Establishing the ACE Consumer Panel

The composition and terms of reference (TOR) of established PPI groups in overseas HTA and government agencies were reviewed to determine which responsibilities assigned to these groups were applicable to the ACE Consumer Panel and which additional responsibilities were required locally. Organizational websites and social media platforms were then searched to identify potential candidates who held senior appointments in local patient organizations and voluntary groups. Given the limited number of prominent patient advocates in Singapore, many candidates were already known to the CEE team. Each candidate was assessed against core competencies (Box 1) predefined by the CEE team, considering their employment history, skillset, expertise in patient advocacy, and level of influence among patient communities. Particular attention was given to candidates with strong communication skills, and a proven track record of tangible influence on health-related initiatives.

Twenty candidates were contacted to determine their interest in becoming Panel members. Individuals who did not respond (n = 3) or declined the proposed appointment (n = 2) were excluded. The CEE team documented candidates’ relevant past and current appointments and memberships to ensure transparency about organizational affiliations and potential financial and nonfinancial conflicts of interest (COIs), recognizing that patient organizations often receive private funding or have industry relationships through their patient support activities. All disclosed COIs were assessed through established ACE governance procedures. As an advisory body, the Panel was not required to vote or make formal decisions about specific health technologies.

A final list of fifteen candidates was presented to the MOH Director-General of Health who appointed two Co-Chairs and thirteen members to the Panel for an initial two-year term from April 2022 to March 2024. The Panel comprised leaders from different patient organizations with various backgrounds, including patients, caregivers, doctors, physiotherapists, dieticians, and healthcare administrators. Collectively, their organizations represented a wide range of health conditions, including autoimmune disorders, cancer, cardiovascular disease, diabetes, gastrointestinal diseases, kidney and musculoskeletal conditions, rare disorders, and respiratory illnesses. The Panel’s TOR and members’ profiles were published on the ACE website to promote transparency and accountability (11).

Facilitating Engagement Through Meetings and Communication

ACE’s approach to engaging the Panel proactively addressed common barriers and enablers to participation to empower all members to contribute to discussions (Reference Pagatpatan and Ward12–Reference Dumez and L’Espérance15). Members shared insights based on their lived experiences within Singapore’s healthcare system and multiethnic society, drawing from their cultural, relational, medical, and healthcare navigation knowledge (Reference Gauvin, Abelson, Giacomini, Eyles and Lavis3;Reference Rasburn, Crosbie and Tonkinson16). Facilitated dialogue and targeted prompts from the CEE team supported deliberations, helping members balance personal viewpoints with the needs of the wider patient community, including the perspectives of diverse cultural groups and populations who may be marginalized or underrepresented.

The first Panel meeting was held virtually in June 2022 with MOH senior leadership in attendance, which signaled institutional support for patient involvement. Subsequent hybrid (virtual and in-person) meetings were convened twice a year to allow members to engage face-to-face where possible, while accommodating those with health conditions, caregiving responsibilities, or other commitments that might limit physical attendance.

Before each meeting, agendas were finalized with the Co-Chairs, pre-reading materials were circulated in advance, and members were asked to declare COIs related to agenda items that could reasonably be seen to influence, or be influenced by, participation in the Panel. Examples of declared COIs included paid employment, grants, funding to attend conferences, and participation in clinical trials, which were discussed with the Co-Chairs and reviewed under ACE’s governance processes to ensure appropriate mitigation.

Meetings typically included updates on CEE-led initiatives and discussions co-facilitated by the Co-Chairs and CEE team. Although input into individual HTA evaluations was outside the Panel’s remit, the meetings provided a valuable platform for members to improve their understanding of HTA processes and ACE’s work. Members participated constructively and consistently demonstrated strong partnership synergy, achieving consensus on key discussions despite representing a wide range of experiences. Following each meeting, minutes were circulated via email.

To ensure that Panel members remained connected between meetings, the CEE team developed CEE Updates – a periodic resource highlighting ACE’s recent patient involvement activities and published educational materials (17). Members were also invited to provide written input into projects from other ACE workstreams or participate in HTA training opportunities (18;19). To acknowledge the Panel’s contributions, ACE hosted an appreciation dinner after the final meeting of the term, offering members and ACE staff a chance to connect and strengthen their partnership.

