthcare Venue: Zoom Webinar needs of the senior community. Partnering the Registration: https://bit.ly/3cOTxoz *SingHealth Duke-NUS Supportive and Palliative Care community remains pivotal to the sustainability Centre - Singapore Hospice Council Palliative Care of our care delivery, providing those we serve Multidisciplinary Forum with the hope for quality and meaningful living. 20-28 MARCH 2021 Singapore Cancer Society – TalkMed Relay For Life 2021 This event offers everyone a chance to celebrate cancer survivors and caregivers’ triumphs against the EDITORIAL COMMITTEE disease, remember loved ones lost to cancer and fight back against the disease. Participants can fundraise for the cancer community by running / walking / Editor Christina Wee cycling / swimming or come up with their own Associate Editor Anne Loh fundraising challenge to show cancer patients that they are not alone in the fight against cancer. Alexandra Hospital Yvonne Lee Venue: Anywhere (Virtual Event) Assisi Hospice Angela Yeo Admission: Free Buddhist Compassion Relief Tzu Chi Editorial Team Registration: https://scsrelayforlife.sg/ (Registration Tzu Chi Foundation (Singapore) closes on 19 March 2021) Changi General Hospital Rasidah bte Alias Dover Park Hospice Jenny Goo 1 APRIL 2021 - 31 MAY 2021 HCA Hospice Care Toh Wei Shi SHC @ Ang Mo Kio Public Library Khoo Teck Puat Hospital Tricia Tan Explore and learn more about palliative care and Lien Centre for Palliative Care Tang Swee Noi end-of-life care planning through stories and Metta Hospice Care Cecilia Soh printed resources! MWS Home Care & Home Hospice Nicolette Yeo Venue: Level 1, 4300 Ang Mo Kio Avenue 6, S(569842) Ren Ci Hospital Sharon Tan In view of the COVID-19 situation, please check our website www.singaporehospice.org.sg for updates. The Palliative Care Centre for Tan Li Kuan Excellence in Research and Education Sengkang General Hospital Farah Rahman Singapore Cancer Society Kumudha Panneerchelvam Singapore General Hospital Mavis Law Singapore Hospice Council Sheena Koong SingHealth Community Hospitals Muhammad Azhar bin Abdul Rahim St Andrew’s Community Hospital Peh Lay Koon St Joseph’s Home Shereen Ng 1 Lorong 2 Toa Payoh #07-00, Braddell House, S (319637) St Luke’s Hospital Chua Hwee Leng T: 6538 2231 • E: [email protected] Tan Tock Seng Hospital Candice Tan www.singaporehospice.org.sg Tsao Foundation Desiree Lim

Design Christian Subrata Contents are not to be quoted or reproduced without the prior Printer Yung Shung Printrade Pte Ltd written permission of the Singapore Hospice Council.

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