Advance Care Planning Training for Nurses

The Effectiveness of a Multi-media Experiential Training Programme in Advance Care Planning for Nurses Working in Acute Care Settings

The aims of this study are to examine the effectiveness of a multi-media experiential training programme in advance care planning (ACP) for nursing staff in acute care settings. The main questions it aims to answer are:

• can the programme enhance nurses' decision-support skills
• can the programme strengthen nurses' knowledge and confidence, and improve their attitude toward ACP?

Researchers will compare the participants in the intervention group (receive training programme) with those who are in the control group (receive no intervention) to evaluate the effectiveness of the programme.

Study Overview

• Status: Recruiting
• Conditions: Advance Care Planning
• Intervention / Treatment: Other: Multi-media experiential training programme

Detailed Description

The study adopts a cluster randomised controlled trial with 12 weeks (T2) and 24 weeks (T3) follow-ups. A total of 234 eligible nurses working in 26 acute care hospital wards will be randomised at ward level in a 1:1 ratio into either control or intervention arms. Guided by the Theory of Planned Behaviour, we will conduct path analysis to assess the role of nurses' knowledge, attitudes and confidence on the nurses' skill performance on decision support after the intervention.

• Study Type: Interventional
• Enrollment (Estimated): 234
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Mandy MK Tse; Phone Number: 852-39433019; Email: mankeitse@cuhk.edu.hk
• Study Contact Backup: Name: Vivian Wu; Phone Number: 852-39431244; Email: vivianwu@cuhk.edu.hk

Study Locations

• Hong Kong
  • Kwun Tong, Hong Kong
    • Recruiting
    • United Christian Hospital
    • Contact: Ying Tung Chan; Phone Number: 2379 9611
  • Mong Kok, Hong Kong
    • Recruiting
    • Queen Elizabeth Hospital
    • Contact: Lok Yan Ng; Phone Number: 35052601
  • Sha Tin, Hong Kong
    • Recruiting
    • Prince of Wales Hospital
    • Contact: Ka Fai Mr Wong; Phone Number: 35052601
  • Shatin, Hong Kong
    • Recruiting
    • Shatin Hospital
    • Contact: Fion HUI; Phone Number: 39197623
  • Shatin, Hong Kong
    • Recruiting
    • Shatin cheshire home
    • Contact: Kwok; Phone Number: 2636 7288
  • Tseung Kwan O, Hong Kong
    • Recruiting
    • Haven of Hope Hospital
    • Contact: Patty Lui; Phone Number: 2703 8000
  • Tuen Mun, Hong Kong
    • Recruiting
    • Tuen Mun Hospital
    • Contact: Red Chan; Phone Number: 2468 5111
  • Wong Chuk Hang, Hong Kong
    • Recruiting
    • Grantham Hospital
    • Contact: Wendy; Phone Number: 2518 2111

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• registered nurse with at least two years' clinical experience

Exclusion Criteria:

• had prior specialty training in Advance Care Planning communication.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention group; will receive a multi-media experiential training programme.	Other: Multi-media experiential training programme; Webpage and mobile applications of training material on ACP, to be offered four weeks before the workshop; A three-hour multimedia workshop (8-10 nurses per group) including enhanced lectures and a role play encounter with standardised patients. Immediate feedback on their quality of decision support skills will be given. The workshops will be delivered by an experienced advance practice nurse with a palliative care specialty.; Writing a reflective journal after the role play with standardised patients
No Intervention: control group; will NOT receive a multi-media experiential training programme

