Advance Directives and End-of-Life Care: Knowledge, Attitudes and Perceptions in Mexico

Background Advance directives, known as voluntades anticipadas in Mexico, are an essential component of patient-centred palliative care, enabling individuals to document their preferences for end-of-life care. However, limited awareness and understanding of advance directives remain significant barriers to their adoption in Mexico. This study aimed to assess knowledge, attitudes, and perceptions of voluntades anticipadas among 306 participants in Mexico and explore their implications for palliative care practices and policy. Methods A cross-sectional survey was conducted among a convenience sample of users of a third level care hospital in Mexico City. The survey instrument included questions on knowledge, attitudes, and perceptions of advance directives, as well as demographic characteristics and end-of-life care preferences. Descriptive statistics and bivariate analyses were performed on the data. Results A total of 306 participants completed the survey. While 11.8% were familiar with the concept of advance directives, only 4.9% had formalised their preferences. Participants highlighted barriers such as lack of awareness, perceived complexity of the process, and cultural sensitivities around discussing end-of-life care and death. Notably, 85% agreed that public information campaigns could enhance understanding and adoption of advance directives. Preferences for end-of-life care included a desire to die without pain (86%) and not being a burden to the family (90%), with nearly 68% of the participants disclosing not being prepared to die alone, underscoring the need for culturally sensitive approaches in palliative care delivery. Conclusions This study underscores the urgent need to raise awareness about voluntades anticipadas in Mexico and integrate advance care planning into healthcare policy and practice. Public education campaigns, targeted awareness initiatives, healthcare provider training, and supportive policy frameworks are essential to provide an environment where patients feel enabled to articulate and document their end-of-life care preferences. While exploratory in nature, this study findings provide valuable insights tailored strategies for creating culturally grounded strategies to improve palliative care and uphold respect for patient autonomy in Mexico.