Advance care planning: awareness and readiness amongst stroke survivors undergoing inpatient rehabilitation in a multi-ethnic Asian country: an exploratory study

Stroke remains a major contributor to morbidity and mortality worldwide. Survivors have strong reasons to engage in Advance Care Planning (ACP), yet ACP remains relatively new in Asia. This study aimed to (1) investigate awareness and attitudes towards ACP among stroke survivors admitted to an inpatient rehabilitation centre; (2) assess their readiness for ACP discussions after stroke; and (3) identify factors influencing ACP awareness and willingness to engage in ACP in Singapore. A cross-sectional study was conducted among stroke survivors admitted to an inpatient rehabilitation centre in Singapore between June 2022 and July 2023. Eligible participants were adults without significant cognitive impairment or aphasia. Clinical data were extracted from medical records and survey were conducted. Logistic regression analyses identified factors associated with pre-stroke ACP awareness and willingness to learn more about ACP. A total of 101 stroke survivors were recruited. Thirty-three participants (32.7%) had pre-stroke awareness of ACP, and 11 (11.8%) had completed ACP prior to stroke. Among 89 participants without pre-existing ACP, 71 (79.8%) were willing to learn more, and 70 (78.8%) agreed to referral for further ACP discussion. Univariate analyses showed that female gender (OR 2.632; p = 0.042) and higher education level (OR 1.952; p = 0.008) were significant positive factors associated with having pre-stroke ACP awareness. Among participants without prior ACP, female gender was the only significant positive factor associated with the willingness to learn more about ACP (OR 5.850; p = 0.025). ACP awareness and completion rates remain low in Singapore’s multiethnic Asian population. Education level and gender influence ACP awareness and uptake. The inpatient rehabilitation setting represents a key opportunity to engage stroke survivors in ACP discussions. Targeted strategies addressing educational and gender disparities should be integrated into stroke rehabilitation programmes.