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Advance Care Planning in Malaysia

Lim ZN, Ng WJ, Lee CC

Z Evid Fortbild Qual Gesundhwes, 2023 Aug;180:103-106.
PMID: 37357108 DOI: 10.1016/j.zefq.2023.05.019

BACKGROUND: In Malaysia, advance care planning is still in its infancy. There is no national implementation of Advance Care Planning.
AIMS: To describe the national state of advance care planning development in Malaysia METHODS: Review of relevant advance care planning literature locally and internationally was undertaken.
RESULTS: Positive development in Malaysia includes implementation of advance care planning at institutional level, initiatives to develop educational programmes as well as research activities to understand the attitude and perception of patients on advance care planning. However, there remain challenges, including lack of knowledge and awareness, lack of legislative framework to guide advance care planning implementation and lack of strong initiatives at a national level.
CONCLUSIONS: It is evident that there is much to learn nationally and internationally about ACP before any decision on implementation of ACP is made in Malaysia. ACP is a public health issue and requires concerted effort of all stakeholders, including Government agencies, academic institutions, and non-government organizations to raise public awareness. More research is needed to shape the future direction of ACP development in Malaysia.

Matched MeSH terms: Advance Care Planning*
American Muslim Engagement With Advance Care Planning: Insights From a Community Survey

Yunus RM, Duivenbode R, Padela AI

Am J Hosp Palliat Care, 2024 Apr;41(4):405-413.
PMID: 37641456 DOI: 10.1177/10499091231198216

Background and Objectives: Advance Care Planning (ACP) is a critical tool in advancing patient self-determination in health care delivery. Despite increasing research into racial/ethnic minorities' engagement with ACP in the US, studies on Muslim Americans are relatively scarce. We aimed to examine levels of ACP engagement among Muslim adults and measure associations between socio-demographic and religiosity characteristics and ACP engagement. Methodology: This was a survey study among Muslims attending mosque seminars in Chicago and Washington DC. Religiosity characteristics were assessed using a modified version of the Duke University Religion Index (DUREL) and the Psychological Measure of Islamic Religiousness (PMIR). ACP engagement was measured by the 4-item ACP Engagement Survey (4-ACPES) and 2 additional items covering ACP religious dimensions. Statistical analyses were performed using SPSS 28.0. Results: Out of 152 respondents, 56.2% to 72.6% were in the pre-contemplation stage of ACP across the 6 ACP items. Bivariate analyses showed that ACP engagement was correlated with participant age, ethnicity, duration of stay in the US and country of birth. Multivariable analyses demonstrated no association between religiosity characteristics and ACP engagement; independent predictors of ACP engagement were race/ethnicity (being South Asian), country of birth (born outside the US) and duration of stay in the US (longer years). Discussion/Conclusion: Our study suggests that American Muslims are largely unprepared to engage with ACP. Moreover, religiosity does not predict ACP engagement. We call for greater community outreach and educational programs that instill awareness and knowledge on the importance of ACP, and provide resources for tailored religiously-oriented conversations that assist individuals with ACP.

Matched MeSH terms: Advance Care Planning*
Fulltext Clinical Impact of Education Provision on Determining Advance Care Planning Decisions among End Stage Renal Disease Patients Receiving Regular Hemodialysis in University Malaya Medical Centre

Hing Wong A, Chin LE, Ping TL, Peng NK, Kun LS

Indian J Palliat Care, 2016 Oct-Dec;22(4):437-445.
PMID: 27803566

Advance care planning (ACP) is a process of shared decision-making about future health-care plans between patients, health care providers, and family members, should patients becomes incapable of participating in medical treatment decisions. ACP discussions enhance patient's autonomy, focus on patient's values and treatment preferences, and promote patient-centered care. ACP is integrated as part of clinical practice in Singapore and the United States.

Matched MeSH terms: Advance Care Planning
The mediating role of family cohesion in the relationship between death anxiety and readiness toward advance care planning among Chinese community-dwelling older adults: A cross-sectional study

Gao F, Chui PL, Che CC, Wang K

Geriatr Nurs, 2025;61:192-199.
PMID: 39566231 DOI: 10.1016/j.gerinurse.2024.10.061

OBJECTIVE: To determine the mediating role of family cohesion in the relationship between death anxiety and readiness toward advance care planning (ACP).
METHODS: This study included 965 Chinese community-dwelling older adults. Pearson correlation coefficient was conducted to assess the relationship between readiness toward ACP, death anxiety, and family cohesion. Structural equation model was used to examine the study hypothetical model.
RESULTS: 965 valid questionnaires were collected. Death anxiety is significantly related to the readiness toward ACP (r = -0.437, P < 0.01) and family cohesion (r = -0.444, P < 0.01), and family cohesion exhibited a positive correlation with readiness toward ACP (r = 0.499, P < 0.01). Family cohesion partially mediated the effect of death anxiety on readiness toward ACP, accounting for 35.94 % of the total effect.
CONCLUSIONS: Family cohesion mediates the relationship between death anxiety and readiness toward ACP. Healthcare professionals should implement measures to alleviate death anxiety and promote family cohesion in older adults, thereby enhancing their readiness toward ACP.

Matched MeSH terms: Advance Care Planning*
Fulltext The development and validation of the advance care planning questionnaire in Malaysia

Lai PS, Mohd Mudri S, Chinna K, Othman S

BMC Med Ethics, 2016 10 18;17(1):61.
PMID: 27756366

BACKGROUND: Advance care planning is a voluntary process whereby individual preferences, values and beliefs are used to aid a person in planning for end-of-life care. Currently, there is no local instrument to assess an individual's awareness and attitude towards advance care planning. This study aimed to develop an Advance Care Planning Questionnaire and to determine its validity and reliability among older people in Malaysia.

METHODS: The Advance Care Planning Questionnaire was developed based on literature review. Face and content validity was verified by an expert panel, and piloted among 15 participants. Our study was conducted from October 2013 to February 2014, at an urban primary care clinic in Malaysia. Included were those aged >50 years, who could understand English. A retest was conducted 2 weeks after the first administration.

RESULTS: Participants from the pilot study did not encounter any problems in answering the Advance Care Planning Questionnaire. Hence, no further modifications were made. Flesch reading ease was 71. The final version of the Advance Care Planning Questionnaire consists of 66 items: 30 items were measured on a nominal scale, whilst 36 items were measured on a Likert-like scale; of which we were only able to validate 22 items, as the remaining 14 items were descriptive in nature. A total of 245 eligible participants were approached; of which 230 agreed to participate (response rate = 93.9 %). Factor analysis on the 22 items measured on a Likert-scale revealed four domains: "feelings regarding advance care planning", "justifications for advance care planning", "justifications for not having advance care planning: fate and religion", and "justifications for not having advance care planning: avoid thinking about death". The Cronbach's alpha values for items each domain ranged from 0.637-0.915. In test-retest, kappa values ranged from 0.738-0.947.

CONCLUSIONS: The final Advance Care Planning Questionnaire consisted of 63 items and 4 domains. It was found to be a valid and reliable instrument to assess the awareness and attitude of older people in Malaysia towards advance care planning.

Matched MeSH terms: Advance Care Planning*