Cultural Adaptation of the Serious Illness Conversation Guide for Caregivers of Persons with Dementia in Singapore

Abstract Introduction Goals-of-care (GOC) discussions are often delayed or uninitiated for persons with dementia (PwD), 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. Methods We adapted the SICG for caregivers of PwD 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 Caregivers expressed a strong preference for Version 3, with Wilcoxon signed-rank tests showing statistically significantly higher ratings relative to Version 1. Qualitative findings revealed that caregivers valued empathy, contextual clarity, and reassurance of continued clinical support. None of the caregivers had been informed by their loved ones of their goals and priorities, reaffirming the value of the SICG-C. Revised prompts were highly aligned with caregivers’ informational and emotional needs, and were well-received. Conclusion The SICG-C enables clinicians to initiate timely, values-based GOC discussions with caregivers of PwD. 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.