{
  "abstract": "Introduction: The 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. Aim: To explore attitudes towards ACP and identify factors influencing ACP discussion amongst adults in public primary care setting in Singapore. Methods: A 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. Results: Of 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. Conclusion: Patients 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.",
  "abstract_shown": true,
  "affiliations": [
    "Medical Department, Kallang Polyclinic, National Healthcare Group Polyclinics, Singapore",
    "Clinical Research Unit, National Healthcare Group Polyclinics, Singapore",
    "Clinical Services, National Healthcare Group Polyclinics, Singapore"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Chee Luan Lim"
    },
    {
      "affs": [
        1
      ],
      "name": "Jing Xin Vanessa Phua"
    },
    {
      "affs": [
        2
      ],
      "name": "Yi Xuan Shannon Goh"
    },
    {
      "name": "Poay Sian Sabrina Lee"
    },
    {
      "name": "Hui Ying Valerie Teo"
    },
    {
      "name": "Wern Ee Tang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c27r5q78pzn2y.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0359632",
  "fulltext_url": null,
  "id": "c27r5q78pzn2y",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0359632",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2739|Palliative Care and End-of-Life Issues"
    ],
    [
      "plos",
      "/Biology and life sciences/Psychology/Psychological attitudes"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Primary care"
    ],
    [
      "plos",
      "/People and places/Geographical locations/Asia/Singapore"
    ],
    [
      "plos",
      "/People and places/Population groupings/Age groups/Children"
    ],
    [
      "plos",
      "/People and places/Population groupings/Families/Children"
    ],
    [
      "plos",
      "/Research and analysis methods/Research design/Survey research/Questionnaires"
    ],
    [
      "plos",
      "/Social sciences/Anthropology/Cultural anthropology/Religion"
    ],
    [
      "plos",
      "/Social sciences/Psychology/Psychological attitudes"
    ],
    [
      "plos",
      "/Social sciences/Sociology/Education/Educational attainment"
    ],
    [
      "plos",
      "/Social sciences/Sociology/Human families"
    ],
    [
      "plos",
      "/Social sciences/Sociology/Religion"
    ]
  ],
  "openalex": "W7214944462",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0359632&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-30",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/c27r5q78pzn2y.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:37Z",
      "native_id": "10.1371/journal.pone.0359632",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0359632"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Palliative Care and End-of-Life Issues",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Patients’ attitudes towards advance care planning (ACP) and factors affecting ACP discussion: A cross-sectional questionnaire study",
  "title_text": "Patients’ attitudes towards advance care planning (ACP) and factors affecting ACP discussion: A cross-sectional questionnaire study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:37Z",
  "url": "https://research.draconitic.com/paper/c27r5q78pzn2y",
  "venue": "PLOS One",
  "versions": []
}