Emergency Healthcare Providers’ Knowledge about and Attitudes toward Advance Directives: A Cross-Sectional Study between Nurses and Emergency Medical Technicians at an Emergency Department
Main Article Content
Keywords
emergency nurses, emergency medical technicians, advance directive, knowledge, attitudes
Abstract
This study compares the knowledge levels about advance directives (ADs) and life-sustaining treatment (LST) plans in end-of-life patients between emergency nurses and emergency medical technicians (EMTs). A cross-sectional study design was employed, and convenience sampling recruited 96 nurses and 68 EMTs from 12 emergency medical centers. The survey, conducted assessed knowledge about and attitudes toward ADs using both online and offline methods. The findings indicate that emergency healthcare providers had moderate conceptual knowledge about ADs and LST, with approximately half or fewer demonstrating knowledge about ADs, including the legal preparation process, roles of family or healthcare providers, and healthcare proxy. Nurses exhibited significantly greater knowledge than EMTs regarding ADs and LST. Positive attitudes among emergency healthcare providers were moderately low, with nurses showing less positivity than EMTs. Differences were noted based on age, years in the profession, personal end-of-life experiences, and perceived need for ADs, with younger and less experienced providers having lower knowledge levels. The study suggests a need for early professional education and training to improve emergency healthcare providers' confidence in delivering advanced care planning
References
1. Aguilar-Sanchez J.M., Cabanero-Martinez M.J., Puerta Fernandez F., Ladios-Martin M., Fernandez-de-Maya J., Mamas M.A., Sperrin M., Watson M.C., Coutts A., Wilde K., et al. (2017). Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland. Eur. J. Heart Fail. 19:1095–1104. doi: 10.1002/ejhf.822.
2. Sav A., King M.A., Whitty J.A., Kendall E., McMillan S.S., Kelly F., Hunter B., Wheeler A.J. (2015). Burden of treatment for chronic illness: A concept analysis and review of the literature. Health Expect. 18:312–324. doi: 10.1111/hex.12046.
3. Smith G.L., Lopez-Olivo M.A., Advani P.G., Ning M.S., Geng Y., Giordano S.H., Volk R.J. (2019). Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes. J. Natl. Compr. Canc. Netw. 17:1184–1192. doi: 10.6004/jnccn.2019.7305.
4. Rocker G., Downar J., Morrison R.S. (2016). Palliative care for chronic illness: Driving change. CMAJ. 188:E493–E498. doi: 10.1503/cmaj.151454.
5. Stiel S., Heckel M., Seifert A., Frauendorf T., Hanke R.M., Ostgathe C. (2015). Comparison of terminally ill cancer- vs. non-cancer patients in specialized palliative home care in Germany—A single service analysis. BMC Palliat. Care. 14:34. doi: 10.1186/s12904-015-0033.
6. Gott M., Gardiner C., Small N., Payne S., Seamark D., Barnes S., Halpin D., Ruse C. (2009). Barriers to advance care planning in chronic obstructive pulmonary disease. Palliat. Med. 23:642–648. doi: 10.1177/0269216309106790.
7. Howard M., Bernard C., Tan A., Slaven M., Klein D., Heyland D.K. (2015). Advance Care Planning: Let’s Start Sooner. Can. Fam. Physician. 61:663–665.
8. Rietjens J.A.C., Sudore R.L., Connolly M., Van Delden J.J., Drickamer M.A., Droger M., Van der Heide A., Heyland D.K., Houttekier D., Janssen D.J.A., et al. (2017). Definition and recommendations for advance care planning: An international consensus supported by the European Association for Palliative Care. Lancet Oncol. 18:e543–e551. doi: 10.1016/S1470-2045(17)30582-X.
9. Silveira M. (n.d.). Advance Care Planning and Advance Directives. Available online: https://www.uptodate.com/contents/advance-care-planning-and-advance-directives
10. Boddy J., Chenoweth L., McLennan V., Daly M. (2013). It’s just too hard! Australian health care practitioner perspectives on barriers to advance care planning. Aust. J. Prim. Health. 19:38–45. doi: 10.1071/PY11070.
11. National Institute on Aging (n.d.). Advance Care Planning: Healthcare Directives. Available online: https://www.nia.nih.gov/health/advance-care-planning-healthcare-directives
12. Pérez M.d.V., Macchi M.J., Agranatti A.F. (2013). Advance directives in the context of end-of-life palliative care. Curr. Opin. Support. Palliat. Care. 7:406–410. doi: 10.1097/spc.0000000000000007.
