Impact of Advance Care Planning (ACP) on care of patients with heart failure: A randomized controlled trial

Principal Investigator:

Chetna Malhotra, Assistant Professor, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore

Study Team:

David Sim Kheng Leng, Fazlur Rehman Jaufeerally, Eric Finkelstein, Yeo Khung Keong, Tan Poh Yong, Nadkarni Nivedita, Genevieve Wong, Tan Boon Cheng, Clarice Ng, Lim Jing Fen, Chuang Ya-Ting


Advance care planning (ACP) is considered to be one of the most promising interventions to enable patients with life limiting illnesses to receive treatment at the end of life according to their own preferences and to promote and of life conversations between patients and their health care providers. Singapore has launched several pilot programs for ACP, however, the effectiveness of ACP in meeting patient’s end of life care preferences has never been evaluated in the Asian context.


This study aims to assess whether patients receiving ACP have a greater likelihood of receiving end of life care consistent with their preferences compared to patients receiving usual care. In addition, we also compare health care expenditures, patient’s understanding of own illness, their participation in decision making, quality of life, anxiety and depression between those receiving ACP and those with usual care.


The design is a randomized control trial (RCT) of ACP versus normal care. A total of 282 patients with Class III and IV heart failure (New York Heart Association Functional Classification) are enrolled. Eligible patients are recruited and followed for one year or till they die, whichever is earlier, and interviewed every 4 months during this duration. Additionally, the study includes up to 1 caregiver per patient enrolled.

Study sites:

National Heart Centre Singapore

Singapore General Hospital


If benefits of ACP are confirmed via the RCT proposed here, then it will help to promote acceptance of ACP among patients and health care providers across Singapore.


Impact of Advance Care Planning on Care of Patients with Heart Failure: Study Protocol for a Randomized Controlled Trial.

Malhotra C, Sim DKL, Jaufeerally F, Nadkarni N, Wong GCS, Tan BC, Ng CSH, Tho PL, Lim J, Chuang CYT, Fong FHM, Liu J, Finkelstein EA. Trials. 2016; 17(1):285.

Project Start Date:

1 February 2015

Contact Person: