Assessment of advance care planning readiness and its determinants among peritoneal dialysis patients in China

Advance care planning (ACP) is essential for respecting patient autonomy and improving end-of-life care quality. However, the level of ACP readiness and its determinants among individuals receiving peritoneal dialysis (PD) in China remain insufficiently explored. This study employed a cross-sectional descriptive-analytical design. From January to June 2025, 129 adults receiving PD were recruited using convenience sampling from two tertiary hospitals in Sichuan Province, China. Demographic characteristics, including age, sex, marital status, educational level, employment status, disease duration, dialysis duration, and comorbidities, were collected. ACP readiness was assessed using the Chinese version of the Advance Care Planning Readiness Scale (ACPRS), which has demonstrated good reliability and validity in Chinese chronic disease populations. Death anxiety and social support were measured using the Chinese versions of the Templer Death Anxiety Scale (CT-DAS) and the Social Support Rating Scale (SSRS), respectively. Multiple linear regression analysis was conducted after verifying assumptions of normality, homoscedasticity, and absence of multicollinearity. The mean ACP readiness score was 65.89 ± 14.07 (range: 22–110), indicating a moderately low level of readiness. In the final regression model, longer dialysis duration (B = 3.43, p = 0.015), a greater number of comorbidities (B = 2.72, p = 0.028), and higher social support (B = 0.55, p = 0.040) were positively associated with ACP readiness, whereas higher death anxiety was negatively associated with ACP readiness (B = − 1.03, p = 0.026). The final model explained 31.6% of the variance in ACP readiness (adjusted R² = 0.270). ACP readiness among individuals receiving PD in China remains suboptimal and is shaped by clinical burden, psychosocial resources, and death-related emotional responses. Reduced ACP readiness may hinder timely end-of-life decision-making and increase the decisional burden on families. Interventions should focus on strengthening social support, addressing death anxiety, and integrating culturally sensitive ACP discussions into routine PD care. These findings underscore the importance of context-specific ACP strategies within the sociocultural framework of China.