Measuring and monitoring the quality of dying in the UN Decade of Healthy Ageing.

WHO aims to identify metrics to monitor the quality of dying, complementing those indicators proposed under the UN Decade of Healthy Ageing. However, the proposed criteria for a good death are contentious. Needs and priorities vary between individuals and their carers, across conditions, over time, and across communities and cultures.

Cost-Effectiveness of Long-Chain Omega-3 Supplementation for the Secondary Prevention of Cardiovascular Disease in the United States.

Objectives: A variety of eicosapentaenoic (EPA) and docosahexaenoic (DHA) omega-3 dietary supplements of varying dosage and pricing are available in the United States and commonly used for secondary cardiovascular prevention. Although these interventions' efficacy has been studied, their cost-effectiveness remains unknown. The goal of this article is to assess whether omega-3 dietary supplements are cost-effective for secondary cardiovascular prevention in adults in the United States.

Do Caregivers of Asian Patients with Advanced Cancer Help or Hinder Patient Understanding of Illness and Involvement in Decision Making?

PurposeIt is unclear whether caregivers help or hinder patients' involvement in decision making and understanding of illness. We thus investigated the extent to which caregivers' preferred level of patient involvement in decision making and understanding of treatment goals are associated with those of patients.MethodsWe used survey data from 229 patients with metastatic cancer and their family caregivers living in Singapore spanning 2 y prior to the patient's death.

Quality of Care for Patients With Advanced Illness Scale: Development, Preference Elicitation, and Evaluation of Measurement Properties.

Objectives: To develop the Quality of Care for Patients with Advanced Illness (QCPAI) scale, derive preference-weighted scoring, and evaluate measurement properties for comprehensively assessing advanced care quality from the patient's perspective.

Methods: A 15-item QCPAI scale, including self-administered and caregiver proxy versions, was developed through a 5-step process (scoping review, item development, translation, cognitive debriefing, and reconciliation) in English and Chinese. A study was conducted among 200 advanced cancer patients and their caregivers, with baseline and 1-week follow-up surveys.

Cost-Effectiveness of Left Ventricular Assist Device for Transplant-Ineligible Patients.

Importance: Singapore is considering subsidizing left ventricular assist devices (LVADs) for end-stage heart failure (ESHF) and uses cost-effectiveness evidence to inform the determination. Yet, no economic evaluation has thus far been conducted.

Objective: To estimate the lifetime cost-effectiveness of LVAD compared with optimal medical management for transplant-ineligible patients.

A Randomized Trial Using an Online Grocery Store to Evaluate a Multicomponent Digital Intervention to Improve Diet Quality.

Introduction: Poor diet is a key contributor to rising rates of noncommunicable diseases. This study tested the ability of an online grocery store that includes a multicomponent digital intervention identified through the Multiphase Optimization Strategy to improve the nutritional quality of shopper's purchases.

Study Design: This was a 2-arm RCT.

Reverse Time-to-Death as Time-Scale in Time-to-Event Analysis for Studies of Advanced Illness and Palliative Care.

Incidence of adverse outcome events rises as patients with advanced illness approach end-of-life. Exposures that tend to occur near end-of-life, for example, use of wheelchair, oxygen therapy and palliative care, may therefore be found associated with the incidence of the adverse outcomes. We propose a concept of reverse time-to-death (rTTD) and its use for the time-scale in time-to-event analysis based on partial likelihood to mitigate the time-varying confounding.

Complementary and Alternative Medicine Use in the Last Year of Life: The COMPASS Cancer Cohort Study.

Context: There has been growing interest in the role of complementary and alternative medicine (CAM) as part of end-of-life care.

Objectives: This study prospectively examined the prevalence, predictors and outcomes of ingestible CAM use among cancer patients in their last year of life in Singapore.

Methods: This study (N = 427) utilized data across 12 months (four time points) prior to patient death.

Effectiveness and cost-effectiveness of an app and rewards-based intervention in type 2 diabetes: A randomised controlled trial.

Aim: Digital health interventions and economic incentives have shown promise in facilitating diabetes self-management, though evidence is limited. Therefore, this study aimed to evaluate the effectiveness and cost-effectiveness of a comprehensive app-based diabetes self-management programme with rewards for healthy behaviours and health outcomes.

Materials And Methods: The TRIal to slow the Progression Of Diabetes (TRIPOD) study was an open-label, parallel-group, randomised controlled trial conducted at Duke-NUS Medical School, Singapore.

Efficacy of an mHealth-delivered behavioral intervention on weight loss and cardiometabolic risk in African American postpartum people with overweight or obesity: the SnapBack randomized controlled trial.

Objective: The objective of this study was to evaluate the efficacy of a mobile health (mHealth)-delivered behavioral intervention on changes in postpartum weight and cardiometabolic risk factors (blood pressure [BP], lipids, and hemoglobin A1c) over 12 months.

Methods: A randomized controlled trial of 300 African American postpartum people with overweight and obesity enrolled in Philadelphia Women, Infants, and Children (WIC) clinics was conducted. Participants were randomized to usual WIC care (n = 151) or a 12-month mHealth-delivered intervention (n = 149) comprising behavior change goals, interactive self-monitoring text messages, and counseling support.

Cost-effectiveness of group medical visits and microfinance interventions versus usual care to manage hypertension in Kenya: a secondary modelling analysis of data from the Bridging Income Generation with Group Integrated Care (BIGPIC) trial.

Background: The Bridging Income Generation with Group Integrated Care (BIGPIC) trial in rural Kenya showed that integrating usual care with group medical visits or microfinance interventions reduced systolic blood pressure and cardiovascular risk in participants. We aimed to estimate the incremental cost-effectiveness of three BIGPIC interventions for a modelled cohort and by sex, as well as the cost of implementing these interventions.

Methods: For this analysis, we used data collected during the BIGPIC trial, a four-group, cluster-randomised trial conducted in the western Kenyan catchment area of the Academic Model Providing Access to Healthcare.

Healthcare burden of cognitive impairment: Evidence from a Singapore Chinese health study.

Background: Cognitive impairment (CI) raises risks for unplanned healthcare utilisation and expenditures and for premature mortality. It may also reduce risks for planned expenditures. Therefore, the net cost implications for those with CI remain unknown.

Societal Preferences for Subsidizing Treatments Targeting Patients With Advanced Illness: A Discrete Choice Experiment.

Objectives: Cost-effectiveness analyses are increasingly used to inform subvention decisions for moderately life extending treatments but apply several simplifying assumptions that may be inconsistent with public preferences. Contrary to standard assumptions, we hypothesize that societal willingness to allocate public funding toward these treatments is (1) diminishing for incremental improvements in survival and quality of life (QoL) and (2) greater for subvention policies that exclude the oldest old (>80 years).

Methods: We tested these hypotheses using a web-based discrete choice experiment (n = 425) in Singapore.

Are cash incentives always king? A randomized controlled trial evaluating hedonic versus cash incentives (TEH-C).

Introduction: Physical inactivity is a risk factor for obesity and non-communicable diseases. Despite myriad health and non-health benefits resulting from physical activity (PA), most individuals do not meet PA recommendations. Providing an incentive for meeting activity goals may increase activity levels.

Navigating Public Policy Responses to a Pandemic: The Balancing Act Between Physical Health, Mental Health, and Household Income.

Objective: During COVID-19, governments imposed restrictions that reduced pandemic-related health risks but likely increased personal and societal mental health risk, partly through reductions in household income. This study aimed to quantify the public's willingness to accept trade-offs between pandemic health risks, household income reduction, and increased risk of mental illness that may result from future pandemic-related policies.

Methods: A total of 547 adults from an online panel participated in a discrete choice experiment where they were asked to choose between hypothetical future pandemic scenarios.

Prognostic awareness and prognostic information preferences among advanced cancer patients in Kenya.

Background:  Cancer is the third leading cause of death in Kenya. Yet, little is known about prognostic awareness and preferences for prognostic information.

Aim:  To assess the prevalence of prognostic awareness and preference for prognostic information among advanced cancer patients in Kenya.

Cost-Effectiveness of a Multicomponent Primary Care Intervention for Hypertension.

Background: The SingHypertension primary care clinic intervention, which consisted of clinician training in hypertension management, subsidized single-pill combination medications, nurse-delivered motivational conversations and telephone follow-ups, improved blood pressure control and cardiovascular disease (CVD) risk scores relative to usual care among patients with uncontrolled hypertension in Singapore. This study quantified the incremental cost-effectiveness, in terms of incremental cost per unit reduction disability-adjusted life years, of SingHypertension relative to usual care for patients with hypertension from the health system perspective.

Methods And Results: We developed a Markov model to simulate CVD events and associated outcomes for a hypothetical cohort of patients over a 10-year period.

Goals of Care Among Patients With Advanced Cancer and Their Family Caregivers in the Last Years of Life.

Importance: Understanding goals of care for terminally ill patients at the end of life is crucial to ensure that patients receive care consistent with their preferences.

Objectives: To investigate the patterns of goals of care among patient-caregiver dyads over the last years of the patient's life and the associations of the goals of care with patient-caregiver characteristics.

Design, Setting, And Participants: This prospective cohort study of 210 patient-caregiver dyads involved surveys every 3 months from July 8, 2016, until the patient's death or February 28, 2022.

Development of the Parental Experience with Care for Children with Serious Illnesses (PRECIOUS) quality of care measure.

Background: Parent-reported experience measures are part of pediatric Quality of Care (QoC) assessments. However, existing measures were not developed for use across multiple healthcare settings or throughout the illness trajectory of seriously ill children. Formative work involving in-depth interviews with parents of children with serious illnesses generated 66 draft items describing key QoC processes.

Cost-effectiveness of sodium zirconium cyclosilicate for advanced chronic kidney patients in Singapore.

Introduction: Hyperkalaemia (HK) is prevalent among patients with chronic kidney disease (CKD) and chronic heart failure, especially if they are treated with renin-angiotensin-aldosterone system inhibitors (RAASi). This study evaluated the cost-effectiveness of a newly developed anti-HK therapy, sodium zirconium cyclosilicate (SZC), to the current standard of care for treating HK in advanced CKD patients from the Singapore health system perspective.

Methods: We adapted a global microsimulation model to simulate individual patients' potassium level trajectories with baseline potassium ≥5.

Weight Gain Prevention Outcomes From a Pragmatic Digital Health Intervention With Community Health Center Patients: Randomized Controlled Trial.

Background: The prevalence of obesity and its associated comorbidities continue to rise in the United States. Populations who are uninsured and from racial and ethnic minority groups continue to be disproportionately affected. These populations also experience fewer clinically meaningful outcomes in most weight loss trials.

PRECIOUS demonstrated satisfactory measurement properties for assessing the quality of care for children with serious illnesses.

Objectives: To determine the measurement properties of PaRental Experience with care for Children with serIOUS illnesses (PRECIOUS), a parent-reported measure of Quality of Care for seriously ill children across care settings and illness trajectories.

Study Design And Setting: Parents self-administered baseline and 2-week follow-up surveys online. Exploratory Factor Analysis was used to determine PRECIOUS's factor structure and select items.

Cancer patients' awareness of extent of disease: anxiety, depression, quality of life.

Objective: In Asian cultures, the belief that full disclosure would harm the patient's health would lead to non-disclosure. The study aimed to determine whether making patients aware of the extent of their disease will lead to psychological morbidity and poor quality of life (QOL).

Methods: This was a cross-sectional study among 195 patients with stage 4 cancer who were aware of their cancer diagnosis at the medical oncology, radiation oncology and palliative care units at an academic cancer centre.