"A Role You can Fill": Education Legitimizes Allied Health and Nursing Roles in Advance Care Planning: A Mixed Methods Study.

Abstract

Introduction: The implementation of advance care planning (ACP) has traditionally been confined to medical officers and specialist nurses. This study evaluated the effect of a multimodal Advance Care Planning Education (ACPEd) program for allied health professionals and generalist nurses.

Methods: Conducted within a regional health service in Queensland, Australia, the study used a single-arm, explanatory sequential mixed methods design involving 30 participants completing a three-hour workshop, and a learning circle attended by 10 participants. Quantitative data were collected through preintervention and postintervention surveys assessing perceived confidence, knowledge, skills, and role legitimacy. Qualitative data from the learning circles explored changes in clinical practice and role identity.

Results: Significant improvements were observed in confidence, t (29) = -7.820, P= <.001; knowledge, t (27) = -12.87, P= <.001; and skills, t (29) = -6.814, P= <.001. There was no significant change in perceived health professional roles, t (26) = 2.182, P= .19, indicating a strong belief that all health professional groups have a role in ACP. Three overarching themes emerged: prioritizing ACP, recognizing role legitimacy, and evolving perspectives on engagement. Despite persistent barriers including time constraints and team dynamics, participants demonstrated increased capacity and intent to initiate ACP discussions, with the ACP Tracker a key facilitator for clinical care.

Discussion: The findings suggest that targeted, interprofessional education may support the development of role identity and legitimacy for ACP among allied health professionals and generalist nurses. The ACPEd program is a scalable model for embedding ACP into practice, with implications for policy and professional development.