Objective To explore the current status and determinants of advance care planning （ACP） engagement among terminal cancer patients, and to provide reference for targeted intervention.Methods A total of 349 terminal cancer patients were surveyed using a general information questionnaire, the Chinese version of the Advance Care Planning Engagement Survey （ACPES）, the Family Support Scale （PSS-Fa）, and the Post-Traumatic Growth Inventory （PTGI）.Results The total score of ACP engagement was 84.54±23.05.Most patients were in the precontemplation and contemplation stage (36.7% and 37.2% respectively), 22.3% were in the preparation stage and 3.7% were in the action stage.Regression analysis showed that, education level, course of di-sease, the experience of making medical decisions for others, family support, and post-traumatic growth were the main influencing factors of ACP engagement （all P＜0.05）. Conclusion The ACP engagement among terminal cancer patients is at low to moderate level and only minority of patients are at the preparation and action stages of change.Interventions and support should be targeted to those with low education level, short course of disease, poor family support and low post-traumatic growth.