Nurses' knowledge of advance directives and perceived confidence in end‐of‐life care: a cross‐sectional study in five countries

Coffey, Alice; McCarthy, Geraldine; Weathers, Elizabeth; Friedman, M. Isabel; Gallo, K. M.; Ehrenfeld, Mally; Chan, Sophia; Li, William; Poletti, Piera; Zanotti, Renzo; Molloy, D. William; McGlade, Ciara; Fitzpatrick, Joyce J.; Itzhaki, Michal

doi:10.1111/ijn.12417

Cited by 56 publications

(47 citation statements)

References 27 publications

(67 reference statements)

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“…Concerning the knowledge of ADs, nurses fared better in our study, similar to the cited data among US nurses [29–31]. Furthermore, the good knowledge may be attributed to the provision of AD education programs and in-service professional development in cancer nursing training.…”

Section: Discussionsupporting

confidence: 87%

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

et al. 2019

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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.

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Section: Discussionsupporting

confidence: 87%

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

et al. 2019

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“…Advance directives are one of the critical components of palliative care. Unfortunately, nursing staff less frequently discussed care preferences with residents’ family members because the staff are unfamiliar with advance directives and lack confidence and competence in discussing advanced directives with them (Chen, Wang, Lu, & Fuh, ; Coffey et al., ; Dempsey, ).…”

Section: Relevance To Clinical Practicementioning

confidence: 99%

Palliative care for advanced dementia: Knowledge and attitudes of long‐term care staff

Chen

Lin²,

et al. 2017

Journal of Clinical Nursing

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“…Nurses play a central role in providing clinical care and patient education and support during important medical decisions . Although it is known that healthcare providers’ ACP attitudes and preferences may influence those of their patients, the ACP use of nurses has received very limited study …”

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confidence: 99%

“…[13][14][15] Although it is known that healthcare providers' ACP attitudes and preferences may influence those of their patients, [16][17][18][19] the ACP use of nurses has received very limited study. 20,21 Thus the purpose of this study was to evaluate predictors of patient-clinician ACP discussions and those of ACP documentation (that may differ from each other 22 ) among older community-dwelling nurses. We used data from the ongoing Nurses' Health Study (NHS) of approximately 60,000 women aged 66 to 93 years who had been followed for 40 or more years.…”

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confidence: 99%

Predictors of Advance Care Planning in Older Women: The Nurses’ Health Study

Kang

Bynum

Zhang

et al. 2018

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Relatively little is known regarding predictors of advance care planning (ACP) in former nurses. We aimed to evaluate potential predictors of ACP documentation and discussion. DESIGN Cross‐sectional study, 2012‐2014. SETTING Nurses’ Health Study. PARTICIPANTS A total of 60,917 community‐dwelling female nurses aged 66 to 93 years living across the United States. MEASUREMENTS Based on self‐reports, participants were categorized as having (1) only ACP documentation, (2) ACP documentation and a recent ACP discussion with a healthcare provider, or (3) neither. Multivariable log‐binomial models were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of the two separate ACP categories vs those with neither. We evaluated various demographic, health, and social factors. RESULTS The large majority (84%) reported ACP documentation; 35% reported a recent ACP discussion. Demographic factors such as age and race were associated with both ACP categories. In multivariable analyses, race was most strongly associated: compared with whites, African Americans were 27% less likely (PR = 0.73; 95% CI = 0.69‐0.78) to report ACP documentation alone and 41% (PR = 0.59; 95% CI = 0.54‐0.66) less likely to report documentation with discussion. Additionally, health/healthcare‐related characteristics were more strongly associated with ACP documentation plus discussion. Women with functional limitations (PR = 1.15; 95% CI = 1.10‐1.20), women who were recently hospitalized (PR: 1.10; 95% CI = 1.08‐1.12) or women who had seen a physician for health symptoms (PR = 1.43; 95% CI = 1.35‐1.52) or screening (PR = 1.40; 95% CI = 1.32‐1.49) were more likely to report having both ACP documentation and discussion. Social factors showed limited relationships with ACP documentation only; for documentation plus discussion, being widowed and living alone was associated with higher prevalence (PR = 1.21; 95% CI = 1.19‐1.24) and having little emotional support was associated with lower prevalence (PR = 0.84; 95% CI = 0.81‐0.86). CONCLUSIONS Among older nurses, most of whom reported having documented ACP, 35% reported recent patient‐clinician ACP discussions, indicating a major participatory gap in an element critical to ACP effectiveness. Even in nurses, African Americans reported less ACP documentation or discussion. J Am Geriatr Soc 67:292–301, 2019.

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Nurses' knowledge of advance directives and perceived confidence in end‐of‐life care: a cross‐sectional study in five countries

Cited by 56 publications

References 27 publications

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

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

Palliative care for advanced dementia: Knowledge and attitudes of long‐term care staff

Predictors of Advance Care Planning in Older Women: The Nurses’ Health Study

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