Patients’ attitudes towards advance care planning (ACP) and factors affecting ACP discussion: A cross-sectional questionnaire study
- 1Medical Department, Kallang Polyclinic, National Healthcare Group Polyclinics, Singapore
- 2Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
- 3Clinical Services, National Healthcare Group Polyclinics, Singapore
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.
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BibTeX
@article{lim2026patients,
title = {{Patients’ attitudes towards advance care planning (ACP) and factors affecting ACP discussion: A cross-sectional questionnaire study}},
author = {Chee Luan Lim and Jing Xin Vanessa Phua and Yi Xuan Shannon Goh and Poay Sian Sabrina Lee and Hui Ying Valerie Teo and Wern Ee Tang},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0359632},
url = {https://doi.org/10.1371/journal.pone.0359632},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Patients’ attitudes towards advance care planning (ACP) and factors affecting ACP discussion: A cross-sectional questionnaire study
AU - Chee Luan Lim
AU - Jing Xin Vanessa Phua
AU - Yi Xuan Shannon Goh
AU - Poay Sian Sabrina Lee
AU - Hui Ying Valerie Teo
AU - Wern Ee Tang
PY - 2026
DA - 2026/09/30
JO - PLOS One
DO - 10.1371/journal.pone.0359632
UR - https://doi.org/10.1371/journal.pone.0359632
AB - 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.
SN - 1932-6203
ER -