Effects of an Advance Care Planning Training Program for Certified Palliative Care Nurses in Japan

概要

Effects of an Advance Care Planning Training Program for Certified Palliative Care Nurses in
Japan
Yoko Yahiro1)2), Mika Miyashita1), Katsumi Nasu3)
1) Department of Gerontological and Oncology Nursing, Graduate School of Biomedical and Health
Science, Hiroshima University, Hiroshima, Japan
2) Faculty of Nursing, Department of Nursing, Fukuoka Jogakuin Nursing University, Japan
3) Faculty of Nursing, Department of Nursing, Yasuda Women's University, Japan

Introduction
Advance care planning (ACP) is a comprehensive process in which patients, their families,
and healthcare professional share their concerns and values regarding future treatment and
recuperation, and plan their care in preparation for a future decline in decision-making
capacity.
Awareness of the importance of ACP is increasing in Japanese cancer medicine. Only
approximately 30% of doctors and nearly 20% of nurses recognize that they are actually
practicing ACP. A barrier to ACP is the lack of knowledge and skills. In order to promote the
practice of ACP in Japan, it is necessary to educate medical professionals about ACP.
Certified nurses are involved in the practice, guidance, and consultation in a specific
nursing field. Certified palliative care nurses are facilitating the practice of ACP as the
medical professional closest to a patient’s family. In order to apply ACP to more cancer
patients in Japan in the future, it is essential to have certified palliative care nurses who
have expertise in ACP palliative care, have high technical standards, and lead the team to
practice ACP.
However, there is no training program in Japan where nurses can systematically learn
knowledge and skills related to ACP.
The purpose of this study was to develop a training program that enables systematic and
practical learning of ACP in consideration of Japanese medical care and culture, and to
determine the effectiveness.
Methods
The survey mailed a document describing the purpose, content, and ethical considerations
such as voluntary participation in the study to palliative care certified nurses in Kyushu,
Chugoku, and Shikoku, and those who wished to participate applied online.
The sample size was 34 or more was required for the intervention group and the control
group, but since the control group was 5 people, the pre-post design of 1 group was used. The
Wilcoxon signed rank sum test was conducted to verify the effects of the intervention.

To select the contents of the training program, we reviewed ACP guidelines and training
programs. The following topics were extracted: definition of ACP, ethics, legal basis,
effectiveness of ACP, system construction, and communication. The program was structured
to provide group education in 4 modules with 12 topics group. The training method was
designed so that lectures and group work were introduced so that participants could share
issues related to ACP and discuss solutions. All training was conducted by the researcher
and conducted in person.
Data were collected at three time points: before training (baseline: T0), immediately after
training (T1), and three months after training (T2). Before the start of the training day (T0),
participants answered the questionnaire. Immediately after training (T1), the program was
evaluated using the questionnaire survey. Three months after the training, participants
completed a questionnaire that included the same items as before the training.
Results
Forty-four out of the 60 participants who underwent the training program responded to
the survey three months later. We analyzed the responses of 39 participants (65%),
excluding those with missing values. The average age of participants was 43.21 ± 6.45 years,
and the average years of experience of certified palliative care nurses was 5.05 ± 3.15 years.
The results obtained showed an increase in dialogue on ACP among patients/families and
healthcare professionals (mean before the intervention = 24.49, mean after the intervention
= 27.59, p = 0.045), and a significant decrease in the sense of difficulty with knowledge of
and skills for ACP (mean before the intervention = 4.85, mean after the intervention = 4.30,
p = 0.001). The grades of the stages positively changed from T0 to T2 in 19 (48.7%)
participants, remained unchanged in 14 (35.9%), and negatively changed in 6 (15.4%). More
than 90% of the participants gave positive comments on the evaluation items such as
understanding and satisfaction with the educational program and appropriateness of the
contents.
Conclusion
After attending the training program, participants’ sense of difficulty with their
knowledge of and skills for ACP decreased, and their practice of ACP increased. This
program may promote the practice of ACP for cancer patients in the future.
Further studies are needed to clarify the effectiveness of the program by expanding the
target area and implementing the program for a larger number of subjects.