13. National Agency for Management of Life-Sustaining Treatment (n.d.). Advance Decisions on Life-Sustaining Treatment. Available online: https://www.lst.go.kr/eng/decn/maincontent.do
14. An H.J., Jeon H.J., Chun S.H., Jung H.A., Ahn H.K., Lee K.H., Kim M.H., Kim J.H., Cheon J., Kim J., et al. (2019). Feasibility Study of Physician Orders for Life-Sustaining Treatment for Patients with Terminal Cancer. Cancer Res. Treat. 51:1632–1638. doi: 10.4143/crt.2019.009.
15. National Agency for Management of Life-Sustaining Treatment (n.d.). Statistical Updates: Registration of an Advance Directive on Life-Sustaining Treatment. Available online: https://www.lst.go.kr/comm/monthlyStatistics.do
16. Bravo G., Trottier L., Arcand M., Boire-Lavigne A.-M., Blanchette D., Dubois M.-F., Guay M., Lane J., Hottin P., Bellemare S. (2016). Promoting advance care planning among community-based older adults: A randomized controlled trial. Patient Educ. Couns. 99:1785–1795. doi: 10.1016/j.pec.2016.05.009.
17. Houben C.H.M., Spruit M.A., Groenen M.T.J., Wouters E.F.M., Janssen D.J.A. (2014). Efficacy of advance care planning: A systematic review and meta-analysis. J. Am. Med. Dir. Assoc. 15:477–489. doi: 10.1016/j.jamda.2014.01.008.
18. Jimenez G., Tan W.S., Virk A.K., Low C.K., Car J., Ho A.H.Y. (2018). Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons. J. Pain Symptom Manag. 56:436–459. doi: 10.1016/j.jpainsymman.2018.05.016.
19. Miller H., Tan J., Clayton J.M., Meller A., Hermiz O., Zwar N., Rhee J. (2019). Patient experiences of nurse-facilitated advance care planning in a general practice setting: A qualitative study. BMC Palliat. Care. 18:25. doi: 10.1186/s12904-019-0411-z.
20. Butler J., Binney Z., Kalogeropoulos A., Owen M., Clevenger C., Gunter D., Georgiopoulou V., Quest T. (2015). Advance directives among hospitalized patients with heart failure. JACC Heart Fail. 3:112–121. doi: 10.1016/j.jchf.2014.07.016.
21. Evans N., Bausewein C., Menaca A., Andrew E.V., Higginson I.J., Harding R., Pool R., Gysels M., project PRISMA (2012). A critical review of advance directives in Germany: Attitudes, use and healthcare professionals’ compliance. Patient. Educ. Couns. 87:277–288. doi: 10.1016/j.pec.2011.10.004.
22. Schubart J.R., Levi B.H., Bain M.M., Farace E., Green M.J. (2019). Advance Care Planning Among Patients With Advanced Cancer. J. Oncol. Pract. 15:e65–e73. doi: 10.1200/JOP.18.00044.
23. Chan C.W.H., Ng N.H.Y., Chan H.Y.L., Wong M.M.H., Chow K.M. (2019). A systematic review of the effects of advance care planning facilitators training programs. BMC Health Serv. Res. 19:362. doi: 10.1186/s12913-019-4192-0.
24. Hsieh C.-C., Huang H.-P., Tung T.-H., Chen I.C., Beaton R.D., Jane S.-W. (2019). The exploration of the knowledge, attitudes and practice behaviors of advanced care planning and its related predictors among Taiwanese nurses. BMC Palliat. Care. 18:99. doi: 10.1186/s12904-019-0483-9.
25. Jang N., Park H., Kim M., Lee J., Cho Y., Kim K., Son Y. (2018). Knowledge, Confidence, and Learning Needs Regarding Advance Directives among Hospital Nurses. J. Korean Crit. Care Nurs. 11:35–45.
26. Julia-Sanchis R., Cabanero-Martinez M.J., Zaragoza-Marti M.F., Garcia-Sanjuan S. (2020). Knowledge and attitudes of Spanish mental health professionals towards advance healthcare directives. J. Psychiatr. Ment. Health Nurs. 27:699–708. doi: 10.1111/jpm.12625.
27. Aguilar-Sanchez J.M., Cabanero-Martinez M.J., Puerta Fernandez F., Ladios-Martin M., Fernandez-de-Maya J., Cabrero-Garcia J. (2018). Knowledge and attitudes of health professionals towards advance directives. Gac. Sanit. 32:339–345. doi: 10.1016/j.gaceta.2017.08.006.
28. Sinclair C., Gates K., Evans S., Auret K.A. (2016). Factors Influencing Australian General Practitioners’ Clinical Decisions Regarding Advance Care Planning: A Factorial Survey. J. Pain Symptom Manag. 51:718–727. doi: 10.1016/j.jpainsymman.2015.11.014.
