Advance care planning can document treatment preferences before decisional capacity deteriorates, yet documentation alone does not ensure that subsequent decisions reflect those preferences. Across Asian healthcare settings, preference enactment may depend on family participation, clinicians’ interpretation, organizational processes, and legal or policy arrangements. To examine how advance care planning preferences are documented, interpreted, mediated by family obligations, and translated into healthcare decisions across culturally diverse Asian settings, with particular attention to conditions associated with concordance or non-concordance between prior preferences and later care. Integrative review using design-sensitive appraisal and transparent review-selection reporting. Six reproducible PubMed-indexed search routes covering 2018–2026 returned 65 records. After removal of 11 within-route duplicate or variant returns and 11 cross-route duplicate publications, 43 unique records entered screening. Ten were excluded at title/abstract screening, 33 reports were assessed, and six were excluded after report-level assessment, leaving 27 included evidence units. Empirical, review, consensus, programme-theory, and legal or policy evidence was integrated while preserving differences in design and context. The literature distinguished preference elicitation and documentation from later enactment. Family involvement could support understanding, communication, and preparation, but could also alter how previously expressed preferences were interpreted or operationalized. Evidence from Taiwan demonstrated that documented preferences could remain non-concordant with subsequent end-of-life care. Across settings, implementation was additionally shaped by communication practices, professional readiness, organizational resources, documentation accessibility, role clarity, and legal or institutional procedures. Advance care planning in Asian settings is best understood as a translation process rather than a documentation event. Honoring preferences depends on how patient-authored wishes are carried through family, professional, organizational, and legal decision processes while preserving distinctions between participation, interpretation, delegated authority, and substitution.
