Good death and end-of-life care preferences: perspectives from older Singaporeans

BACKGROUND: Reflecting on the rapidly ageing population with a growing need for end-of-life (EOL) care and ethnic diversity in Singapore, it is important to understand culturally specific views on the meaning of good death and end-of-life (EOL) care plans and preferences. METHODS: This study explores older Singaporeans' perspectives on the meaning of good death and their end-of-life (EOL) care plans and preferences, by conducting 18 in-depth interviews with older Singaporeans. The data was analysed using an iterative thematic analysis involving independent coding followed by iterative discussion and refinement of themes. RESULTS: We found four attributes of good death, including being free of pain or suffering, not being a burden on family members, accepting mortality, and fulfilling parental and spousal responsibility. As regards EOL care plans and preferences, we found that most of the older adults interviewed never had an open and detailed EOL conversation with their family members. Four barriers to EOL care planning or preference discussions were identified: the degree of readiness, fear of making them unhappy, leaving it up to family, and interpersonal and social influence. CONCLUSIONS: To encourage older adults to make EOL care plan while they are healthy and competent, we suggest that the government promote professionally appropriate and family-engaged EOL care services tailored towards individuals, and open and ongoing conversations between older adults and their family members.