Table 4 Comparison of level of agreement regarding ACP between respondents who had or had not received training (N = 250)
Group | Level of agreement (%) | p | |||
|---|---|---|---|---|---|
Strongly disagree/ Disagree | Unsure | Strongly agree/ Agree | |||
Process | |||||
ACP should be integrated into routine care services for patients with chronic illness. | Trained | 5.4% | 11.6% | 82.9% | .831 |
Not trained | 6.7% | 13.3% | 80.0% | ||
ACP conversation can be initiated by any health professional. | Trained | 13.2% | 13.2% | 73.6% | .063 |
Not trained | 17.5% | 22.5% | 60.0% | ||
Better not to initiate ACP unless asked by patients or their family members. | Trained | 84.5% | 7.8% | 7.8% | .013* |
Not trained | 69.2% | 18.3% | 12.5% | ||
ACP should be started early to allow time for contemplation. | Trained | 1.6% | 11.6% | 86.8% | .656 |
Not trained | 3.3% | 11.7% | 85.0% | ||
ACP should not be started before the patients’ condition worsens because their preferences may change according to the context. | Trained | 61.2% | 14.7% | 24.0% | .050* |
Not trained | 45.8% | 21.7% | 32.5% | ||
ACP is not necessary because use of life-sustaining treatments is a medical decision based on patients’ best interests. | Trained | 88.4% | 7.0% | 4.7% | .072 |
Not trained | 77.5% | 14.2% | 8.3% | ||
Documentation of ACP discussion is useful for care management. | Trained | 7.0% | 9.3% | 83.7% | .052 |
Not trained | 5.0% | 20.0% | 75. 0% | ||
Outcomes | |||||
ACP is helpful to clarify patients’ goals and preferences for end-of-life care. | Trained | 1.6% | 1.6% | 96.9% | .193 |
Not trained | 1.7% | 5.8% | 92.5% | ||
ACP destroys patients or their family members’ sense of hope. | Trained | 92.2% | 1.6% | 6.2% | ≤.001*** |
Not trained | 75.0% | 15.8% | 9.2% | ||
Under no circumstances should life-sustaining treatments be withheld or withdrawn from patients. | Trained | 68.2% | 15.5% | 16.3% | .014* |
Not trained | 50.8% | 28.3% | 20.8% | ||
It is hard for patients and/or their family members to reach consensus on end-of-life care. | Trained | 43.4% | 31.8% | 24.8% | ≤.001*** |
Not trained | 21.7% | 37.5% | 40.8% | ||
ACP can help to prevent disputes between health care team and family members on medical decisions. | Trained | 2.3% | 7.8% | 89.9% | .036* |
Not trained | 3.3% | 18.3% | 78.3% | ||
ACP can help to alleviate burden on family decision makers. | Trained | 3.1% | 5.4% | 91.5% | ≤.001*** |
Not trained | 4.2% | 21.7% | 74.2% | ||
Facilitators | |||||
I am comfortable with discussing end-of-life care issues with patients. | Trained | 6.2% | 10.9% | 82.9% | ≤.001*** |
Not trained | 14.2% | 32.5% | 53.3% | ||
I am comfortable with discussing end-of-life care issues with patients’ family members. | Trained | 6.2% | 11.6% | 82.2% | ≤.001*** |
Not trained | 13.3% | 30.8% | 55.8% | ||
My seniors/supervisors support me to conduct ACP. | Trained | 10.1% | 24.8% | 65.1% | ≤.001*** |
Not trained | 18.3% | 55.8% | 25.8% | ||
My co-workers support me to conduct ACP. | Trained | 8.5% | 31.0% | 60.5% | ≤.001*** |
Not trained | 18.3% | 52.5% | 29.2% | ||
The existing ACP policy and guidelines is clear. | Trained | 23.3% | 28.7% | 48.1% | ≤.001*** |
Not trained | 34.2% | 50.8% | 15.0% | ||
Barriers | |||||
It is difficult to determine if the patient has the mental capacity to make medical decisions. | Trained | 54.3% | 21.7% | 24.0% | .020* |
Not trained | 36.7% | 28.3% | 35.0% | ||
Patients usually find end-of-life care discussion a taboo. | Trained | 46.5% | 27.9% | 25.6% | ≤.001*** |
Not trained | 23.3% | 42.5% | 34.2% | ||
Patients usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future. | Trained | 42.6% | 18.6% | 38.8% | .006** |
Not trained | 24.2% | 30.0% | 45.8% | ||
Patients’ family members usually find end-of-life care discussion a taboo. | Trained | 34.9% | 27.1% | 38.0% | ≤.001*** |
Not trained | 12.5% | 29.2% | 58.3% | ||
Patients’ family members usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future. | Trained | 38.0% | 14.7% | 47.3% | ≤.001*** |
Not trained | 15.0% | 31.7% | 53.3% | ||
I am hesitant to follow the preferences stated in the ACP form for fear of legal liability, especially if the patients have not signed an advance directive. | Trained | 60.5% | 18.6% | 20.9% | ≤.001*** |
Not trained | 32.5% | 31.7% | 35.8% | ||
I do not have time to conduct ACP. | Trained | 43.4% | 19.4% | 37.2% | .010* |
Not trained | 26.7% | 32.5% | 40.8% | ||