Health care providers' knowledge, confidence, difficulties, and practices after completing a communication skills training program for advance care planning discussion in Japan

Background: Advance care planning (ACP) is an important factor that affects the quality of end-of-life. However, health care providers are not able to sufficiently support patients' ACP due to their lack of knowledge and psychological burden. This study investigated how the knowledge, attitudes, and practices of health care providers who completed a communication skills training (CST) program for ACP discussion changed before and after the course. Methods: Health care providers who participated in the Education for Implementing End of Life Discussion (E-FIELD) CST training program in Japan were surveyed at three time points: before, immediately after, and 6 months after training. The number of participants who completed all three surveys was 306. Knowledge, confidence, communication difficulties, number of discussions and completions of ACP were measured using a questionnaire. Results: Participants' knowledge and confidence increased right after training compared with before training. The number of ACP discussions and completions increased significantly 6 months after training compared with before training and difficulties tended to decrease. Physicians maintained their confidence, which increased immediately after training until 6 months after training and their number of ACP discussions and completions also increased significantly 6 months after training compared with before training. Conclusions: The CST program for ACP, E-FIELD, has the potential to increase the knowledge, confidence, and number of ACP discussions and completions used by physicians, nurses, and social workers, and also lower their difficulties.