Advance Care Planning Training for Nurses

Study Overview
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Brief Summary
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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.

Detailed Description
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The study adopts a cluster randomised controlled trial with 12 weeks follow-up. 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.

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

Conditions
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Advance Care Planning

Intervention / Treatment
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* Other: Multi-media experiential training programme


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: registered nurse with at least two years' clinical experience Exclusion Criteria: had prior specialty training in Advance Care Planning communication.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>will receive a multi-media experiential training programme. | Other: Multi-media experiential training programme<br>* 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<br>|
| No Intervention: control group<br>will NOT receive a multi-media experiential training programme | |

What is the study measuring?
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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. | one week 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' 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. | one week 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. | 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. | one week 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 . | 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 . | one week 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 . | 12 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. | one week 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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Advance Care Planning, acute care settings, experiential learning, nurse training programme