Ojerinde Gloria Y, Mohammed Kahee A
Internal Medicine, SSM Health St. Mary's Hospital, St. Louis, USA.
Internal Medicine, Saint Louis University - School of Medicine, St. Louis, USA.
Cureus. 2025 Jun 20;17(6):e86416. doi: 10.7759/cureus.86416. eCollection 2025 Jun.
Background Advance Care Planning (ACP) is an essential component of patient-centered care, particularly in end-of-life contexts. This study aimed to assess the knowledge, attitudes, and practices related to ACP among resident physicians at St. Mary's Hospital, St. Louis, USA, with a focus on perceived skillfulness, comfort level, cultural and religious influences, and perceived barriers to ACP discussions. Methods A cross-sectional quantitative study was conducted using an online questionnaire distributed to all Internal Medicine and Family Medicine residents at St. Mary's Hospital. Of the 48 invited residents, 36 completed the survey. Data were analyzed using descriptive statistics via Excel (Microsoft® Corp., Redmond, WA, USA). Ethical exemption was granted by the Institutional Review Board. Results While 61.1% (n = 22) of respondents reported prior training and knowledge of ACP, a significant proportion lacked awareness of state laws and documentation procedures for advance directives. Despite encountering more than five patients weekly, 94.4% (n = 34) had ACP discussions with only one to two patients. Although 86.1% (n = 31) expressed a positive attitude and willingness to engage in ACP discussions, only 33.3% (n = 12) routinely involved family members. Cultural background influenced ACP communication for 41.7% (n = 15) of residents, while 72.2% (n = 26) reported no influence from their religious background. Most residents felt skillful and comfortable discussing core ACP topics, particularly cardiopulmonary resuscitation (CPR), Intensive Care Unit (ICU) admission, and disease prognosis. However, assisting patients in completing advance directives remained a notable area of lower perceived competence. Comfort levels were highest in areas where residents also felt most skilled. Conclusion The findings highlight a gap between theoretical knowledge and practical application of ACP, particularly in legal aspects and documentation. Despite positive attitudes and self-reported competence in communication, limited engagement with patients and families indicates a need for more targeted training, especially in legal frameworks and documentation procedures. Enhancing these areas could better equip residents to conduct meaningful and comprehensive ACP discussions.
背景 预先护理计划（ACP）是以患者为中心的医疗护理的重要组成部分，尤其是在临终情境中。本研究旨在评估美国密苏里州圣路易斯市圣玛丽医院住院医师对ACP的知识、态度和实践情况，重点关注感知技能、舒适度、文化和宗教影响以及ACP讨论的感知障碍。方法 采用在线问卷对圣玛丽医院所有内科和家庭医学住院医师进行横断面定量研究。在48名受邀住院医师中，36人完成了调查。通过Excel（美国华盛顿州雷德蒙德市微软公司）使用描述性统计方法对数据进行分析。机构审查委员会批准了伦理豁免。结果 虽然61.1%（n = 22）的受访者报告曾接受过ACP培训并具备相关知识，但很大一部分人对预先指示的州法律和文件程序缺乏了解。尽管每周遇到超过五名患者，但94.4%（n = 34）的人仅与一两名患者进行过ACP讨论。虽然86.1%（n = 31）表示态度积极并愿意参与ACP讨论，但只有33.3%（n = 12）经常让家庭成员参与。41.7%（n = 15）的住院医师表示文化背景会影响ACP沟通，而72.2%（n = 26）报告宗教背景没有影响。大多数住院医师在讨论ACP核心主题时感觉熟练且自在，尤其是心肺复苏（CPR）、重症监护病房（ICU）收治和疾病预后。然而，协助患者完成预先指示仍然是一个明显感觉能力较低的领域。在住院医师感觉最熟练的领域，舒适度也最高。结论 研究结果凸显了ACP理论知识与实际应用之间的差距，尤其是在法律方面和文件记录方面。尽管态度积极且自我报告沟通能力较强，但与患者及其家属的接触有限表明需要进行更有针对性的培训，特别是在法律框架和文件程序方面。加强这些领域可以使住院医师更好地进行有意义和全面的ACP讨论。
