Attitudes of Health Professionals towards Advance Care Planning (ACP)

This online survey aims to examine the attitudes of local health professionals towards advance care planning (ACP). We would like to invite you to complete the following questionnaire if you are currently practicing as medical doctors, nurses or social workers in any hospital or community care settings. The questionnaire consists of three parts: demographic data, experience with ACP and perceived factors influencing the ACP process. The survey will take around 10 minutes. All participation will be on voluntary basis and you have every right to refuse to answer any questions in the questionnaire. To protect participants’ privacy, your name and personal identifiers will not be collected during data collection. No payment or reward involved. All research data will be kept confidential by locking up in a secure office and computers, and will only be accessible to the Principal Investigator of this study for research purpose only. The findings will increase understanding about the readiness of the local health professionals for ACP and factors related to the implementation process, and thus provide insights on future training and service development. For any enquiry, please feel free to contact the principal investigator, Dr Helen Chan, at 3943 8099 or helencyl@cuhk.edu.hk. Thanks for your attention.

A. Demographic
1. Gender *

1. Gender M F
2. Age *
3. Disciplines *

3. Disciplines Medical doctors Nurses Social workers Allied health professional, e.g. PT, OT…etc. Trainees - Years of training: Trainees - Years of training:
4. Clinical working experience (years) *
5. Highest degree earned *

5. Highest degree earned Bachelor degree Master degree Doctoral degree
6. Current working organisation (can be more than one option) *

6. Current working organisation (can be more than one option) Public hospital Private hospital Neighbourhood Elderly Centre / District Elderly Community centre / Day care centre Residential Care Homes for the Elderly Hospice Private clinic University Others, please specify: Others, please specify:
7. Current working department (can be more than one option) *

7. Current working department (can be more than one option) Medical / Geriatrics Rehabilitation/Infirmary Surgical Palliative Care AED ICU / CCU Oncology Obstetrics / Gynaecology Orthopaedics & Traumatology Psychiatry Others, please specify: Others, please specify:
B. Experience with ACP

Definition of ACP: ACP is an overarching process of proactive communication regarding end-of-life care. Through this process of communication, a patient with advanced progressive disease, his/her health care providers, and his/her family members and caregivers can consider ahead of time what kind of care is appropriate when the patient can no longer make a decision. (Hospital Authority Guidelines on ACP, 2019)
1. To what extent do you consider ACP related to your current clinical duties?
(0 – totally irrelevant to 10 – highly relevant) *

1. To what extent do you consider ACP related to your current clinical duties?
(0 – totally irrelevant to 10 – highly relevant) 0 1 2 3 4 5 6 7 8 9 10
2. Please rate your level of willingness in conducting ACP with your patients or their family
(0 – lowest to 10 – highest) *

2. Please rate your level of willingness in conducting ACP with your patients or their family
(0 – lowest to 10 – highest) 0 1 2 3 4 5 6 7 8 9 10
3. Please rate your level of confidence in conducting ACP with your patients or their family
(0 – lowest to 10 – highest) *

3. Please rate your level of confidence in conducting ACP with your patients or their family
(0 – lowest to 10 – highest) 0 1 2 3 4 5 6 7 8 9 10
4. How familiar are you with the HA ACP guidelines released in Jun 2019? *

4. How familiar are you with the HA ACP guidelines released in Jun 2019? Have read it I know it was released recently but not very familiar Not aware of its existence
5. Have you ever received any formal training related to ACP or end-of-life care discussion? *

5. Have you ever received any formal training related to ACP or end-of-life care discussion? Yes --> go to Q5.1 No --> skip to Q6
5.1. What was the nature of the training? (can be more than one option)

5.1. What was the nature of the training? (can be more than one option) Lecture / Talk / Seminar Online resources Skill building workshop Oversea training Others: Others:
5.2. Total hours of training
5.3. What was the focus of the training? (can be more than one option)

5.3. What was the focus of the training? (can be more than one option) Introduction of concept / guidelines Case studies Communication skills Others: Others:
6. Have you ever conducted ACP conversations with your patients and/or their family members? *

6. Have you ever conducted ACP conversations with your patients and/or their family members? Yes --> go to Q6.1 No --> skip to next section
6.1. How frequently did you conduct ACP conversations?

