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Why it’s never too early to start planning for palliative care

Preparing and communicating our decisions and preferences will be a priceless gift to our loved ones especially in difficult times

We never know when illness may strike. That's why it's never too early to start discussing about end-of-life planning and palliative care with your loved ones. PHOTO: GETTY IMAGES

Life is full of uncertainties. One will never know when a life-threatening illness might strike or when one will die.

It's difficult to think about one's own death, let alone talk about it. As hard as it may seem, it is important to make plans for end-of-life care and share them with loved ones while you're still healthy. Communicating your wishes early can help better prepare loved ones, so that they know exactly what kind of care and treatment you want at that critical end-of-life stage. "This is so that they can help fulfil our wishes to live a life with dignity if we become critically ill, until it is time for us to go in peace," says Singapore Hospice Council (SHC) chief executive Evelyn Leong.

A nationwide study in 2019 by Singapore Management University (SMU) found that 62 per cent of Singaporeans wish to live a full and complete life, without regrets.

The study also showed that the other priorities that Singaporeans have at the end-of-life stage include ensuring that their illness or death will not end up being a financial burden for their family members. They also want to be surrounded by loved ones and to have control over their pain relief and other symptoms.

Noting that death is a taboo topic for many, Ms Leong says: "People usually plan for happy occasions or to celebrate an achievement or a new milestone in life such as home ownership, marriage, birthdays, holiday trips and even retirement. But how many of us actually express our wishes when it comes to healthcare, matters relating to end-of-life or even death?"

She adds: "By planning our wishes for end-of-life, we not only leave a priceless gift for our loved ones but we also gain clarity on how we can live our best life. It is important that we start early when planning for end-of-life and death. This way, we can live more purposeful lives and leave our loved ones better prepared."

Here, Ms Leong shares some important questions to ask yourself:

How should I approach this difficult topic with my loved ones?

According to Ms Leong, these conversations should revolve around matters that are important to the individual. She advises: "These can include asking for forgiveness from people who matter to them, or meeting long-time friends for the last time."

For those who need a helping hand on how to start these difficult conversations, SHC, together with the Tan Tock Seng Hospital Advance Care Planning team, has formulated a series of conversation cards to help facilitate discussions about values, motivations, beliefs and life goals.

What should my end-of-life planning include?

Apart from writing a will, preparing for end-of-life includes Advance Care Planning (ACP) and executing a Lasting Power of Attorney (LPA).

ACP is a process of planning for one's future health and personal care. It involves communicating treatment decisions and preferences in advance so that doctors and loved ones know what to do if a serious illness robs you of the ability to express yourself. Starting this discussion early is ideal so that everyone has the ability to talk about such matters with clarity and calm. Once it is documented, it can be accessed and retrieved when needed, cutting out much of the stress and anxiety that would otherwise accompany decision-making in such a difficult time.

The ACP workbook is a helpful aid to start the ball rolling with this process.

In addition to this, it is also wise to get an LPA done. This is a legal document whereby you appoint one or more persons to act on your behalf in a situation where you have lost the mental capacity to make decisions.

The individual or individuals you choose will be given the legal power under the LPA to act to protect and safeguard your interests, and make decisions with regard to your personal welfare as well as to your property and other affairs. The former would include matters to do with your daily care and living arrangements, while the latter would involve paying of bills and taxes, and handling your investments and property.

When the situation arises, how do I want to be cared for?

All patients with life-threatening illnesses such as advanced cancer can benefit from palliative care, which aims to relieve suffering by managing pain and symptoms to improve the quality of life for patients, their family members and caregivers.

"It is important to correct the mindset and reiterate that palliative care is about a holistic care approach that includes mental, social, spiritual and physical pain management," says Ms Leong.

Palliative care is provided by a team of healthcare professionals including doctors, nurses, social workers and therapists, and can take place at patients' homes or specialist clinics, as well as in nursing homes, hospices and hospitals.

"Patients would need to seek advice from their doctor on the type of palliative care services most suitable for them and their loved ones. If they do not have a regular doctor or healthcare professional, they can get advice from any GP or ask for any community service which has healthcare support to evaluate the suitability of referral," Ms Leong explains.

Play The Living Game

To raise awareness among youths and young adults aged 18 to 35 about palliative care, SHC has produced its first online game, known as The Living Game. Each player can assume the role of either a youth as a patient, a loving daughter as a caregiver or a dedicated volunteer in palliative care. The game then leads players through a series of situations where they have to make key decisions, and learn the consequences of those decisions through the various outcomes that result.

In addition, SHC has also produced a short film called Er Jie, to show how palliative care can support patients and their family members. The theme of reconciliation is highlighted, as is the importance of expressing four important sentiments: "I love you", "I'm sorry", "Please forgive me" and "Thank you" - sentiments which many Singaporeans fail to openly express.

The film's message is that making the best of one's remaining days by spending quality time with loved ones will allow us to leave this life in peace, with no regrets. And that is a goal all of us can actively work towards.

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For more information on end-of-life planning and palliative care, visit singaporehospice.org.sg

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