Current Projects

Current Research Projects

The Cost of Care in Advanced Dementia: Blessing or Burden?

  • Project Duration: 2019-2021
  • Principal Investigators: Dr. Allyn Hum and Dr. Andy Hau Yan Ho
  • Grant Awarding Agency: Funded by the NTU Ageing Research Institute for Society and Education & Geriatric Education Research Institute  (ARISE-GERI), Singapore
  • Amount awarded: S$100,000
  • Abstract of Research: In Singapore, the cost of dementia care is estimated to be as great as for heart disease and cancer. Singapore will spend $1.4 billion annually for healthcare “direct (or ‘formal’) costs”, which will encompasses both medical and non-medical expenses. “Indirect (or ‘informal’) costs” relate to the financial burdens affecting the individual, which includes loss of income for family caregivers who care for them without any financial returns. In Singapore, non-reimbursable and unpaid labor costs range annually from S$15,750 for mild dementia to S$33,408 for moderate dementia. With increased debility and complications in the last stage of dementia, these costs will increase. Beyond the financial burdens, the intangible costs of caregiving for the advanced dementia (AD) sufferer are the psychosocial, emotional and spiritual burdens which are difficult to quantify. Caregivers suffer loss in quality of life and are more likely to suffer poor physical health and emotional distress than non-caregivers. Caregiver burden leading to burnout is a known factor for institutionalization. The main aim of this study is to measure the intangible costs of caregiving for AD patients and compare these costs between those living in the community (home based) and in institutions (i.e., nursing home or hospice). 180 principal family caregivers of advanced dementia patients will be identified and recruited from different healthcare sites (community and institutions) to participate in a longitudinal survey to identify their needs and mental health outcomes. Lived experiences of 30 AD family caregivers of community living (with and without palliative care support) and institution-based (i.e., nursing home) advanced dementia patients will be examined via a longitudinal qualitative approach with a concurrent nested design.

Mindful-Compassion Art Therapy for Dementia Care (MCAT-DC) – Empowering Resilience and Holistic Wellbeing for Sustainable Family Caregiving: A Waitlist Randomized Controlled Trial

  • Project Duration: 2019-2021
  • Principal Investigator: Dr. Andy Hau Yan Ho
  • Grant Awarding Agency: Funded by the NTU Ageing Research Institute for Society and Education (ARISE) Strategic Initiatives, Singapore
  • Amount awarded: S$198,989
  • Abstract of Research: Dementia is a neurodegenerative disease that leads to irreversible decline in one’s cognitive and functional capacity, identity, and personhood. In Singapore, the number of persons with dementia is expected to soar to 187,000 by 2050. Hence, it is imperative to render comprehensive support to dementia sufferers, and especially their family caregivers. While local initiatives have raised public awareness and developed services for dementia care, they do not adequately address the psycho-socio-spiritual needs of family caregivers, as caregiving stress can greatly impede one’s mental and emotional health. International research for dementia family caregivers has thus focused on developing multicomponent interventions that accentuate holistic support to promote healthy and sustainable caregiving. This proposed 3-year study builds on the empirical foundation of Mindful-Compassion Art Therapy (MCAT) to test its efficacy as a multicomponent, holistic, psycho-socio-spiritual intervention for supporting dementia family caregivers. MCAT is a group-based intervention that integrates mindfulness meditation and art therapy, with reflective awareness complementing emotional expression, to foster self-compassion and inner-resilience among professional caregivers. Results from a randomized controlled trial (RCT) with end-of-life care workers revealed MCAT’s effectiveness for reducing burnout and promoting wellbeing to enrich caregiving.

Non-Palliative Care Professionals Caring for End-of-Life Patients: A Lived Experience Study on Needs, Challenges and Actions for Strengthening Clinical Competency and Psycho-Socio-Emotional Capacity in Singapore

  • Project Duration: 2019-2020
  • Principal Investigator: Dr. Andy Hau Yan Ho
  • Grant Awarding Agency: Funded by the Lien Foundation, Singapore
  • Amount awarded: S$120,000
  • Abstract of Research: A 2014 study by the Lien Foundation in Singapore found that medical professionals outside of palliative care perceived themselves as inadequate in communicating with and caring for critically and terminally ill patients, despite the high prevalence of death occurring in non-palliative care units such as geriatric, oncology and intensive care. Being constantly exposed to the trauma, pain and sufferings of their patients and families, while lacking clinical skills, emotional competency and institutional support for end-of-life care work, non-palliative care professionals (NPCPs) are faced with insurmountable stress that would inevitably result in burnout. Burnout is a reaction to chronic job-related stress, and occurs when individuals become overwhelmed with the emotional, mental and physical duress associated with their professional work. Beyond the individual level, burnout has also been found to negatively impact quality of care and expression of empathy among professional care providers, while causing increased medical errors among physicians, and heightened turnover rates of workers in various healthcare institutions. With population ageing, the demand on NPCPs to care for end-of-life patients will surge, alongside with increased but unsupported job expectations, adding to the potential of burnout which can prove detrimental to the safety and quality of patient care. Yet, there is scarce investigations on the experiences, needs and challenges that NPCPs face in caring for end-of-life patients in local and international contexts. The current study aims to address this critical knowledge gap through an in-depth qualitative study that explores and investigates the lived experience of NPCPs from 7 major medical disciplines outside of palliative medicine that responsible for the care of critically and terminally ill patients and their families. The expected findings from will contribute to advancement in both theories and practices in end-of-life care to better support NPCPs in their roles. The knowledge generated can also serve as the foundation for developing an evidence-based and cultural-specific education programme to support and augment end-of-life care by NPCPs in Singapore and Asia.

