Physicians and nurses’ knowledge and attitudes towards advance directives for cancer patients in Saudi Arabia

Abstract

This study aimed to investigate physicians’ and nurses’ knowledge and attitudes toward advance directives (ADs) for cancer patients, which empower patients to take decisions on end-of-life needs if they lose their capacity to make medical decisions. A cross-sectional study was conducted using convenience sampling. The outcomes were responses to the knowledge and attitude questions, and the main outcome variables were the total scores for knowledge and attitudes toward ADs. This study included 281 physicians and nurses (60.5%). Most physicians were men (95, 80.5%), whereas most nurses were women (147, 86.5%). The mean (standard deviation; SD) total knowledge score was 6.8 (4.0) for physicians and 9.1 (3.0) for nurses (p < 0.001). There was a significant difference in the total knowledge score between nurses and physicians, with an adjusted mean difference of 1.54 (95% confidence interval [CI]; 0.08–2.97). Other significant independent predictors of knowledge of ADs were female sex (1.60, 95% CI; 0.27–3.13) and education level (master’s versus bachelor’s: 1.26, 95% CI; 0.30–2.33 and Ph.D. versus bachelor’s: 2.22, 95% CI; 0.16–4.52). Nurses’ attitudes appeared to be significantly more positive than those of physicians, and the mean total attitude score (SD) was 19.5 for nurses (6.2) and 15.1 (8.1) for physicians (p < 0.001). The adjusted mean difference (95% CI) for nurses versus physicians was 3.71 (0.57–6.98). All participants showed a high level of knowledge of ADs; however, nurses showed considerably more positive attitudes than physicians.

Emergency Healthcare Providers’ Knowledge about and Attitudes toward Advance Directives: A Cross-Sectional Study between Nurses and Emergency Medical Technicians at an Emergency Department

“…For example, mental health professionals who comprised physicians, nurses, auxiliary nursing care technicians, psychologists, and social workers had very positive attitudes regarding AD (mean, 80.53; range, 0-90) [26]. In a comparative study [29,30], nurses and physicians showed very high positive attitudes, while nurses' attitudes (mean, 19.5; range, 0-27) were more positive than those of physicians (mean, 15.1; range, 0-27) [29]. Interestingly, compared to EMTs, nurses had more knowledge but less positive attitudes.…”

“…Different measures of knowledge also prevent comparing our results and previous findings. Further, a wide variety in the level of knowledge about ACP and ADs exists according to the areas of practice or specialty/expertise [26,29,30]. Nonetheless, in a systematic synthesis of three survey studies that examined nurses' AD-related concepts, approximately 60% of knowledge was correct among nurses, with the knowledge of critical care nurses being higher than that of oncology and emergency care nurses [42].…”

“…Our study also added information about AD attitudes among Korean emergency healthcare providers, who showed a moderately low level of AD attitudes (mean, 31.04; range, 0-64). In past studies, other healthcare professionals mostly had positive attitudes toward ADs [24,26,27,29,30,44]. For example, mental health professionals who comprised physicians, nurses, auxiliary nursing care technicians, psychologists, and social workers had very positive attitudes regarding AD (mean, 80.53; range, 0-90) [26].…”

“…Among the barriers to the limited access, professional perspectives around ACP and/or ADs were reported to influence the patient's decision on beginning such care or implementing the procedure as desired [6,[23][24][25][26]. In particular, knowledge about and attitudes toward ACP and/or ADs were modifiable factors for increasing the likelihood of initiating ACP or AD use [23,27,28], while their knowledge and/or attitudes seemed to vary across the professions and were dependent on their areas of expertise [26,29,30]. In one study that reported knowledge and attitudes among the healthcare professionals, more knowledge about and positive attitudes toward the law regarding the withholding/withdrawing of LSTs were noted among palliative care specialists and geriatricians compared to other specialists, while their knowledge deficit was still substantial [30].…”

Effects of Dispositional Resilience and Self-Efficacy on Practice in Advanced Care Planning of Terminally Ill Patients among Taiwanese Nurses: A Study Using Path Modeling

“…Although the number of female nurses in the study was far more than male nurses, the results of this study showed that being a female nurse and working at a medical ward were positive predictors of ACP knowledge of terminally ill patients among nurses. A study in Saudi Arabia showed that women had better knowledge on advanced directives for patients with cancer than their male counterparts [14]. In the previous study considering learning motivation, women had a higher level of autonomy in learning motivation than men, that is, women had better motivation to learn independently, and thus, they could take the initiative to learn to maintain their professional knowledge [15,16].…”