6.1. How frequently did you conduct ACP conversations? <= once / month 2 – 5 times / month 5 – 10 times / month > 10 times / month
6.2. Referring to the last time you conducted ACP, why was the discussion arisen?

6.2. Referring to the last time you conducted ACP, why was the discussion arisen? Diagnosis of a life-limiting condition Early cognitive decline in dementia Significant disease progression (in terms of functional decline, symptoms burden, deteriorating quality of life) Discontinuation of disease targeted treatments Transition to palliative care Recovery from an acute severe episode of a chronic disease Following multiple hospital admissions Patient becomes institutionalized Others
6.3. Who initiated the discussion?

6.3. Who initiated the discussion? Doctor Nurse Other health professionals Patient Family members
6.4. Who were included in the discussion? (can be more than one option)

6.4. Who were included in the discussion? (can be more than one option) Doctor Nurse Other health professionals Patient Family members Not sure Others: Others:
6.5. What was the focus of that conversation? (can be more than one option)

6.5. What was the focus of that conversation? (can be more than one option) Prognosis Patient goals, values and preferences Preferences regarding care preferences near end-of-life (including place of care) End-of-life care/ hospice/palliative care services DNACPR for non-hospitalized patients Withholding or withdrawing of life-threatening treatment(s) Advance directive Others: Others:
C. Factors influencing ACP

Factors that may influence the process of ACP are summarized as follows. Would you please rate your level of agreement with these statements based on your clinical experience

