<p>Demographic characteristics (N = 363).</p>

Ethnic distribution matched Singapore’s demographics: 72.5% Chinese, 14.0% Malay, 9.4% Indian, 4.1% others. Overall, ACP was rated as beneficial (mean score 19.96/25) and minimally burdensome (mean score 5.40/25). Fear of death was the most commonly endorsed barrier to ACP discussion (25.9%).

However, fear of death was significantly less common among older adults, declining from 40.0% among participants aged 21–40 years to 14.4% among those aged ≥61 years (p < 0.001), and was also lower among participants with chronic diseases (p = 0.011) and those with family members who had experienced serious illness requiring hospitalisation (p = 0.048). Participants with history of cancer (p = 0.010) or a seriously ill family member (p = 0.001) viewed ACP more positively, while those with lower education (p = 0.023) or hypertension (p = 0.008) found ACP to be more burdensome.</p> <p>Conclusion</p><p>Patients in primary care generally viewed ACP positively.

While fear of death was the most commonly reported barrier, it was less prevalent among older adults and those with illness-related experience. Tailored, culturally sensitive strategies may help improve ACP engagement, particularly among younger and healthier individuals.</p></div>