Knowledge, attitude and practice of community-dwelling adults regarding advance care planning in Malaysia: a cross-sectional study

Abstract

ObjectivesThis study aimed to assess the knowledge, attitude and practice (KAP) among community-dwelling adults in Malaysia regarding advance care planning (ACP), and its associated factors.DesignThis cross-sectional study was conducted from July–September 2018.SettingThis study was conducted at the University Malaya Medical Centre, Kuala Lumpur, Malaysia.ParticipantsWe recruited community-dwelling adults (ambulatory care patients or their accompanying persons) who were ≥21 years old and able to understand English or Malay. A 1:10 systematic sampling procedure was used. Excluded were community-dwelling adults with intellectual disabilities or non-Malaysian accompanying persons. A trained researcher administered the validated English or Malay Advance Care Planning Questionnaire at baseline and 2 weeks later.Primary and secondary outcome measuresThe primary outcome was the KAP regarding ACP. The secondary outcomes were factors associated with KAP.ResultsA total of 385/393 community-dwelling adults agreed to participate (response rate 98%). Only 3.1% of the community-dwelling adults have heard about ACP and 85.7% of them felt that discussion on ACP was necessary after explanation of the term. The desire to maintain their decision-making ability when seriously ill (94.9%) and reducing family burden (91.6%) were the main motivating factors for ACP. In contrast, resorting to fate (86.5%) and perceived healthy condition (77.0%) were the main reasons against ACP. Overall, 84.4% would consider discussing ACP in the future. Community-dwelling adults who were employed were less likely to know about ACP (OR=0.167, 95% CI 0.050 to 0.559, p=0.004) whereas those with comorbidities were more likely to favour ACP (OR=2.460, 95% CI 1.161 to 5.213, p=0.019). No factor was found to be associated with the practice of ACP.ConclusionsDespite the lack of awareness regarding ACP, majority of community-dwelling adults in Malaysia had a positive attitude towards ACP and were willing to engage in a discussion regarding ACP after the term ‘ACP’ has been explained to them.

Advance Directives in Portugal: A Qualitative Survey

“…Despite these aspects of literacy, the results of the study showed that attitudes toward ADs were mostly positive, which agreed with the findings of other studies [18,27,[47][48][49]56,58,[75][76][77]. However, there were also negative and even neutral attitudes.…”

“…The results obtained in relation to literacy of the sample on the ADs, which revealed a lack of knowledge on the subject, were consistent with the findings of other studies [20,27,[41][42][43][44][45][46][47][48][49]. A systematic review of the literature published from 1994 to 2016, revealed a low level of knowledge about ADs [19].…”

Public awareness of advance care planning and hospice palliative care: a nationwide cross-sectional study in Korea

“…Therefore, it can be assumed that the overall attitude toward the health care system of the participants in this study was less likely to distort their answers to the questionnaire. This is also supported by that the trust in the health care system in each country, as investigated in previous studies [ 74 ], differs from the international awareness of ACP or HPC [ 34 – 38 ].…”

“…Comparing awareness across countries is challenging because of differences in health care system, legal implementation, and public insurance coverage. Nevertheless, ACP awareness investigated in our study was relatively lower than those of United States and European countries (40–90%) [ 34 – 36 ], but similar to or higher than those of Asian countries (3–36%) [ 37 , 38 ]. Previous studies conducted prior to the enactment of the Act on Life-Sustaining Treatment Decisions found that Koreans’ awareness of ACP ranged from 10 to 16% [ 31 , 37 ].…”

“…Several studies have reported that diagnosis of chronic disease might reduce EOL discussion with doctors or affect non-accepting attitude toward EOL care planning [ 48 , 49 ], which supports our finding and suggests that poor health itself can limit the ability to plan ahead or access to doctors. While some studies have reported that poor health condition is associated with positive attitude or willingness to implement ACP or HPC [ 38 , 50 , 51 ], other studies have shown that diagnoses of chronic diseases or self-rated health are not significantly associated with awareness of ACP or HPC [ 37 , 47 , 52 , 53 ]. Due to mixed evidence from previous studies, further investigations are still needed to gain a clear understanding of the association between health status and awareness of ACP and HPC.…”