Community health workers’ knowledge and attitudes toward advance directives in China: a cross-sectional study

CHWs in China exhibit limited knowledge of ADs but generally supportive attitudes. However, the gap between expressed support and personal willingness to sign ADs, coupled with the perceived legal barrier, highlights an urgent need for targeted interventions to facilitate ADs implementation. Key policy priorities should include establishing a legal framework for ADs, clarifying the role of CHWs in end-of-life care processes, and incorporating mandatory ADs training into continuing medical education programs.