Completed Research Projects

Completed Research Projects

The Healthcare Worker’s Journey of Care and Recovery: A Qualitative Study on the Lived Experience of Supporting Stroke Patients in Singapore’s Rehabilitation Unit

  • Project Duration: 2019-2022
  • Overall Technical Principle Investigator: Dr Andy Hau Yan Ho
  • Grant Awarding Agency: Rehabilitation Research Institute Singapore (RRIS) Rehabilitation Research Grant 3 – Complementary Grant
  • Amount Awarded: 299,800
  • Abstract of Research: Stroke is often a life-changing event as it is a sudden-onset condition with long-term consequences. Healthcare workers (HCWs) including nurses, physicians, social workers, physiotherapists and occupational therapists work closely with stroke survivors to improve independence in daily activities and quality of life. However, despite playing an important role in their care and recovery, there is limited number of studies that focus on the underlying psycho-socio-practical issues that arise from caring for this group of patients. For example, one study in 2015 observes that nurses’ involvement in rehabilitation in stroke units have not been previously reported although they ‘represent the largest professional group working with stroke-survivors’.1 Employing a phenomenological qualitative research design with an interpretive-systemic framework, the main aim of this project is to identify these issues from the perspectives of HCWs and pave the way for guidelines, protocols and programs that can enhance the wellness and professional competency of HCWs. Specifically, our expected findings will serve to inform and advance policies and practices of stroke care in hospital, rehabilitation and community settings, which can potentially lead to the development of better training and supportive programmes to empower HCWs whose care experiences are often complex, insightful, yet rarely explored in research. With a holistic understanding of service provision and care experiences, we can develop better support for HCWs which will in turn translate to better care for stroke patients.

 

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 thiscritical 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.

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.

 

A Qualitative Study on the Lived Experience of Bereaved Parents of Children with Life-Limiting Illness: Advancing Parental Bereavement Support in Singapore and Greater Asia. 

  • Project Duration: 2017-2019
  • Principal Investigator: Dr Andy Hau Yan Ho
  • Grant Awarding Agency: Funded the Singapore Ministry of Education (MOE) Academic Research Fund (AcRF) Tier 1 Grant.
  • Amount awarded: S$74,985
  • Abstract of Research: Contrary to the common belief that most deaths occur in later life, world statistics show that over 11.4 million children and youth die annually due mainly to life-limiting illnesses and congenital conditions. In Singapore, approximately 400-500 children and youth between the ages of 0 to 24 die every year, leaving thousands of parents, grandparents and extended families heartbroken and devastated. Despite these significant figures, there is a dearth knowledge on how bereaved parents cope with their child’s end of life and eventual death, leading to consequential inadequacy on parental bereavement support services locally and internationally. This first-of-its kind study is conceived to fill this important knowledge gap via a qualitative research design to explore the lived experience of 30 Singaporean single-or-couple parents whose child suffered from a life-limiting illness before the age of 19, and as a result passed away in subsequent years [N=30]. These explorations conducted either in English/Mandarin/Malay through Meaning-Oriented Interviews will identify the shared commonalities in the experience of child loss, the struggles and strength of living with grief, as well as the factors that support or impede bereavement outcomes. Participant recruitment via purposive sampling from 3 most respect pediatric palliative care providers, including Children’s Cancer Foundation, HCA Hospice Care Star PALS, and Club Rainbow, will facilitate the examination of parental bereavement among a wide spectrum of critical illnesses and cultural backgrounds. Through the process of theory building with Grounded Theory Approach, this study will develop a cultural-specific Parental Bereavement Care Model for Advancing theories and practices in pediatric palliative care and bereavement support services for Singapore and for all Asian communities around the world. The generated findings will be disseminated widely locally and internationally via academic publications, conference presentations, self-help booklets and information pamphlets.

 

Project ARTISAN: Fostering Aspiration and Resilience through Intergenerational Storytelling and Art-based Narratives.

  • Project Duration: 2018-2019
  • Principal Investigator: Dr. Andy Hau Yan Ho
  • Grant Awarding Agency: Funded by the National Art Council Singapore, Research and Development Grant
  • Amount awarded: S$40,700
  • Abstract of Research: While many community arts-based programme were found to enhance social inclusion amongst older adults and lead to improvements in holistic wellbeing, physical and mental health, there is currently no available data to illuminate the benefits of an intergenerational arts programme involving elderly-youth dyads in Singapore. Also, there is a dearth of research that examines the interplay between art space and art content in cultivating positive psycho-socio-emotional changes on art participants in the local context. This pilot study adopts a Participatory Action Research (PAR) approach to develop a novel ARTISAN intergenerational arts programme that aims to promote life meaning, resilience and wellbeing, as well as to enhance social support and national identity among the older and younger generations Singapore. Utilizing a wait-list randomized controlled trial design (RCT), 34 elderlies and 34 youths (N=68) were invited to participate in a 5-week, 10-hour intervention programme. Through the integrative processes of curated museum visits (art space), facilitated storying (art facilitation), creative art-making and reflective writing (art content), the intervention focused on the exploration of five unique themes to engage senior-youth dyads. Quantitative data obtained before and after the intervention will be triangulated with qualitative data generated from feasibility focus groups and reflective writings to explore its potential benefits and benefiting processes in achieving the aforementioned outcomes. To encourage social change and empowerment, public art exhibitions showcasing the artworks from this programme were also held within the community. Hence, by developing, implementing and systematically evaluating a novel ARTISAN art-based programme that connects the youths and older adults with curated art space, art content and art facilitation, this study value adds and fills an existing gap within the arts and culture literature in Singapore. Furthermore, it allows the study of the benefits of arts as a viable and cost-effective platform in increasing community engagement and enhancing wellbeing and social cohesion; mediating the detrimental effects of critical social issues brought about by an aging population and increasing social distance. The expected outcomes of this pioneering study will generate new knowledge, contributing to the advancement of art and health research in Singapore, as well as the advancements in both theories and practices for creative aging and intergenerational bonding. Being first of its kind, it forms the foundation for the development of other theoretically-driven and effective intergenerational art-based programmes that can be useful for different cohorts of older adults and youths; allowing appropriate social policies, supportive schemes and relevant courses of actions to be established in response to the government’s call for more intergenerational programmes. The findings from this study will also form the foundation for a larger Population Health Project on Arts and Wellness.

