Perceived knowledge and intention to prepare advance directives: a cross-sectional study of Thai gynecologic cancer patients and families

To examine perceived and objective knowledge of advance directives (AD), attitudes toward end-of-life care, and factors associated with intention to prepare AD among Thai gynecologic cancer patients and their family members attending a tertiary hospital in Bangkok.​ RESULTS DESCRIPTION: A cross-sectional survey was conducted with 101 patients and 105 accompanying family members recruited between August 2017 and January 2018. Over 60% of both groups had never heard of AD and mean objective knowledge scores were low (3.4/8 for patients and 3.7/8 for family members), with common misconceptions including equating AD with euthanasia. Most participants preferred a natural death without life-prolonging measures. Yet only 6% of patients and 1% of family members had completed an AD, while 22% and 27%, respectively, reported an intention to prepare one. Multiple regression showed that perceived knowledge was the only significant predictor of intention to prepare an AD for both patients (B = 0.339, p < 0.001) and family members (B = 0.246, p < 0.001), suggesting that interventions that enhance perceived understanding may strengthen engagement in advance care planning.