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connect the world

in cognitively impaired, older or seriously As part of the “Enabling Malaysian to Actively
ill patients (such as patients with cancer, Age Study” (EMAAS) program (funded by
heart failure, or end-stage renal disease). the University Malaya Research Grant), the
The majority of these studies assessed the University of Malaya Primary Care Research
readiness of patients and proxies to engage Group has developed and validated an
in conversation regarding ACP and whether instrument - the Advance Care Planning
they would write an advance directive. With Questionnaire - to assess the knowledge,
cancer patients, most physicians preferred attitude, and practice of ACP in Malaysia. The
to postpone the conversation regarding ACP Advance Care Planning Questionnaire has been
to later in the illness trajectory, when patients validated in English. We have translated this
had a major change in functional status, when instrument to Malay, and have completed its
poor prognosis is certain or when treatment validation. We plan to use both the English and
options are exhausted. This reflects the Malay versions of the Advance Care Planning
physicians’ belief that patients would simply Questionnaire to assess the knowledge, attitude
not be interested in ACP until the issues and practice of Malaysians towards ACP, and to
are relevant. determine if Malaysians are ready for ACP.

Overall, available literature suggests that all Additionally, there is a gap in the literature
stakeholders were reluctant to engage in ACP regarding the views of Asians on ACP.
at an earlier time-point and preferred to dawdle Geographically, Asia is the largest continent
until the issues were more clinically relevant in the world, and has the highest population.
and salient. Under normal circumstances, A better understanding of the views of Asians
patients would have more time for non- and those that have migrated (i.e. the effect of
pressured deliberation. In comparison, not acculturation) can help policy makers navigate
many studies have been conducted among through the culturally-sensitive issues in the
primary care physicians and ambulatory implementation of ACP in Asian or culturally-
patients. However, if ACP is left till a later diverse countries. Hence, a systematic review
point in time, a patient may be pressured into on Asian views on ACP and the effect of
making an ill-informed decision. acculturation will be conducted.

Currently, ACP is not legislated in Malaysia. A In addition, a qualitative study will also be
qualitative study performed among 15 older conducted to identify barriers and facilitators
people (aged 65–83 years) in Malaysia found of primary care physicians and ambulatory
that they have never heard of ACP but were patients on when would be the best time to
receptive to its concept. This observation initiate a conversation regarding ACP. It is
concurred with another study conducted our hope that findings from these studies will
among 56 Malaysian patients undergoing guide policymakers on whether ACP should be
haemodialysis which reported that 76% of legislated in Malaysia.
patients have never heard about ACP.

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