The exploration of the knowledge, attitudes and practice behaviors of advanced care planning and its related predictors among Taiwanese nurses

Abstract

BackgroundDespite the documented and well known patient benefits of ACP, the completion of ACP, only a minority of patients, during the advanced or EOL stage of their illnesses, receive such care. The misconceptions about ACP for healthcare providers, such as nurses, might become potential barriers to the effective implication of ACP. Also, from the transcultural perspective, it is evident essential to explore Taiwanese nurses’ attitudes, knowledge, and actions of ACP. The purposes of this study were to explore the implication of ACP or hospice care for nurses caring for non-cancer chronic illness patients at a regional teaching hospital in Taiwan; and, to identify predictors of those nurses’ knowledge, attitudes, and actions toward ACP.MethodsThis cross-sectional study with a purposive sample of 218 nurses was conducted at a teaching hospital in southern Taiwan. Structured questionnaires were employed and data were analyzed with descriptive statistics, t-test, one-way ANOVAs, Pearson’s correlation and multiple regressions.Results16.1% of Taiwanese physicians actively initiated ACP issues or conversations with patients or their family members. Nurses’ attitudes toward ACP were fairly positive but their knowledge about ACP was insufficient and actions of ACP were not positively executed. The predictors of ACP-Knowledge (ACP-K) included position title, education hours and lacking of educational training. The predictors of ACP-Attitude (ACP-A) included ACP-K and “fear of patient or family member not accepting”, whereas ACP-A, position title, “patients do not feel necessary” and “not sure physician’s concern” were the predictors of ACP-Act.ConclusionContinuous education and training for nurses regarding ACP needs to be improved by taking those predictors found in this current study into account, and more studies on the nurse’s role in ACP also should be further examined.Trial registrationKAFGH 106–012. Date of registration 1 May 2017.

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

“…Our results showed that nurses with better ACP attitudes also had better ACP practice with terminally ill patients. Many previous studies have shown similar results [8,10,25]. Attitudes refer to the participant's feelings about the problem, while practice is the way of expressing an attitude.…”

“…This study found that nurses with ACP knowledge of terminally ill patients had better attitudes toward the ACP of terminally ill patients. A prior study conducted in Taiwan showed that the better the knowledge of ACP among nurses, the more positive attitude toward ACP [8]. Nurses with ACP knowledge would have greater confidence to enter an ACP discussion with a positive attitude.…”

“…It can also reduce the pressure and anxiety of family members facing the medical treatment and decision-making process of terminally ill patients, and improve the quality of life [5][6][7]. Prior studies have investigated KAP-ACP behaviors of nurses [1,[8][9][10]. However, some of these studies focused on the population of oncology or emergency nurses, and most of them explored the related factors of KAP-ACP.…”

Multi-Site Study of Provider Self-Efficacy and Beliefs in Explaining Judgments About Need and Responsibility for Advance Care Planning

“…Other researchers from several countries have found that the negative beliefs by nurses impact the ACP process. 24,25 Much current and past literature reiterates that ACP is a complex ongoing process that includes multiple actors and components and can vary greatly by setting and state of health or disease of residents. Providers are one of the critical actors in the ACP process and as such their willingness and education represent essential elements or preconditions for effective ACP.…”

Does the Experience of Caring for a Severely Disabled Relative Impact Advance Care Planning? A Qualitative Study of Caregivers of Disabled Patients

“…Advance care planning (ACP) refers to a process of communication and discussion on the patient's expected end-of-life care among the patient, family members, proxy decision-maker, and medical staff [13,14]. In addition to considering the patient's autonomy and values [15], ACP undergoes a continuous communication, preparation, and reflective discussion process, which reduces the emotional stress in caregivers when caring the terminal patients [16].…”