Abstract
The lack of knowledge of advance care planning and training of communication skills among nurses in Taiwan is one of the main reasons for the low rate of advance directive signing. However, there is no specific and effective solution to this problem. The purposes of this study were (1) to develop and pilot testing of an advance care planning simulation-based communication training program and (2) to evaluate the feasibility and acceptability of the program. This study was conducted in three phases. Phase 1: Developing an advance care planning simulation-based communication training program; Phase 2: Conducting a pilot test; Phase 3: Evaluating the feasibility and acceptability of the program. Twelve convenient participants from a medical center in central Taiwan were selected. The participants believed that team-based learning was beneficial for several reasons. First, it helped to clarify the participants' understanding of advance care planning and improve their communication skills. Second, role-playing, as one of the components, was helpful for discovering their own shortcomings in communication skills while debriefing enabled them to identify their blind spots in the communication process. Finally, the reflection log documented their weekly performance so they were able to reflect upon their weekly performance, improve their performance, and become more confident. All twelve participants signed the consent form and completed the whole training program. The participants were satisfied with the program, affirming that the timing and content of the program were appropriate and that the expected learning outcomes could be achieved. According to participant feedback, the program was beneficial in improving their knowledge of advance care planning and confidence in communication. Thus, it is feasible and acceptable to introduce communication of advance care planning programs into the staff training protocols of healthcare organizations. Clinical trial registration: NCT04312295.
Highlights
Chronic kidney disease (CKD) is a significant worldwide health issue with heavy economic burden [1]
The first axis was the conveying of professional knowledge, including the Hospice Palliative Care Act, the Patient Right to Autonomy Act, and the advance directive documents
The advance care planning (ACP)-SCT program workshop was conducted by a facilitator, the first author, specializing in palliative care and an ACP counselor
Summary
Chronic kidney disease (CKD) is a significant worldwide health issue with heavy economic burden [1]. ESRD is a difficult condition to cope with. For patients and their loved ones, end-of-life decisions may include patients’ distressing inability to speak for themselves. There have been advances in hemodialysis technology, dialysis may not improve survival in elderly patients with multiple complications. Instead, it may affect quality of life [2]. Patients over 80 years of age with CKD have a mortality rate of up to 50% within one year of starting HD [3]. Ventilator-dependent CKD patients receiving HD have an in-hospital mortality rate of 69.6% and an extremely poor prognosis [4]. Some patients may receive life-sustaining treatments, such as cardiopulmonary resuscitation and ventilation, which might not have been the patients’ wishes
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