Development and Evaluation of a novel Narrative E-Writing Intervention (NeW-I) for Parents of Children with Life-Limiting Illness: A Pilot Randomized Controlled Trial for Advancing Holistic Paediatric  Palliative Care and Parental Bereavement Support

  • Project Duration: 2018-2020
  • Principal Investigator: Dr. Andy Hau Yan Ho
  • Grant Awarding Agency: Funded by the Temasek Foundation Innovatives, Singapore Millenium Foundation Grant Programme
  • Amount awarded: S$253,390
  • Abstract of Research: Conventional grief support interventions for parents whose children are terminally ill often begin only after the child’s death. Despite robust evidence which shows that pre-loss interventions that enhance death preparedness can alleviate psychological distress and prevent adverse grief outcomes among family caregivers of dying patients, there is no known program designed specifically to address the psycho-emotional-spiritual needs of parents facing child loss. And while the National Strategy for Palliative Care in Singapore aims to promote holistic end-of-life care services to patients and their caregivers, vast inadequacy continues to exist in the support provided to parents caring for a dying child in the local context. A novel therapist-facilitated, online intervention is conceived to fill this
    critical service gap. Adopting an evidence-based approach, the research team has developed a strength-focused and meaning-oriented Narrative e-Writing Intervention (NeW-I) for parents anticipating the death of their child due to a chronic life-limiting condition. The design of NeW-I is informed by an existing body of research (i.e. international systemic review and local qualitative inquires) that critically examines the lived experience of bereaved parents of children with life-limiting illnesses. NeW-I will be implemented in Singapore in collaboration with KK Women and Child’s Hospital and Club Rainbow Singapore. A pilot Randomized Control Trial (RCT) with a built-in accessibility and feasibility study will examine the efficacy of the NeW-I therapeutic protocol for enhancing quality of life, spiritual wellbeing, hope and perceived social support, as well as reducing depressive symptoms, caregiver burden and anticipatory grief among a purposive sample of 66 participants. NeW-I aspires to enhance quality of life, spiritual well-being, hope and sense of social support, as well as alleviating depressive symptoms, caregiving burden, and adverse grief outcomes among Singaporean parents facing the terminal illness and eventual death of their sick child. The findings generated will form the foundation of a full-scale RCT for advancing holistic paediatric palliative care and parental bereavement support locally and around the world.


A Multicentre Randomized Controlled Trial of a Novel Family Dignity Intervention (FDI) for Asian Palliative Care

  • Project Duration: 2017-2020
  • Principal Investigator: Dr Andy Hau Yan Ho
  • Grant Awarding Agency: Funded the Singapore Ministry of Education (MOE) Academic Research Fund (AcRF) Tier 2 Grant.
  • Amount awarded: S$541,421
  • Abstract of Research: In Singapore, demand for palliative care has surged over the past decade and will continue to rise in the future under the context of population ageing. The Government and the Ministry of Health have honorably aspired to enhance the provision of holistic palliative care to patients and families facing chronic and terminal illnesses. However, most palliative interventions still focus predominately on pain and symptom management without addressing psycho-socio-spiritual concerns. To date, there is no available palliative care intervention for dignity enhancement in the Singapore, and little has been done with the Asian population. Building on our empirical foundations and expertise in dignity and dignity therapy, this randomized controlled trial will develop and test a novel “Family Dignity Intervention” for older Asian terminally-ill patients and their family caregivers. The FDI will emphasize dyad work to facilitate open dialogue, strengthen family connectedness, and cultivate familial Compassion so as to create a supportive and constructive platform that foster the expressions of appreciation, achieving reconciliation, fortifying family bonds, solidifying and passing on transcendental wisdom and values across generations. The expected outcomes of this pioneering study will generate new knowledge contributing to advancement in both clinical theories and practices in palliative end-of life care for Singapore and for all Asian communities around the world.