Are care staff equipped for end-of-life communication? A cross-sectional study in long-term care facilities to identify determinants of self-efficacy

Abstract

BackgroundEnd-of-life conversations are rarely initiated by care staff in long-term care facilities. A possible explanation is care staff’s lack of self-efficacy in such conversations. Research into the determinants of self-efficacy for nurses and care assistants in end-of-life communication is scarce and self-efficacy might differ between care staff of mental health facilities, nursing homes, and care homes. This study aimed to explore differences between care staff in mental health facilities, nursing homes, and care homes with regard to knowledge about palliative care, time pressure, and self-efficacy in end-of-life communication, as well as aiming to identify determinants of high self-efficacy in end-of-life communication.MethodsTwo cross-sectional Dutch studies, one in mental health facilities and one in nursing and care homes (PACE study). Nurses and care assistants were invited to complete a questionnaire in 2015. Multivariable logistic regression analyses were performed to identify determinants of high self-efficacy.ResultsFive hundred forty one nurses and care assistants completed a survey; 137 worked in mental health facilities, 172 in nursing homes, and 232 in care homes. Care staff at mental health facilities were the most knowledgeable about the World Health Organization’s definition of palliative care: 76% answered 4–5 out of 5 items correctly compared to 38% of nursing home staff and 40% of care home staff (p < 0.001). Around 60% of care staff in all settings experienced time pressure. Care staff had high self-efficacy regarding end-of-life communication with patients: the overall mean score across all facilities was 5.47 out of 7 (standard deviation 1.25). Determinants of high self-efficacy were working in a mental health facility, age > 36, female, with formal palliative care training, and knowledge of the palliative care definition.ConclusionMental healthcare staff knew more about palliative care and had higher self-efficacy in end-of-life communication compared to nursing and care home staff. Educating care staff about providing palliative care and training them in it might improve end-of-life communication in these facilities.

Cultural Adaptation, Validation, and Analysis of the Self-Efficacy in Palliative Care Scale for Use with Spanish Nurses

“…An association was also found between the professionals’ level of self-efficacy in palliative care and their previous training in end-of-life care, both in contrast tests and in the linear regression model, with a higher level being observed in professionals who had received training. This is consistent with previous studies, which point to training as a key aspect [22,23,36,37,48]. One study in the United Kingdom evaluated the change in scale scores in medical students after a theoretical-practical training programme in palliative care and observed an increase in the subscales of communication, patient management, and teamworking [36].…”

“…The SEPC has been used in a multicentre study in long-term care facilities in 6 European countries (Belgium, England, Finland, Italy, The Netherlands, and Poland) [22], but, although a forward–backward translation was conducted in each country, the authors did not report data about formal validation except in the original English version. This scale has also been used in a study to identify determinants of high self-efficacy in nurses and care assistants of long-term-care centres in Germany, but the researchers did not specify if they used a translated or a validated German version [23].…”

Effect of palliative care training on perceived self-efficacy of the nurses

“…Not surprisingly, nurses trained in palliative care bear higher self-efficacy [29]. Knowledge is considered a stable and fundamental element for nursing performance.…”

“…These programs often focus on acute patient care and fail to regard patients in the end stage of life. As a result, nurses who are unaware of palliative care may not be prepared to cope with patients who are passing out [29,31,32].…”

The Crucial Role of Nurses and Social Workers in Initiating End-of-Life Communication to Reduce Overtreatment in the Midst of the COVID-19 Pandemic

“…Barriers, from level of competency through to system level legislation, can have an impact on effective engagement of end-of-life discussions and in turn they can negatively affect the quality of end-of-life care for patients. However, potential solutions are also suggested both at the internal service level (palliative care and communication training [11] and mentoring) and at system-wide level (regulation, legislation, and accreditation) [4].…”