Predictors of Intention to Participate in Advance Care Planning Among People with Cancer in a University Hospital in Bangkok, Thailand: A Cross-Sectional Study

Abstract

The rising incidence of cancer in Thailand, the poor prognosis of people with advanced-stage disease, and cultural barriers to discussions about death all contribute to insufficient awareness of the advance care planning process among the Thai population.
This cross-sectional study examined factors influencing the intention to participate in advance care planning among people with cancer in a university hospital setting. A total of 155 people with cancer were recruited through simple random sampling from the oncology outpatient unit of a university hospital in Bangkok, Thailand, during November 2024 and February 2025. The following instruments were employed: the Mini-Cog assessment for cognitive screening, the Personal and Health-Related Information Questionnaire, and the Advance Care Planning Questionnaire, which comprises measures of knowledge, attitudes, subjective norms, and intention to participate regarding care planning. The data were examined through descriptive statistics and multiple regression analysis.
The results indicate that knowledge, attitudes, subjective norms, and covariates collectively and significantly predicted intention to participate in the advance care planning process among people with cancer, accounting for 42.1% of variance. Attitudes towards advance care planning were the strongest predictor, followed by subjective norms and knowledge. The findings highlight the need to cultivate positive attitudes, strengthen understanding, and actively involve key influencers to improve participation in advance care planning within this population. In particular, nursing practice should prioritize early assessment of patients’ attitudes and engage family influencers in advance care planning discussions, ensuring alignment with Thai cultural values and promoting greater engagement among individuals with cancer.