Perspective Chapter: Advance Care Planning Among Cancer Patients – The Unmet Needs in Low- and Middle-Income Countries

Advance care planning (ACP) is an interactive, person-centred process through which individuals, at any stage of health, engage with healthcare providers to clarify their values, preferences, and goals for future medical care, ensuring that treatment decisions remain concordant with patient wishes even when they are no longer able to communicate them directly. In Kenya, as in the rest of sub-Saharan Africa, cancer ranks as the third leading cause of death, with approximately 35,867 new cases and 22,888 deaths recorded in 2024, reflecting a growing burden of advanced and often incurable disease at diagnosis. Despite evidence that ACP improves end-of-life outcomes, including higher rates of advance directive completion, reduced use of intensive, non-beneficial end-of-life interventions, increased and earlier uptake of hospice and palliative care services, and diminished psychological and bereavement burden among surviving family members, its uptake remains persistently low, particularly in resource-constrained and culturally diverse settings such as Kenya. This chapter provides a comprehensive background on ACP, tracing its conceptual evolution and core components, and reviews global epidemiological and clinical evidence on its uptake and practice among cancer patients. It further examines the facilitators and barriers to ACP engagement, spanning patient, provider, and systemic levels, and contextualises these findings within existing policy, legal, and healthcare environment, including the absence of formal legislative recognition of advance directives. A study on assessment of ACP practice and advance directive uptake among cancer patients in Kenya that offerred evidence to inform local policy and clinical practise serves as the primary study underpinning this review.