Nurses' intention and attitude to participate in advance care planning: An extended theory of planned behaviour using structural equation modelling-A cross-sectional study

Aims: This study aimed to investigate the factors influencing nurses' intentions to participate in advance care planning (ACP) by examining the mediating roles of attitude, subjective norm, and perceived behavioural control in the relationship between knowledge and intention, using an extended theory of planned behaviour and structural equation modelling. Methods: A descriptive cross-sectional survey was conducted between January and April 2023, involving 515 registered nurses, selected through two-stage sampling. Data were collected using a self-administered online survey distributed via the internal communication system of hospital. Structural equation Modelling was employed to analyse the relationships among knowledge, attitude, subjective norm, perceived behavioural control and intention to participate in ACP. Results: The results supported two hypotheses regarding the relationships between knowledge, attitude, subjective norm, perceived behavioural control, and intention (p < 0.05). While the direct effect of knowledge on intention was not significant (beta = 0.087, p = 0.292), the total indirect effect through attitude, subjective norm and perceived behavioural control was significant (beta = 0.449, p < 0.001), accounting for approximately 83.77% of the total effect on intention. This underscores the critical role of these mediators in influencing nurses' intention to participate in ACP. Conclusions: This study highlights the significant indirect influence of knowledge on nurses' intentions to participate in ACP through attitude, subjective norms and perceived behavioural control. These findings suggest that targeted educational is needed to enhance ACP participation among nurses.