The general public's perceptions of advance care planning (ACP) in the Asia-Pacific region: a systematic review.

BACKGROUND: Populations are rapidly ageing. Advance Care Planning (ACP) is an important activity to help prepare for future healthcare needs. Little is known of the perceptions of the general public of the Asia-Pacific region in relation to these activities. Within the context of the Asia-Pacific region, this review aimed to explore awareness of, attitudes towards, experiences of, and the needs, wishes, and/or expectations related to ACP/Advance Directives (AD) of the general public. METHODS: The systematic review protocol was registered with PROSPERO (December 17, 2023): CRD42023491109). PubMed, CINAHL, PsycINFO, Embase, and Emcare databases were searched 2013 to 2023 for primary research, of any design, that reported perspectives and experiences of the general adult public of the Asia-Pacific region relating to their awareness, attitudes, experience, and expectations of ACP/AD. The literature searches were updated in PubMed to 31 December 2025. Selected studies were quality appraised using the Mixed Methods Appraisal Tool. Findings were synthesised using Cochrane’s narrative synthesis approach. RESULTS: Out of 3,275 records retrieved, 14 studies were included in this review. This review found that awareness of ACP/AD among the general public in the Asia-Pacific region is relatively low and it was not uncommon for them to know nothing about substitute decision maker decision makers and other terms related to ACP/AD. While they believe ACP is necessary and important, only a minority have had previous discussions regarding ACP and the reported completion of AD was minimal. Various factors that influence people’s willingness to engage in ACP/AD were found, such as wanting legal parameters to protect patient autonomy. Expectations of medical professionals to have good communication skills when discussing ACP were highlighted as well as the need for legal parameters to support ADs. CONCLUSION: This review highlights that awareness of ACP/AD among the general public in the Asia-Pacific region is low. As proven by the small number of papers which informed this review, more robust studies are needed on various aspects of this topic in the context of the Asia-Pacific region. Such studies would inform the best ways to move forward in improving the awareness and knowledge of, and to improve attitudes towards, ACP/AD to ensure people’s treatment decisions are discussed, documented, respected and enacted.