Impact of the Consumer Panel

When the Panel was first established, involving patients in HTA was new in Singapore and there were no existing processes in place. The Panel worked closely with the CEE team to build partnerships with local patient organizations and co-create processes that would support meaningful patient involvement in ACE’s work. By adapting international best practices to Singapore’s unique healthcare context and considering cultural values, local healthcare priorities, and diverse patient experiences, they developed processes that were relevant, practical, and met patients’ needs. This collaborative effort led to the development of ACE’s Process and Methods Guide for Patient Involvement (1), along with supporting factsheets and a patient glossary (19).

Throughout the Panel’s first term (April 2022 to March 2024), the CEE team documented their contributions by recording meeting attendance, active involvement in co-development processes, and key inputs across ACE’s work. Members championed patient-centered approaches, advised on priority setting, and played an integral role in developing plain language materials designed to improve health literacy (Table 1).

Table 1. Contributions and impact made by the ACE Consumer Panel during their first term

ACE: Agency for Care Effectiveness; CEE: Consumer Engagement and Education; HTA: health technology assessment.

Panel members’ perspectives

At the end of the Panel’s first term, a Likert-scale survey with open-ended questions (see Supplementary Material) was conducted to evaluate members’ satisfaction with their engagement with ACE, identify areas for improvement, and gather feedback on their role within the Panel. The survey, developed with reference to the Public and Patient Engagement Evaluation Tool (PPEET; (20;Reference Abelson, Li, Wilson, Shields, Schneider and Booseveld21)), consisted of seventeen statements to assess members’ agreement levels and open-ended prompts to capture the reasoning behind their responses. Three questions were also included at the end of the survey to allow members to provide more detailed qualitative feedback on their experiences and aspirations.

Eleven of the fifteen members completed the survey (73.3 percent response rate). All respondents agreed or strongly agreed that they understood the Panel’s purpose and their role. Additionally, all members reported that participating in the Panel enhanced their understanding of ACE, HTA, and the importance of patient involvement in healthcare decision making (Box 2).

All members found the meeting frequency and support provided by ACE was appropriate, particularly valuing the pre-reading materials and hybrid meeting format. While nine members agreed or strongly agreed that the Panel reflected a diverse range of patient groups and perspectives, two members suggested expanding representation, reflecting a shared value of inclusiveness in the engagement process.

Ten members agreed that the meetings addressed a wide range of important topics and that they could share their views openly. This openness fostered trust, with most members expressing confidence that ACE considered their input when shaping processes and policies. They also felt that ACE’s patient involvement initiatives met their expectations and helped raise public awareness of HTA and ACE’s work.

Survey responses highlighted two key areas for improvement. First, a clearer feedback loop was suggested to understand how patient input influences ACE’s work. Second, some members expressed interest in extending their involvement beyond the Panel’s scope to influence decision making in other divisions of MOH. When asked about their aspirations for the Panel, some members hoped it would continue to be a catalyst for meaningful patient engagement and inspire similar initiatives in other organizations (Box 3).

All members felt that participating on the Panel was a good use of their time. They valued the collaborative environment, opportunities to contribute to ACE’s objectives, and the personal growth it enabled. Several members reported enhanced effectiveness in their roles within their patient organizations, citing a deeper understanding of HTA and improved advocacy skills. Member K praised the Panel’s authenticity: “Inclusion and diversity. No engagement was tokenistic. Probably the most impactful committee I’m on.”

Moving forward with the Panel

The Panel’s feedback reinforced that trust, open communication, capacity building, and flexible engagement approaches are crucial for sustaining relationships and fostering meaningful patient involvement at the organizational level (Reference Westerink, Oirbans and Garvelink14;Reference Engler, Phil, Gerber, Bosse, Voight and Mergenthal22). The partnership between ACE and the Panel has set a strong foundation for future progress in patient involvement, fostering a collaborative environment where they can work together effectively and adapt to evolving needs.

In April 2024, the Panel commenced its second term (ending in March 2026) with an expanded membership of eighteen, including eleven reappointed members and seven new representatives from additional patient organizations and marginalized communities, enhancing its inclusivity and representativeness.

Looking ahead, the Panel aims to foster a more impactful and collaborative approach to patient involvement in HTA. As healthcare systems adapt to technological advances, meaningful engagement will be essential for sustainable person-centered care. This will require ongoing investment in education, skills-building, and feedback mechanisms to cultivate trust and empower patients and caregivers to contribute effectively (Box 4).

The Panel’s success has inspired similar patient involvement initiatives in other healthcare disciplines in Singapore, such as clinical research (23), reflecting a growing recognition of the value of structured patient engagement. As these efforts mature, evaluating their impact on health outcomes and developing best practices for Asia will be essential. With patient involvement still nascent across much of the region, Singapore is well-placed to lead the development of culturally relevant and effective models.