29. AlFayyad I.N., Al-Tannir M.A., AlEssa W.A., Heena H.M., Abu-Shaheen A.K. (2019). Physicians and nurses’ knowledge and attitudes towards advance directives for cancer patients in Saudi Arabia. PLoS ONE. 14:e0213938. doi: 10.1371/journal.pone.0213938.
2. Sav A., King M.A., Whitty J.A., Kendall E., McMillan S.S., Kelly F., Hunter B., Wheeler A.J. (2015). Burden of treatment for chronic illness: A concept analysis and review of the literature. Health Expect. 18:312–324. doi: 10.1111/hex.12046.
3. Smith G.L., Lopez-Olivo M.A., Advani P.G., Ning M.S., Geng Y., Giordano S.H., Volk R.J. (2019). Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes. J. Natl. Compr. Canc. Netw. 17:1184–1192. doi: 10.6004/jnccn.2019.7305.
4. Rocker G., Downar J., Morrison R.S. (2016). Palliative care for chronic illness: Driving change. CMAJ. 188:E493–E498. doi: 10.1503/cmaj.151454.
5. Stiel S., Heckel M., Seifert A., Frauendorf T., Hanke R.M., Ostgathe C. (2015). Comparison of terminally ill cancer- vs. non-cancer patients in specialized palliative home care in Germany—A single service analysis. BMC Palliat. Care. 14:34. doi: 10.1186/s12904-015-0033.
6. Gott M., Gardiner C., Small N., Payne S., Seamark D., Barnes S., Halpin D., Ruse C. (2009). Barriers to advance care planning in chronic obstructive pulmonary disease. Palliat. Med. 23:642–648. doi: 10.1177/0269216309106790.
7. Howard M., Bernard C., Tan A., Slaven M., Klein D., Heyland D.K. (2015). Advance Care Planning: Let’s Start Sooner. Can. Fam. Physician. 61:663–665.
8. Rietjens J.A.C., Sudore R.L., Connolly M., Van Delden J.J., Drickamer M.A., Droger M., Van der Heide A., Heyland D.K., Houttekier D., Janssen D.J.A., et al. (2017). Definition and recommendations for advance care planning: An international consensus supported by the European Association for Palliative Care. Lancet Oncol. 18:e543–e551. doi: 10.1016/S1470-2045(17)30582-X.
9. Silveira M. (n.d.). Advance Care Planning and Advance Directives. Available online: https://www.uptodate.com/contents/advance-care-planning-and-advance-directives
10. Boddy J., Chenoweth L., McLennan V., Daly M. (2013). It’s just too hard! Australian health care practitioner perspectives on barriers to advance care planning. Aust. J. Prim. Health. 19:38–45. doi: 10.1071/PY11070.
11. National Institute on Aging (n.d.). Advance Care Planning: Healthcare Directives. Available online: https://www.nia.nih.gov/health/advance-care-planning-healthcare-directives
12. Pérez M.d.V., Macchi M.J., Agranatti A.F. (2013). Advance directives in the context of end-of-life palliative care. Curr. Opin. Support. Palliat. Care. 7:406–410. doi: 10.1097/spc.0000000000000007.
13. National Agency for Management of Life-Sustaining Treatment (n.d.). Advance Decisions on Life-Sustaining Treatment. Available online: https://www.lst.go.kr/eng/decn/maincontent.do
14. An H.J., Jeon H.J., Chun S.H., Jung H.A., Ahn H.K., Lee K.H., Kim M.H., Kim J.H., Cheon J., Kim J., et al. (2019). Feasibility Study of Physician Orders for Life-Sustaining Treatment for Patients with Terminal Cancer. Cancer Res. Treat. 51:1632–1638. doi: 10.4143/crt.2019.009.
15. National Agency for Management of Life-Sustaining Treatment (n.d.). Statistical Updates: Registration of an Advance Directive on Life-Sustaining Treatment. Available online: https://www.lst.go.kr/comm/monthlyStatistics.do
16. Bravo G., Trottier L., Arcand M., Boire-Lavigne A.-M., Blanchette D., Dubois M.-F., Guay M., Lane J., Hottin P., Bellemare S. (2016). Promoting advance care planning among community-based older adults: A randomized controlled trial. Patient Educ. Couns. 99:1785–1795. doi: 10.1016/j.pec.2016.05.009.
17. Houben C.H.M., Spruit M.A., Groenen M.T.J., Wouters E.F.M., Janssen D.J.A. (2014). Efficacy of advance care planning: A systematic review and meta-analysis. J. Am. Med. Dir. Assoc. 15:477–489. doi: 10.1016/j.jamda.2014.01.008.
18. Jimenez G., Tan W.S., Virk A.K., Low C.K., Car J., Ho A.H.Y. (2018). Overview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons. J. Pain Symptom Manag. 56:436–459. doi: 10.1016/j.jpainsymman.2018.05.016.
