Background Advanced care planning(ACP) is a key component of palliative care services. However, starting a discussion at the first outpatient visit is challenging due to time restraints and no prior relationship building with the patient.

Methods This research is a retrospective medical record review. The authors obtained data from all outpatients at Karunruk Palliative Care Center, Srinagarind Hospital, Khon Kaen University, Thailand between 1 October 2021 to 30 September 2022. Data analysis used frequency and percentages for descriptive data, and univariate and multivariate logistic regression for analyzing factors associated with home death preference.

Results There were 377 OPD consults; 198(52.52%) were male, 74.27% were over 60 years of age and 75.33% were married. Most patients(80.11%) were diagnose as cancer and their palliative performance status(PPS); 10–30% 19(6.29%), 40–60% 216(71.52%) and 70–90% 67(22.19%). Over half the patients (58.09%) had no comorbid disease, 32.36% had 1–2 co-morbidities, and 9.55% had over 2. At the first visit, 335/377(88.86%) patients were pleased to discuss ACP. 298/335(88.96%) chose full comfort ACP, and 253/335(75.52%) wished to die at home. After ACP discussion no patient preferred full code ACP. Univariate logistic regression analysis showed those with 1–2 co-morbidities, >2 co-morbidities, cancer and requesting full comfort ACP were associated with home death ACP. Odd ratios were 0.56, 0.41, 2.54 and 2.68. 95%CI were 0.32–0.97, 0.18–0.95, 1.44–4.48, 1.32–5.42 and P-value = 0.038, 0.038, 0.001, 0.006 respectively. Multivariate logistic regression found cancer and full comfort ACP were associated with home death ACP choice with odd ratios = 2.00 and 2.50. 95%CI were 1.01–3.97, 1.22–5.14, and P-value = 0.046, 0.013 respectively.

Conclusion ACP discussions can be performed with high success rate in the first OPD visit. Cancer diagnosis and full comfort ACP preferences were strongly associated with home death preference.