 

The Arts for Ageing Well: A landscape study on art participation and holistic wellbeing among current and future older generations of Singapore. 

  • Project Duration: 2016-2018
  • Principal Investigator: Dr Andy Hau Yan Ho
  • Grant Awarding Agency: Funded by the National Art Council of Singapore, Research and Development Fund.
  • Amount awarded: S$200,000
  • Abstract of Research: Fashionable terms such as active aging, graceful aging and creative aging are all intricately woven through the principal health promotion goals of personal autonomy, social participation and community involvement. One has to look no further than to the Arts to realize its vital significance in cultivating these goals, as art participation has long been known to have tangible effects on health and mental health. However, there is no available data to illuminate the intricate relationships between art participation and holistic health among the older generations of Singapore. Hence, there is an imminent need to critically examine the landscape of art participation among Singapore’s young-old and older adults, to investigate the relationships between art participation and holistic well-being, as well as to identify the various facilitating and debilitating factors of art participation and active ageing. The current study is the first-ever attempt to critically address this important knowledge gap by utilizing a holistic investigative approach with both quantitative and qualitative methodologies for exploring and understanding the notion of “Art for Ageing Well”. The expected findings will generate new knowledge contributing to the advancement of practices and policies for promoting sustainable art participation among Singapore’s current and future older generations.

 

An Evaluation of the National Advance Care Planning Programme – A Qualitative Study

  • Project Duration: 2016-2017
  • Co-Principal Investigator: Dr Andy Hau Yan Ho
  • Grant Awarding Agency: Funded by the Singapore Ministry of Health, in collaboration with The Agency of Integrated Care.
  • Amount Awarded: $1,040,200
  • Abstract of Research: Advance Care Planning(ACP) is a voluntary process of discussion on future care preferences between an individual, his or her family and healthcare providers. ACP describes the type of care the person would prefer, if he or she is to become very sick and unable to make health care decisions in the future. Carried out successfully, the ACP process will lead to appropriate documentation and adherence of individual care preferences across different healthcare settings, whereby individuals wishes will be respected and honored.  Studies have reported that ACP is associated with improved quality of care at the end of life, fewer in-hospital deaths and an increased use of hospice. In 2011, a national ACP programme was launched in Singapore, of which focuses on achieving the three objectives of: (i) increasing awareness about ACP among healthcare professionals, community and religious leaders, and the public; (ii) recruiting and training ACP facilitators to conduct ACP conversations in health and social care organisations; and (iii) establishing and strengthening systems to support ACP implementation, including a national ACP IT system. Five years onwards, an evaluation of the effectiveness  of the National ACP programme is required. The qualitative component of this evaluation  examines how ACP has been implemented and embedded within the existing clinical practice, by exploring the experiences of facilitators and referring clinicians who conducted ACP session, and patient-family dyads who received ACP within acute care settings.

 

Development and evaluation of a novel Mindful-Compassion Art Therapy (MCAT) Supervision for self-care and collegial support among end-of-life care professionals in Singapore.

  • Project Duration: 2016-2018
  • Principal Investigator: Dr Andy Hau Yan Ho
  • Grant Awarding Agency: Funded by the Nanyang Technological University Start Up Grant.
  • Amount awarded: S$34,994
  • Abstract of Research: The need for empathy and the difficulties of coping with morality when caring for the dying and the bereaved pose great psychological and spiritual strains. Palliative care professionals are particularly prone to burnout given the intense emotional and existential nature of their work. Supervision is one important way to provide adequate support that focuses on both professional and personal competencies in working with death and loss. Previous research has provided robust evidence that support the inclusion of art therapy within supervision for it had effectively reduced burnout and enhanced emotional regulation. Combining the practice of mindfulness in art-therapy based supervision, with reflective awareness complementing emotional expression, has immense potential to create a dynamic platform for self-care and collegial support, of which could ultimately cultivate resilience and compassion resilience among those immersed the field of end-of-life care. This pioneering study develops and tests a novel Mindful-Compassion Art Therapy (MCAT) for its effectiveness in reducing work-related stress among EOL care workers in Singapore, as well as its capacity in elevating participants’ sense of resilience, self-awareness, acceptance and compassion. The expected outcomes of this study will advance theories and practices in caring for end of life caregivers both locally and internationally.