1293 A comparative study of implementation and practices of advance care planning in the Asia Pacific Region

<h3>Aim</h3> This study aims to examine the implementation and practices of Advance Care Planning (ACP) across the Asia Pacific region. We had two research questions: How is ACP conceptualized, initiated, and made accessible across Asia Pacific sectors? What unique factors shape ACP practices in this region? <h3>Background</h3> The Asia Pacific region is experiencing a rapid increase in aging population, thus creating a critical need for ACP to support individuals in living well till the end-of-life. Despite growing interest, ACP implementation varies significantly across sectors, influenced by cultural, social, and policy differences. This study aims to map the ACP landscape among members of the Asia Pacific Hospice Palliative Care Network (APHN). <h3>Methods</h3> An online cross-sectional survey was conducted in 2022, with purposively sampled experts and leaders in ACP practice. They are from APHN member sectors, each with at least five years of ACP-related experience. Forty experts from 15 of the 18 APHN sectors responded to a 22-item questionnaire, with multiple experts from each sector included to enable triangulation of responses. <h3>Results</h3> ACP is a recent development in the Asia Pacific compared to Western regions, with a diversity of approaches in its conceptualization, initiation, and accessibility. Notably in Taiwan, New Zealand, and Singapore, national or organizational ACP programs were associated with greater perceived uptake and accessibility. In Hong Kong, India, Indonesia, South Korea, Malaysia, Sri Lanka, Thailand, and Vietnam, a family-based ACP model predominates, with discussions often conducted with family members before involving patients. Key barriers to ACP adoption include insufficient healthcare professional empowerment (13 of 15), persistent social taboos (11 of 15), and limited public awareness (9 of 15 sectors). <h3>Unique Contribution</h3> This study provides the first cross-sectoral comparison of ACP practices across the Asia Pacific region, highlighting how cultural, organizational, and policy contexts influence ACP approaches. It underscores the variation in family-based ACP models and identifies barriers in some levels, offering insight into unique factors that may support or hinder ACP integration in the region. <h3>Implications for Policy or Practice</h3> The findings suggest a need for culturally adaptive ACP policies and practices that respect family-based decision-making traditions while considering individual empowerment in the Asia Pacific region. Policymakers should consider establishing national frameworks, improving public awareness, and offering specialized training to healthcare professionals to enhance ACP accessibility and acceptance. This approach can create a more supportive environment for ACP adoption across the Asia Pacific region.