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Nurse's decision support skills as assessed by the Brief Decision Support Analysis Tool (DSAT10)	DSAT10 instrument is an observational feedback tool for evaluating decisional support interactions between health care workers and patients. The DSAT-10 includes 16 items divided into five domains of: Decision-Making Status; Knowledge of Options, Risks, and Benefits; Values Associated with Outcomes of Options. Scores range from zero to ten, with higher scores indicating more decisional support being verbalized during the patient-provider interaction.	Baseline
Nurse's decision support skills as assessed by the Brief Decision Support Analysis Tool (DSAT10)	DSAT10 instrument is an observational feedback tool for evaluating decisional support interactions between health care workers and patients. The DSAT-10 includes 16 items divided into five domains of: Decision-Making Status; Knowledge of Options, Risks, and Benefits; Values Associated with Outcomes of Options. Scores range from zero to ten, with higher scores indicating more decisional support being verbalized during the patient-provider interaction.	immediate post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Nurses' attitudes towards Advance Care Planning	Nurses' attitudes towards ACP will be measured by nine five-point Likert scale items with 1=strongly disagree and 5= strongly agree. Higher scores indicate a more positive attitude. The scale was developed and validated by Putman-Casdorph et al . The nine items cover topics such as the perceived helpfulness of ACP, and worries about the legal consequences of limiting treatment.	Baseline
Nurses' knowledge of Advance Care Planning	Knowledge of advance care planning and advance directives will be assessed by a 10-item true / false questionnaire which is developed taking reference with Siu et al. and Yee et al. The knowledge test will be validated by an expert panel including academics and clinicians.	Baseline
Nurses' level of confidence to conduct Advance Care Planning	Nurses' level of confidence to conduct ACP will be measured by a single item five-point Likert scale with 1= not confident at all to 5 = extremely confident .	Baseline
Nurses' level of confidence to conduct Advance Care Planning	Nurses' level of confidence to conduct ACP will be measured by a single item five-point Likert scale with 1= not confident at all to 5 = extremely confident .	12 weeks post-intervention
Actual experience of Advance Care Planning in the last 12 weeks	Actual experience in ACP discussion will be measured by this question: "How many times have you participated in ACP discussion with your patients in the last 12 weeks?" In addition, documentation of the ACP discussion in the last 12 weeks will be retrieved from patients' medical records.	Baseline
Actual experience of Advance Care Planning in the last 12 weeks	Actual experience in ACP discussion will be measured by this question: "How many times have you participated in ACP discussion with your patients in the last 12 weeks?" In addition, documentation of the ACP discussion in the last 12 weeks will be retrieved from patients' medical records.	12 weeks post-intervention
Nurses' attitudes towards Advance Care Planning	Nurses' attitudes towards ACP will be measured by nine five-point Likert scale items with 1=strongly disagree and 5= strongly agree. Higher scores indicate a more positive attitude. The scale was developed and validated by Putman-Casdorph et al . The nine items cover topics such as the perceived helpfulness of ACP, and worries about the legal consequences of limiting treatment.	immediate post-intervention
Nurses' attitudes towards Advance Care Planning	Nurses' attitudes towards ACP will be measured by nine five-point Likert scale items with 1=strongly disagree and 5= strongly agree. Higher scores indicate a more positive attitude. The scale was developed and validated by Putman-Casdorph et al . The nine items cover topics such as the perceived helpfulness of ACP, and worries about the legal consequences of limiting treatment.	12 weeks post-intervention
Nurses' knowledge of Advance Care Planning	Knowledge of advance care planning and advance directives will be assessed by a 10-item true / false questionnaire which is developed taking reference with Siu et al. and Yee et al. The knowledge test will be validated by an expert panel including academics and clinicians.	immediate post-intervention
Nurses' knowledge of Advance Care Planning	Knowledge of advance care planning and advance directives will be assessed by a 10-item true / false questionnaire which is developed taking reference with Siu et al. and Yee et al. The knowledge test will be validated by an expert panel including academics and clinicians.	12 weeks post-intervention
Nurses' knowledge of Advance Care Planning	Knowledge of advance care planning and advance directives will be assessed by a 10-item true / false questionnaire which is developed taking reference with Siu et al. and Yee et al. The knowledge test will be validated by an expert panel including academics and clinicians.	24 weeks post-intervention
Nurses' level of confidence to conduct Advance Care Planning	Nurses' level of confidence to conduct ACP will be measured by a single item five-point Likert scale with 1= not confident at all to 5 = extremely confident .	immediate post-intervention
Nurses' level of confidence to conduct Advance Care Planning	Nurses' level of confidence to conduct ACP will be measured by a single item five-point Likert scale with 1= not confident at all to 5 = extremely confident .	24 weeks post-intervention
Nurses' satisfaction with the training programme	Nurses' satisfaction with the training programme will be assessed by an eight-item five-point Likert scale with 1=strongly disagree and 5= strongly agree at post-test only. Higher scores indicate higher satisfaction. The scale is developed with reference to So et al. and has been validated by an expert panel including academics and clinicians.	immediate post intervention
Actual experience of Advance Care Planning in the last 12 weeks	Actual experience in ACP discussion will be measured by this question: "How many times have you participated in ACP discussion with your patients in the last 12 weeks?" In addition, documentation of the ACP discussion in the last 12 weeks will be retrieved from patients' medical records.	24 weeks post-intervention
Adherence to patients' expressed preference for care	measured by this question: Please circle the following to describe health care professionals' adherence to patients' expressed preference for care :	12 weeks post-intervention
Adherence to patients' expressed preference for care	measured by this question: Please circle the following to describe health care professionals' adherence to patients' expressed preference for care :	24 weeks post-intervention

Collaborators and Investigators

• Sponsor: Chinese University of Hong Kong
• Investigators: Principal Investigator: Carmen Chan Yip Wing-han, Chinese University of Hong Kong

Publications and helpful links

General Publications

• Putman-Casdorph H, Drenning C, Richards S, Messenger K. Advance directives: evaluation of nurses' knowledge, attitude, confidence, and experience. J Nurs Care Qual. 2009 Jul-Sep;24(3):250-6. doi: 10.1097/NCQ.0b013e318194fd69.
• Siu MW, Cheung TY, Chiu MM, Kwok TY, Choi WL, Lo TK, Ting WM, Yu PH, Cheung CY, Wong JG, Shua SE. The preparedness of Hong Kong medical students towards advance directives and end-of-life issues. East Asian Arch Psychiatry. 2010 Dec;20(4):155-62.
• So WKW, Kwong ANL, Chen JMT, Chan JCY, Law BMH, Sit JWH, Chan CWH. A Theory-Based and Culturally Aligned Training Program on Breast and Cervical Cancer Prevention for South Asian Community Health Workers: A Feasibility Study. Cancer Nurs. 2019 Mar/Apr;42(2):E20-E30. doi: 10.1097/NCC.0000000000000543.

Study record dates

Study Major Dates

• Study Start (Actual): May 15, 2023
• Primary Completion (Estimated): June 1, 2024
• Study Completion (Estimated): December 1, 2024

Study Registration Dates

• First Submitted: November 6, 2022
• First Submitted That Met QC Criteria: November 20, 2022
• First Posted (Actual): November 23, 2022

Study Record Updates

• Last Update Posted (Actual): March 12, 2024
• Last Update Submitted That Met QC Criteria: March 8, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: Advance Care Planning; acute care settings; experiential learning; nurse training programme
• Other Study ID Numbers: 2018.610

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No