1-Strongly disagree
2-Disagree
3-Unsure
4-Agree
5-Strongly agree

*
	1	2	3	4	5
1. ACP should be integrated into routine care services for patients with chronic illness.	1. ACP should be integrated into routine care services for patients with chronic illness.1	1. ACP should be integrated into routine care services for patients with chronic illness.2	1. ACP should be integrated into routine care services for patients with chronic illness.3	1. ACP should be integrated into routine care services for patients with chronic illness.4	1. ACP should be integrated into routine care services for patients with chronic illness.5
2. ACP conversation can be initiated by any health professional.	2. ACP conversation can be initiated by any health professional.1	2. ACP conversation can be initiated by any health professional.2	2. ACP conversation can be initiated by any health professional.3	2. ACP conversation can be initiated by any health professional.4	2. ACP conversation can be initiated by any health professional.5
3. Better not to initiate ACP unless asked by patients or their family members.	3. Better not to initiate ACP unless asked by patients or their family members.1	3. Better not to initiate ACP unless asked by patients or their family members.2	3. Better not to initiate ACP unless asked by patients or their family members.3	3. Better not to initiate ACP unless asked by patients or their family members.4	3. Better not to initiate ACP unless asked by patients or their family members.5
4. ACP is helpful to clarify patients’ goals and preferences for end-of-life care.	4. ACP is helpful to clarify patients’ goals and preferences for end-of-life care.1	4. ACP is helpful to clarify patients’ goals and preferences for end-of-life care.2	4. ACP is helpful to clarify patients’ goals and preferences for end-of-life care.3	4. ACP is helpful to clarify patients’ goals and preferences for end-of-life care.4	4. ACP is helpful to clarify patients’ goals and preferences for end-of-life care.5
5. ACP should be started early to allow time for contemplation.	5. ACP should be started early to allow time for contemplation.1	5. ACP should be started early to allow time for contemplation.2	5. ACP should be started early to allow time for contemplation.3	5. ACP should be started early to allow time for contemplation.4	5. ACP should be started early to allow time for contemplation.5
6. ACP should not be started before the patients’ condition worsens because their preferences may change according to the context.	6. ACP should not be started before the patients’ condition worsens because their preferences may change according to the context.1	6. ACP should not be started before the patients’ condition worsens because their preferences may change according to the context.2	6. ACP should not be started before the patients’ condition worsens because their preferences may change according to the context.3	6. ACP should not be started before the patients’ condition worsens because their preferences may change according to the context.4	6. ACP should not be started before the patients’ condition worsens because their preferences may change according to the context.5
7. I am comfortable with discussing end-of-life care issues with patients.	7. I am comfortable with discussing end-of-life care issues with patients.1	7. I am comfortable with discussing end-of-life care issues with patients.2	7. I am comfortable with discussing end-of-life care issues with patients.3	7. I am comfortable with discussing end-of-life care issues with patients.4	7. I am comfortable with discussing end-of-life care issues with patients.5
8. I am comfortable with discussing end-of-life care issues with patients’ family members.	8. I am comfortable with discussing end-of-life care issues with patients’ family members.1	8. I am comfortable with discussing end-of-life care issues with patients’ family members.2	8. I am comfortable with discussing end-of-life care issues with patients’ family members.3	8. I am comfortable with discussing end-of-life care issues with patients’ family members.4	8. I am comfortable with discussing end-of-life care issues with patients’ family members.5
9. Under no circumstances should life-sustaining treatments be withheld or withdrawn from patients.	9. Under no circumstances should life-sustaining treatments be withheld or withdrawn from patients.1	9. Under no circumstances should life-sustaining treatments be withheld or withdrawn from patients.2	9. Under no circumstances should life-sustaining treatments be withheld or withdrawn from patients.3	9. Under no circumstances should life-sustaining treatments be withheld or withdrawn from patients.4	9. Under no circumstances should life-sustaining treatments be withheld or withdrawn from patients.5
10. ACP is not necessary because use of life-sustaining treatments is a medical decision based on patients’ best interests.	10. ACP is not necessary because use of life-sustaining treatments is a medical decision based on patients’ best interests.1	10. ACP is not necessary because use of life-sustaining treatments is a medical decision based on patients’ best interests.2	10. ACP is not necessary because use of life-sustaining treatments is a medical decision based on patients’ best interests.3	10. ACP is not necessary because use of life-sustaining treatments is a medical decision based on patients’ best interests.4	10. ACP is not necessary because use of life-sustaining treatments is a medical decision based on patients’ best interests.5
11. ACP destroys patients or their family members’ sense of hope.	11. ACP destroys patients or their family members’ sense of hope.1	11. ACP destroys patients or their family members’ sense of hope.2	11. ACP destroys patients or their family members’ sense of hope.3	11. ACP destroys patients or their family members’ sense of hope.4	11. ACP destroys patients or their family members’ sense of hope.5
12. It is difficult to determine if the patient has the mental capacity to make medical decisions.	12. It is difficult to determine if the patient has the mental capacity to make medical decisions.1	12. It is difficult to determine if the patient has the mental capacity to make medical decisions.2	12. It is difficult to determine if the patient has the mental capacity to make medical decisions.3	12. It is difficult to determine if the patient has the mental capacity to make medical decisions.4	12. It is difficult to determine if the patient has the mental capacity to make medical decisions.5
