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Background While anyone aged 18 years or older can complete an Advance Care Directive (ACD) in South Australia, there is limited understanding of who is using the online ACD platform and their key preferences regarding healthcare and living arrangements. Evaluating engagement with the online ACD system provides insights to enhance accessibility, support consumer decision-making, and guide future service improvements.Methods As part of routine service monitoring, the SA Health online ACD platform was reviewed to assess consumer engagement and identify opportunities for quality improvement. Website data from January and February 2025 was analysed, including the number of completed ACDs, demographic trends, substitute decision-maker (SDM) appointments, common health concerns, and preferences regarding healthcare refusals and living arrangements. No identifiable personal information was collected or retained.Results A total of 265 ACDs were completed online during the review period. The majority of users were aged 65–79 years (41%), followed by those 80 years or older (20%). Most were female (63%) and lived in metropolitan areas (71%).Of those completing an ACD, 94% appointed at least one SDM, with many appointing multiple SDMs. The age of SDMs decreased as more were appointed, with the first SDM typically being older and subsequent SDMs younger.More than half (56%) of individuals listed at least one major health concern, primarily chronic conditions. Two-thirds (66%) included refusals of specific medical interventions, such as life support (66%) and resuscitation (34%), typically in scenarios where recovery was unlikely, or the individual would require high levels of care.Most participants (82%) provided statements about personal values and wishes, with common themes including staying connected with loved ones (59%), maintaining cognitive and physical independence (33%), and ensuring comfort and pain management (20%). Additionally, 74% of users expressed preferences regarding living arrangements, with 88% indicating a desire to remain at home for as long as possible.Conclusion This quality improvement review highlights trends in online ACD completion and consumer preferences for future care. Findings will help inform strategies to enhance the accessibility and usability of the online ACD platform, support public education efforts, and ensure individuals are better equipped to document their preferences. Future work should focus on understanding whether users proceed to finalise their ACDs through witnessing and sharing them with healthcare providers.