When facilitators prioritise documentation over communication: a conversation analytic study on advance care planning consultations

This paper seeks to shed light on the extent to which Advance Care Planning (ACP) facilitators rely on documents to conduct discussions. The study examines ACP discussions conducted in Singapore and uses the Conversation Analysis (CA) method to analyse how such discussions are facilitated. A review of the literature reveals that a high degree of importance is placed on documenting end-of-life decisions, communication skills of clinicians were crucial and highly correlated to the quality of care that patients receive in end-of-life care, and training received by ACP facilitators were inadequate in preparing them to conduct end-of-life discussions effectively. Audio-visual data were collected from two public hospitals in Singapore and comprises clinician-patient interactions during ACP discussions. The data finds that ACP facilitators display a tendency to orient to the form and/or discussion worksheet, and thus structuring ACP discussions according to the materials. The implications of such practices include that patients’ concerns may not be heard or addressed. These practices are attributed to the documentation-first and clinician-led approaches adopted by facilitators and could be the result of a lack of appropriate training.Bachelor of Arts in Linguistics and Multilingual Studie