13. Patients usually find end-of-life care discussion a taboo.	13. Patients usually find end-of-life care discussion a taboo.1	13. Patients usually find end-of-life care discussion a taboo.2	13. Patients usually find end-of-life care discussion a taboo.3	13. Patients usually find end-of-life care discussion a taboo.4	13. Patients usually find end-of-life care discussion a taboo.5
14. Patients usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future.	14. Patients usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future.1	14. Patients usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future.2	14. Patients usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future.3	14. Patients usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future.4	14. Patients usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future.5
15. Patients’ family members usually find end-of-life care discussion a taboo.	15. Patients’ family members usually find end-of-life care discussion a taboo.1	15. Patients’ family members usually find end-of-life care discussion a taboo.2	15. Patients’ family members usually find end-of-life care discussion a taboo.3	15. Patients’ family members usually find end-of-life care discussion a taboo.4	15. Patients’ family members usually find end-of-life care discussion a taboo.5
16. Patients’ family members usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future.	16. Patients’ family members usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future.1	16. Patients’ family members usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future.2	16. Patients’ family members usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future.3	16. Patients’ family members usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future.4	16. Patients’ family members usually find end-of-life care discussion difficult, e.g. difficult to understand the treatments or predict the future.5
17. It is hard for patients and/or their family members to reach consensus on end-of-life care.	17. It is hard for patients and/or their family members to reach consensus on end-of-life care.1	17. It is hard for patients and/or their family members to reach consensus on end-of-life care.2	17. It is hard for patients and/or their family members to reach consensus on end-of-life care.3	17. It is hard for patients and/or their family members to reach consensus on end-of-life care.4	17. It is hard for patients and/or their family members to reach consensus on end-of-life care.5
18. ACP can help to alleviate burden on family decision makers.	18. ACP can help to alleviate burden on family decision makers.1	18. ACP can help to alleviate burden on family decision makers.2	18. ACP can help to alleviate burden on family decision makers.3	18. ACP can help to alleviate burden on family decision makers.4	18. ACP can help to alleviate burden on family decision makers.5
19. ACP can help to prevent disputes between health care team and family members on medical decisions.	19. ACP can help to prevent disputes between health care team and family members on medical decisions.1	19. ACP can help to prevent disputes between health care team and family members on medical decisions.2	19. ACP can help to prevent disputes between health care team and family members on medical decisions.3	19. ACP can help to prevent disputes between health care team and family members on medical decisions.4	19. ACP can help to prevent disputes between health care team and family members on medical decisions.5
20. I am hesitant to follow the preferences stated in the ACP form for fear of legal liability, especially if the patients have not signed an advance directive.	20. I am hesitant to follow the preferences stated in the ACP form for fear of legal liability, especially if the patients have not signed an advance directive.1	20. I am hesitant to follow the preferences stated in the ACP form for fear of legal liability, especially if the patients have not signed an advance directive.2	20. I am hesitant to follow the preferences stated in the ACP form for fear of legal liability, especially if the patients have not signed an advance directive.3	20. I am hesitant to follow the preferences stated in the ACP form for fear of legal liability, especially if the patients have not signed an advance directive.4	20. I am hesitant to follow the preferences stated in the ACP form for fear of legal liability, especially if the patients have not signed an advance directive.5
21. I do not have time to conduct ACP.	21. I do not have time to conduct ACP.1	21. I do not have time to conduct ACP.2	21. I do not have time to conduct ACP.3	21. I do not have time to conduct ACP.4	21. I do not have time to conduct ACP.5
22. My seniors/supervisors support me to conduct ACP.	22. My seniors/supervisors support me to conduct ACP.1	22. My seniors/supervisors support me to conduct ACP.2	22. My seniors/supervisors support me to conduct ACP.3	22. My seniors/supervisors support me to conduct ACP.4	22. My seniors/supervisors support me to conduct ACP.5
23. My co-workers support me to conduct ACP.	23. My co-workers support me to conduct ACP.1	23. My co-workers support me to conduct ACP.2	23. My co-workers support me to conduct ACP.3	23. My co-workers support me to conduct ACP.4	23. My co-workers support me to conduct ACP.5
24. The existing ACP policy and guidelines is clear.	24. The existing ACP policy and guidelines is clear.1	24. The existing ACP policy and guidelines is clear.2	24. The existing ACP policy and guidelines is clear.3	24. The existing ACP policy and guidelines is clear.4	24. The existing ACP policy and guidelines is clear.5
25. Documentation of ACP discussion is useful for care management.	25. Documentation of ACP discussion is useful for care management.1	25. Documentation of ACP discussion is useful for care management.2	25. Documentation of ACP discussion is useful for care management.3	25. Documentation of ACP discussion is useful for care management.4	25. Documentation of ACP discussion is useful for care management.5

What are the other factors / issues that influence your involvement in ACP?
Disclaimer This form is owned by Sze Man Tam (NUR).
Please send comments and enquiries related to the form to here.
If you find the form is in violation of the Terms of Service, please let us know here.

Attitudes of Health Professionals towards Advance Care Planning (ACP)

Attitudes of Health Professionals towards Advance Care Planning (ACP)

A. Demographic

B. Experience with ACP

C. Factors influencing ACP