ArticlePloS one2026
Patients' attitudes towards advance care planning (ACP) and factors affecting ACP discussion: A cross-sectional questionnaire study.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe rate of advance care planning (ACP) adoption in Singapore continues to be suboptimal, despite its recognised significance. Identifying the obstacles to ACP uptake is essential for enhancing its implementation, particularly within primary care environments.
aimTo explore attitudes towards ACP and identify factors influencing ACP discussion amongst adults in public primary care setting in Singapore.
methodsA cross-sectional study was undertaken among adults aged 21 years and older at a public primary care clinic in central Singapore. Participants completed an anonymous, self-administered questionnaire available in English, Chinese, and Malay, which assessed attitudes toward ACP and factors influencing its adoption. Data were analysed using IBM SPSS Statistics version 28.0.
resultsOf 471 questionnaires, 400 were returned (84.9% response rate), and 363 were fully completed. Participants' mean age was 56 years; 58.7% were female. Ethnic distribution matched Singapore's demographics: 72.5% Chinese, 14.0% Malay, 9.4% Indian, 4.1% others. Overall, ACP was rated as beneficial (mean score 19.96/25) and minimally burdensome (mean score 5.40/25). Fear of death was the most commonly endorsed barrier to ACP discussion (25.9%). However, fear of death was significantly less common among older adults, declining from 40.0% among participants aged 21-40 years to 14.4% among those aged ≥61 years (p < 0.001), and was also lower among participants with chronic diseases (p = 0.011) and those with family members who had experienced serious illness requiring hospitalisation (p = 0.048). Participants with history of cancer (p = 0.010) or a seriously ill family member (p = 0.001) viewed ACP more positively, while those with lower education (p = 0.023) or hypertension (p = 0.008) found ACP to be more burdensome.
conclusionPatients in primary care generally viewed ACP positively. While fear of death was the most commonly reported barrier, it was less prevalent among older adults and those with illness-related experience. Tailored, culturally sensitive strategies may help improve ACP engagement, particularly among younger and healthier individuals.
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