19. Miller H., Tan J., Clayton J.M., Meller A., Hermiz O., Zwar N., Rhee J. (2019). Patient experiences of nurse-facilitated advance care planning in a general practice setting: A qualitative study. BMC Palliat. Care. 18:25. doi: 10.1186/s12904-019-0411-z.
20. Butler J., Binney Z., Kalogeropoulos A., Owen M., Clevenger C., Gunter D., Georgiopoulou V., Quest T. (2015). Advance directives among hospitalized patients with heart failure. JACC Heart Fail. 3:112–121. doi: 10.1016/j.jchf.2014.07.016.
21. Evans N., Bausewein C., Menaca A., Andrew E.V., Higginson I.J., Harding R., Pool R., Gysels M., project PRISMA (2012). A critical review of advance directives in Germany: Attitudes, use and healthcare professionals’ compliance. Patient. Educ. Couns. 87:277–288. doi: 10.1016/j.pec.2011.10.004.
22. Schubart J.R., Levi B.H., Bain M.M., Farace E., Green M.J. (2019). Advance Care Planning Among Patients With Advanced Cancer. J. Oncol. Pract. 15:e65–e73. doi: 10.1200/JOP.18.00044.
23. Chan C.W.H., Ng N.H.Y., Chan H.Y.L., Wong M.M.H., Chow K.M. (2019). A systematic review of the effects of advance care planning facilitators training programs. BMC Health Serv. Res. 19:362. doi: 10.1186/s12913-019-4192-0.
24. Hsieh C.-C., Huang H.-P., Tung T.-H., Chen I.C., Beaton R.D., Jane S.-W. (2019). The exploration of the knowledge, attitudes and practice behaviors of advanced care planning and its related predictors among Taiwanese nurses. BMC Palliat. Care. 18:99. doi: 10.1186/s12904-019-0483-9.
25. Jang N., Park H., Kim M., Lee J., Cho Y., Kim K., Son Y. (2018). Knowledge, Confidence, and Learning Needs Regarding Advance Directives among Hospital Nurses. J. Korean Crit. Care Nurs. 11:35–45.
26. Julia-Sanchis R., Cabanero-Martinez M.J., Zaragoza-Marti M.F., Garcia-Sanjuan S. (2020). Knowledge and attitudes of Spanish mental health professionals towards advance healthcare directives. J. Psychiatr. Ment. Health Nurs. 27:699–708. doi: 10.1111/jpm.12625.
27. Aguilar-Sanchez J.M., Cabanero-Martinez M.J., Puerta Fernandez F., Ladios-Martin M., Fernandez-de-Maya J., Cabrero-Garcia J. (2018). Knowledge and attitudes of health professionals towards advance directives. Gac. Sanit. 32:339–345. doi: 10.1016/j.gaceta.2017.08.006.
28. Sinclair C., Gates K., Evans S., Auret K.A. (2016). Factors Influencing Australian General Practitioners’ Clinical Decisions Regarding Advance Care Planning: A Factorial Survey. J. Pain Symptom Manag. 51:718–727. doi: 10.1016/j.jpainsymman.2015.11.014.
29. AlFayyad I.N., Al-Tannir M.A., AlEssa W.A., Heena H.M., Abu-Shaheen A.K. (2019). Physicians and nurses’ knowledge and attitudes towards advance directives for cancer patients in Saudi Arabia. PLoS ONE. 14:e0213938. doi: 10.1371/journal.pone.0213938.
Article Sidebar
Published
Mar 02, 2022
Article Details
How to Cite
Fahad Murdhi Jabban Alanazi, Abdulaziz Saud Bardi Alanazi, Khalid Saud Jazaa Alrashdi, Hamoud Falah Ramdan Alanazi, Fahad Fares Khleef Alshammari, Ahmed Muidh Nazal Alanazi, Bander Khalid B Alanazi. (2022). Emergency Healthcare Providers’ Knowledge about and Attitudes toward Advance Directives: A Cross-Sectional Study between Nurses and Emergency Medical Technicians at an Emergency Department. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 794-802. https://doi.org/10.53555/jptcp.v29i04.5544
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Fahad Murdhi Jabban Alanazi, Abdulaziz Saud Bardi Alanazi, Khalid Saud Jazaa Alrashdi, Hamoud Falah Ramdan Alanazi, Fahad Fares Khleef Alshammari, Ahmed Muidh Nazal Alanazi, Bander Khalid B Alanazi. (2022). Emergency Healthcare Providers’ Knowledge about and Attitudes toward Advance Directives: A Cross-Sectional Study between Nurses and Emergency Medical Technicians at an Emergency Department. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 794-802. https://doi.org/10.53555/jptcp.v29i04.5544