Nursing home staff members’ knowledge, experience and attitudes regarding advance care planning: a cross-sectional study involving 12 Italian nursing homes

Background: Advance care planning may be beneficial for nursing home residents, but its implementation is suboptimal in several countries. Aims: To investigate knowledge of, attitudes towards, and experience with advance care planning of nursing home staff members in Italy. Methods: Cross-sectional survey involving all healthcare professionals working in 12 Italian nursing homes. Statistical analyses investigated interactions between participants’ characteristics, knowledge, attitudes and frequency of advance care planning discussion with residents. Results: Of the 185 participants (80.5% female, mean age 43.6 ± 9.2 years), 29.7% reported that they had heard of advance care planning, but their actual knowledge was suboptimal. Participants had positive attitudes towards advance care planning, and most of them clearly recognized its benefits. Apprehension about upsetting the patient or their family, or that patients were not ready for these conversations were the main concerns. Only 16% of respondents discussed advance care planning at least sometimes, usually upon patient/family input. Greater knowledge was significantly correlated with more positive attitudes towards advance care planning. The issues of healthcare professionals’ knowledge and training in advance care planning, and of knowledge and awareness of advance care planning in patients, their families, and the general population were considered either main barriers or facilitators. Discussion: Nursing home staff members’ concerns towards advance care planning seemed to be related to a misconception about patient and family willingness to discuss it. Conclusions: A multifaceted strategy including educational and training programmes and the increase of public awareness is needed to implement advance care planning in Italian nursing homes.