Knowledge, Attitudes, and Practices Regarding Advance Care Planning Among Preoperative Patients in Malaysia

Background: Advance care planning (ACP) enables patients to articulate their values and preferences for future medical care. Little is known about the attitudes and practices of preoperative patients from lower middle-income countries toward ACP. This study aimed to assess the knowledge, attitudes, and practices regarding ACP among preoperative patients in Malaysia and identify its associated factors. Method: A cross-sectional study was conducted from May to October 2024 at University Malaya hospital in Malaysia. In total, 135 patients attending the preoperative clinic were recruited through convenience sampling. Data were collected using a validated Advance Care Planning Questionnaire. Multiple logistic regression was performed to identify factors associated with ACP engagement. Result: Baseline awareness of ACP was low (17%), yet 87.4% of participants acknowledged its importance. More than two-thirds expressed willingness to engage in ACP discussions in future clinic visits, and 88.6% preferred family members as surrogate decision-makers. Patients with comorbidities like hypertension had higher odds to favor ACP (odds ratio [OR] = 5.287, 95% confidence level [CI]: 1.145–21.411, p = 0.033), while those under 65 years old (OR = 0.246, 95% CI: 0.065–0.933, p = 0.039) and male patients (OR = 0.326, 95% CI: 0.119–0.891, p = 0.029) were less incline to ACP. Conclusion: Preoperative patients are receptive to ACP, highlighting the preoperative clinic as a strategic setting for ACP.