title: What do renal health-care professionals in Singapore think of advance care planning for patients with end-stage renal disease?
abstract: OBJECTIVE
  Previous studies have focused either on advance medical directives rather than advance care planning (ACP), or on patient's perspectives on ACP rather than those of the health-care providers. This study aimed to explore the knowledge, attitudes and experience of renal health-care professionals in Singapore on ACP for patients with end-stage renal failure.
  
  
  METHODS
  A 41-item questionnaire was distributed to physicians, nurses, medical social workers (MSW) and other allied health professionals working in renal units. The questionnaire had four sections: demographics of the respondents, knowledge of, attitudes to and experience with ACP.
  
  
  RESULTS
  Of a total of 620 survey forms, 562 were returned, giving a response rate of 90.6%. Medical social workers and physicians had higher knowledge scores than the rest. Of doctors and MSW, 82.4% and 100%, respectively, considered ACP discussions as part of their role, but only 37.1% of nurses and 38.1% of other allied health-care professionals thought likewise. Nurses appeared to be the least confident in conducting ACP discussions, and most fearful of upsetting patients and families. Medical social workers were the most confident. The main barriers for physicians appeared to be lack of time, concerns regarding family backlash and the perception that patients were not prepared to discuss ACP.
  
  
  CONCLUSIONS
  Training of renal health-care professionals in ACP should aim to correct misunderstandings surrounding ACP, address potential barriers and impart communication skills. In particular, renal nurses will need encouragement to initiate discussions and be equipped with the skills to do so.
authors.affiliation: Department of Palliative Medicine, Khoo Teck Puat Hospital, Singapore. alethea.yee.c.p@nccs.com.sg
authors.forename: Alethea
authors.initials: A
authors.lastname: Yee
authors.forename: Ying Ying
authors.initials: YY
authors.lastname: Seow
authors.forename: Sze Huey
authors.initials: SH
authors.lastname: Tan
authors.forename: Cynthia
authors.initials: C
authors.lastname: Goh
authors.forename: Limin
authors.initials: L
authors.lastname: Qu
authors.forename: Grace
authors.initials: G
authors.lastname: Lee
mesh_terms: D032722:Advance Care Planning; D001291:Attitude of Health Personnel; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D009726:Nurses; D010820:Physicians; D012846:Singapore; D012947:Social Work; D011795:Surveys and Questionnaires