Background Advance Care Planning (ACP) is vital for efforts to promote good end-of-life care, and this is especially important among nursing home (NH) residents. However, NH staff may not be trained to facilitate these discussions. A virtual one-day facilitation course that also encompassed discussion about the goals, ethics, and legislation related to ACP, was implemented, with separate sessions for General ACP (GACP) and Preferred Plan of Care (PPC) facilitation. We aimed to evaluate the impact of this training curriculum on participants’ knowledge, attitudes and confidence (KAC) in ACP facilitation.
Methods Study participants who had no prior experience with either GACP or PPC completed a KAC survey before training, and at three-months. Questions were modified from published ACP-related KAC surveys and contextualised to Singapore. Knowledge about ACP was assessed based on 17 True/False questions. Attitudes towards ACP was measured based on agreement with 14 statements on a 5-point Likert scale. Confidence in ACP facilitation was measured for 12 skills on a 5-point Likert scale.
Results Over 15 months, 16 training sessions were conducted for attendees from 8 nursing homes. of the 63 attendees eligible for the surveys, 41 and 26 participants completed the baseline and follow-up survey respectively. At three-months, participants responded incorrectly to 12 out of 17 questions, with >40% doing so in relation to ACP activation, completion and on discussions with residents with dementia. Comparing results at baseline and follow-up, participants maintained or increased both their agreement with the importance and impact of ACP, and their confidence in facilitating ACP (81%-92%).
Discussion and Conclusions Participants’ KAC appeared to have improved after the training. The training curriculum will be adapted to provide more case studies on when an ACP can be activated and when the discussion is deemed completed, and how to approach discussions with patients with dementia.
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