Patterns of engagement in advance care planning among older people living with cancer: a cross-sectional survey

Older adult patients with cancer may be at increased risk of poor health outcomes due to age-related conditions. Although advance care planning (ACP) can support individuals in engaging in shared decision making and goal-concordant care, ACP uptake may be shaped by family oriented cultural values. This study examined the perceptions of ACP among older adult patients with cancer and explored their patterns of ACP engagement. This cross-sectional survey measured participants’ self-reported perceptions of ACP and readiness to engage. We recruited older adults (> 60 years) with non-hematological cancer attending an oncology outpatient clinic in Thailand. Latent class analysis was used to identify distinct patterns of ACP engagement. In total, 279 patients participated, most of whom had gastrointestinal, breast, or head and neck cancer. One-quarter (25.4%) had metastatic disease; however, the majority (70.0%) perceived their health as “good.” Approximately one-third of the participants were either prepared for or engaged in ACP discussions. ACP discussions with family members were more common than those with doctors. Three distinct engagement patterns were identified: “ACP adopters” (52.4%), characterized by high likelihood of engaging in all types of ACP; “Goal talkers” (12.5%), who had high motivation for goals-of-care discussions but limited action-taking; and “Low-engagement” individuals (35.1%), who showed generally low motivation. While only 1.1% had completed formal documentation, 35.2% reported being ready to write advance directives. While many older adult Thai patients with cancer are receptive to ACP in principle, actual engagement, particularly with healthcare professionals and formal documentation processes, remains limited. Family based discussions were more common, suggesting that culturally adapted interventions are required to promote broader and more formal ACP engagement.