Authors (including presenting author) :
Lam YHR(1), Lo RSK(2), Yuen KK(3), Mo SLS(1)
Affiliation :
(1) Medical Social Services (Hospital Authority), Queen Mary Hospital
(2) Department of Medicine and Therapeutics, Chinese University of Hong Kong
(3) Department of Clinical Oncology, Queen Mary Hospital
Introduction :
Patients’ readiness for discussing Advance Care Planning (ACP) are multi-factorial. One’s understanding of ACP and the family relationship are well known factors. To find out the factor influencing patient’s readiness most will improve the care pathway.
Objectives :
To explore the significance of family relationship on ACP discussion.
Methodology :
30 patients of hospice centre and their core family members were recruited to join the study from Oct 2020 to Mar 2021. All subjects received general education on ACP. 20 families right after the ACP education class were grouped as intervention group whereas the other 10 families which received conventional service were grouped as control group by convenience sampling. Medical Social Worker (MSW) then rendered structured counselling service to each family in intervention group for facilitating mutual understanding, managing ambivalence of family relationship, anxiety as well as expectation on ACP through Chinese version of Serious Illness Conversation Guide.
Both groups were measured the family harmony change by using the validated Chinese Version of Family Harmony Scale 24 items (FHS-24).
Result & Outcome :
The mean age of patients was 69.1 and 70.8 in intervention group and control group respectively. Female was predominant in intervention group (60%, n=12) while male was predominant in control group (60%, n=6). The majority of subjects in intervention group lived with spouse (55%, n=11), followed by living with children (20%, n=4).
All families in intervention group went through the ACP process. The ACP discussion was associated with more effective communication (p=0.042), better conflict resolution (p=0.025) and better forbearance (p=0.017) of patients. Furthermore, there was a positive change on patient’s overall family harmony (p=0.002). Moreover, 50% (n=10 families) finally documented Advance Directive (AD). Nevertheless, none from control group signed AD in three conservative months and the change on overall family harmony of patients was not significant.
Given that patients with same knowledge on ACP, without settling the family relationship issues, patients and their families are not ready to discussing ACP. Structured family intervention fosters the family culture for their readiness of ACP discussion. Incorporating elements of education on ACP and family intervention will enhance patients’ end of life care pathway. In view of the limited sample size, further study is required to get empirical result.
