Lessons learned from self-efficacy of healthcare professionals for advance care planning

Abstract

Background: Advance care planning (ACP) is a reflective, deliberative, and structured process based on dialogue and free agreement between the person concerned and healthcare professionals. Argentina has no national ACP program or systematic approach for patients diagnosed with advanced chronic disease. Healthcare providers who treat these patients highlight some main obstacles in initiating the ACP process. Perceived self-efficacy is one of the main predictors of success in learning processes and promotes the acquisition of new behaviours and positive results in implementing ACP. We aimed to sensitise professionals and explore their self-efficacy for ACP before specific training. Participants and methods: This exploratory, prospective, descriptive study used the self-efficacy ACP-SEs scale already validated in Argentina. We surveyed 236 healthcare professionals (n 125 physicians/n 111 non-physicians) before specific training courses (2019–2021). Results: Participants’ experience, training needs, and practices. Most respondents were females (43 years old). Non-physicians (n 111) were 40 nurses, 32 psychologists, 16 social workers, 15 physiotherapists, and 8 other health backgrounds. Over 50% had 5–20 years of professional and primary care experience. When comparing professions, half of the physicians increased by up to 5.23 points higher on the self-efficacy scale than non-physicians. Most participants had no personal advance directives and neither helped a relative nor a patient sign a document. Half of the participants had previously undergone training. Half of the professionals who had done ACP significantly increased their value on the scale by up to 7.5 points more than those who did not. Differences between physicians and non-physicians revealed areas of improvement involving communication skills, roles and tasks, and legal issues. Conclusions: Healthcare providers' skills improve with experience and require training to increase self-efficacy. Our findings should encourage tailor-made training programs in the future. One of the goals of this study was to spark discussions before specific training courses and develop appropriate teaching methods based on perceived self-efficacy in Argentina.