Cultural adaptation of the serious illness conversation guide for caregivers of persons with dementia in Singapore

Q: What did caregivers find most acceptable about the final version of the guide?

Caregivers preferred the later version (Version 3) over Version 1 and rated most items significantly higher. They valued professionalism and reassurance from clinicians, and they preferred language that avoided implying poor prognosis while supporting continuity of care and partnership.

Sep 28, 2026

Uploaded by mieayamfan

Structured goals-of-care (GOC) discussions are often delayed or not initiated for people with dementia, contributing to end-of-life treatments that may not reflect patient values. This study adapted and iteratively revised the Serious Illness Conversation Guide for caregivers in Singapore by shifting patient-facing language to caregiver-facing phrasing, testing versions through interviews, and confirming acceptability through caregiver ratings. Qualitative results highlighted the need for professional reassurance and carefully sensitive wording.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

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Ng etal. BMC Geriatrics (2025) 25:1075 BMC Geriatrics [https://doi.org/10.1186/s12877-025-06761-4](https://doi.org/10.1186/s12877-025-06761-4) RESEARCH Open Access Cultural adaptation of the serious illness conversation guide for caregivers of persons with dementia in Singapore Alston Ng 1,2, Vignesh Sivasamy3 and Shirlyn Hui Shan Neo 1,2* Abstract Introduction Goals-of-care (GOC) discussions are often delayed or uninitiated for people with dementia, potentially contributing to inappropriate end-of-life treatment. The Serious Illness Conversation Guide (SICG) facilitates structured GOC discussions about patient values and care preferences, but a dementia-specific Guide adapted to the Asian cultural context has yet to be developed. This study aimed to adapt and iteratively revise the SICG-C, and assess its acceptability among caregivers of people with dementia. Methods We adapted the SICG for caregivers of people with dementia in Singapore using a three-phase, approach. Phase 1 involved adapting the patient-facing SICG to caregiver-facing language (version 1) . In Phase 2, we iteratively tested the guide with 6 and 13 caregivers in 2 rounds of interviews to derive the final version of the Guide. In Phase 3, 50 caregivers rated each SICG-C item from Versions 1 and 3 using a structured questionnaire, with presentation order alternated to minimise order effects. Results Sixty-nine caregivers were recruited in this study. Qualitative interviews revealed that caregivers valued professionalism and reassurance from clinicians, while also emphasising their own experiential knowledge as distinct from clinical expertise. Many struggled to articulate their loved ones’ priorities due to cognitive decline and the absence of prior discussions, often expressing uncertainty about whether their assumptions reflected what their loved ones would have wanted. Caregivers were sensitive to language implying poor prognosis and preferred phrasing that conveyed continuity of care and partnership. None of the caregivers had been informed by their loved ones of their goals and priorities, reaffirming the value of the SICG-C. In the final survey (n = 50), caregivers showed a strong preference for Version 3 over Version 1, with 21 of 22 items rated significantly higher (all p<0 . 001) . The final SICG-C was rated highly acceptable. Conclusion The SICG-C enables clinicians to initiate timely, values-based GOC discussions with caregivers of people with dementia. Its structured, sensitive language addresses caregiver concerns and may be used to support proactive care planning in dementia. Further research is needed to evaluate implementation in routine clinical practice. Keywords Serious illness care, Dementia, Values and preferences, Goals of care, Communication *Correspondence: Shirlyn Hui Shan Neo [shirlyn. neo.h.s@singhealth.com.sg](shirlyn. neo.h.s@singhealth.com.sg) 1Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore 168583, Singapore 2Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore 3Department of Geriatric Medicine, Singapore General Hospital, Singapore, Singapore © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commo

FAQs

What did caregivers find most acceptable about the final version of the guide?

Caregivers preferred the later version (Version 3) over Version 1 and rated most items significantly higher. They valued professionalism and reassurance from clinicians, and they preferred language that avoided implying poor prognosis while supporting continuity of care and partnership.

Sep 28, 2026

Uploaded by mieayamfan