Implementation of Serious Illness Conversations Program

There were a series of projects related to serious illness communication, of which the titles are listed below:

• Cultural adaptation of the Serious Illness Conversation Guide for seriously ill patients in Singapore
• Pilot study of the Serious Illness Care Program in Singapore
• Pilot study to evaluate the acceptability, feasibility, and efficacy of a Patient Support Coordinator (PSC)-facilitated model of serious illness communication

Project 1: Cultural adaptation of the Serious Illness Conversation Guide for seriously ill patients in Singapore
Project 1 aimed to culturally adapt the serious illness conversation guide from the U.S version to the local Singaporean language in English and in Chinese. Patient conditions involved included both cancer and non-cancer patients (cardiac failure, renal failure, chronic neurological disease). Recruiting sites were NCCS, NHCS, SGH. Additionally, a caregiver specific guide for persons with dementia was developed.

Project 2: Pilot study of the Serious Illness Care Program in Singapore
Project 2 aimed to test the feasibility, acceptability of components of the U.S Serious Illness Care Program (training for SIC guide, SIC specific documentation template, pre-clinic screening of potentially eligible patients for SIC, in-person nudging for SIC conversation, SIC clinician conversation metrics). This was done through using a prospective mixed methods design, in NCCS and NHCS.

Project 3: Pilot study to evaluate the acceptability, feasibility, and efficacy of a Patient Support Coordinator (PSC)-facilitated model of serious illness communication
Project 3 aimed to explore the utility of a lay coordinator to augment serious illness care and communication. A prospective pilot involving up to 30 breast cancer patients in NCCS was conducted.

Principal Investigator

Dr. Neo Hui Shan Shirlyn, Clinical Assistant Professor, Duke-NUS Medical School; Senior Consultant, National Cancer Centre Singapore

Study Team

Project 1

• National Heart Centre Singapore — Site P.I/Co-I: Dr. Khoo Chun Yan, Ms. Jasmine Ku
• Singapore General Hospital — Site P.I: Dr. Lee Guozhang
• National Cancer Centre Singapore — Co-I NCCS: Dr. Chiang Jian Bang

Project 2

• National Heart Centre Singapore — Site P.I: Dr. Teo Loon Yee Louis
• National Cancer Centre Singapore — Co-I: Dr. Gillian Phua, Dr. Nagavalli DO Somasundarum
• Duke-NUS Medical School — Co-I: Dr. Chetna Malhotra
• Harvard Collaborator: Dr. Joshua Lakin

Project 3

• National Cancer Centre Singapore — Co-I: Dr. Bernard Chua, Dr. Tan Wu Meng

Publications

• Lee AS, Tang SN, Phua GLG, Yee AC, Neo SH. Adaptation of the Serious Illness Conversation Guide to Singapore's Multicultural Setting for Patients With Heart Failure, Renal Failure, or Cancer. Palliative Medicine Reports 5, no. 1 (2024): 122–26. https://doi.org/10.1089/pmr.2023.0086
• Ramakrishnan C, Lee AS, Malhotra C, Phua GLG, Yee A, Neo SH. Adaptation of the Serious Illness Conversation Guide to a Multicultural Context in Singapore: A Qualitative Study. BMJ Open 15, no. 10 (2025): e098264. https://doi.org/10.1136/bmjopen-2024-098264
• Ng A, Yeo SM, Neo SH. Patient Readiness for Serious Illness Conversations: Identifying Psycho-Emotional Barriers Through a Phenomenological Lens. Psycho-Oncology 34, no. 11 (2025): e70317. https://doi.org/10.1002/pon.70317
• Ng A, Phua GLG, Neo SH. Iterative Adaptation and Acceptability Testing of the Serious Illness Conversation Guide for use with Mandarin-speaking Patients. Palliative Medicine Reports.
• Ng A, Sivasamy V, Neo SH. Cultural Adaptation of the Serious Illness Conversation Guide for Caregivers of Persons with Dementia in Singapore. BMC Geriatrics.
• Ng A, Yeo S, Neo SH. Adapting and implementing the Serious Illness Care Programme for outpatient oncology, cardiology and palliative medicine clinics: a mixed-methods feasibility study. BMJ Open 2026;16:e108573. doi: 10.1136/bmjopen-2025-108573
• Hummel E, Tan JYT, Neo SH. Understanding the Facilitators and Barriers to Serious Illness Conversations With Older Adults: A Qualitative Analysis using the Socio-Ecological Framework. Sage Open Aging. 2026;12:30495334261429789. Published 2026 Mar 4. doi: 10.1177/30495334261429789
• Ng A, Yeo SM, Tan WM, Chua B, Erina R, Neo SH. Acceptability and Feasibility of a Patient Support Coordinator (PSC) model to facilitate Serious Illness Communication in Outpatient Oncology. BMC Palliative Care.
• Phua LG, Das R, Lee AS, Sinnathamby AS, Balachandran P, Tang SN, Yee AC, Neo HS. Adapting the serious illness conversation communication training workshop from the western to an Asian context in Singapore. BMC Med Educ. 2026 May 25.
• Ng A, Yeo SM, Neo HS. What makes serious illness conversations acceptable? A mixed-methods study of patient and caregiver experiences in oncology and cardiology. Palliative Care and Social Practice. 2026.

Media Mentions

Commentary: Many seriously ill patients end up living for treatments
Alethea Yee, Shirlyn Neo, Gillian Phua
Read commentary

Any Other Information

• Project 1 was funded by LCPC — Reference Code: LCPC-EX22-0001
• Project 2 was funded by NMRC Research Training Fellowship Seed Fund, Application ID: SEEDFD23jul-0003
• Project 3 was funded by LCPC — Reference Code: LCPC-EX25-0001

Contact Person

Clinical Assistant Professor Neo Hui Shan, Shirlyn: Shirlyn.neo.h.s@singhealth.com.sg