Research report: Dyadic attitudes on end-of-life care and advance care planning: a cross-sectional community study of older adults and family carers

Older adults and their family carers generally supported advance care planning in principle, but their views differed across several end-of-life priorities in a cross-sectional community study in Thailand. The analysis of 480 dyads, comprising 960 people, found that older adults placed greater importance than carers on receiving full information about illness, participating in decision-making, appointing a proxy, relieving distressing symptoms, avoiding burden on the family, having family present, remaining conscious, forgoing life-prolonging treatment when the chance of survival was low, and dying at home. The researchers recruited community-dwelling adults aged 60 or older and their primary family carers from outpatient clinics and communities in Thailand.

Each participant completed structured questionnaires covering end-of-life care preferences, general views of advance care planning and item-level attitudes. Group differences were examined descriptively and with matched-pair tests, while agreement between partners across 15 attitudes was assessed using quadratic weighted kappa. As a cross-sectional study, the work measured differences between paired participants at one point; it did not test an intervention or establish whether advance care planning improves clinical outcomes.

Both older adults and carers viewed advance care planning positively as a way to align care with personal preferences, reduce family conflict and lessen the burden of decision-making. That broad agreement was accompanied by emotional reservations in a substantial minority. Participants reported death-related anxiety, hopelessness and discomfort with advance care planning.

Among older adults, 49.0% were reluctant to engage while they felt they still had unresolved personal matters, indicating that general acceptance of the concept did not translate into equal readiness to participate. Agreement between older adults and carers on the 15 advance care planning items was only slight to moderate, with quadratic weighted kappa values ranging from 0.205 to 0.477. The reported differences were especially apparent in the relative importance assigned to information, decision-making roles, proxies, symptom relief, family burden and preferred place of death.

The findings therefore show that relatives’ estimates of an older adult’s priorities were not consistently aligned with the older adult’s own responses. They do not demonstrate why the pairs differed, and the cross-sectional design cannot establish whether their attitudes changed over time or affected decisions made near the end of life. Family carers also showed a notable pattern in their preferred timing of advance care planning.

They suggested earlier ages for planning for older people generally and for their relatives, yet were more likely to postpone planning for themselves. The study’s authors concluded that the findings support culturally sensitive, structured conversations involving both older adults and family carers within routine care. Such conversations could help distinguish the older adult’s preferences from a carer’s assumptions and identify areas where additional clarification is needed.

Because the sample came from Thai outpatient clinics and communities, the results may not represent every older adult, family carer or cultural setting.

Subject of Research: Agreement between Thai older adults and family carers on end-of-life care preferences and advance care planning attitudes

Article Title: Dyadic attitudes on end-of-life care and advance care planning: a cross-sectional community study of older adults and family carers

Article References: Anantapong, K., Rangsee, P. N., Thongkam, N., Chamroonkiadtikun, P., & Ananchaisarp, T. (2026). Dyadic attitudes on end-of-life care and advance care planning: a cross-sectional community study of older adults and family carers. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15644-2

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15644-2

Keywords: advance care planning, end-of-life care, older adults, family carers, dyadic survey, Thailand, care preferences, decision-making, quadratic weighted kappa, Dyadic, attitudes, end-of-life