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Knowledge and self-efficacy in starting advance care planning among community health and social care professionals in macao: A cross-sectional study

Year: 2026

Type: article

Abstract: Background: Advance care planning (ACP) has limited uptake in Macao despite increasing public interest. Little is known about frontline professionals' readiness to initiate ACP in community and long‑term care. Aims: To assess ACP knowledge, self‑efficacy, and practice among community‑based health and social care professionals in Macao, and to examine how these factors relate to ACP implementation. Design: Cross‑sectional survey of physicians, nurses, therapists and social workers working across tertiary hospitals, community day centres and community long‑term care facilities in Macao. Methods: Structured questionnaire covering demographics, ACP knowledge (11 true/false items), self-efficacy in ACP communication (11 items, 1-10 scale), and ACP practice engagement (four scored items coded 0-2 and summed to 0-8, plus two unscored conditional follow-up questions). Descriptive statistics, correlations and regression explored associations between knowledge, self-efficacy and practice engagement. Results: A total of 213 professionals participated (nurses 67.1%; physicians 6.6%; therapists 7.5%; social workers 18.8%). Engagement in ACP activities was generally low, with 14.1% reporting prior ACP discussions with patients or families. ACP practice engagement was positively associated with knowledge (r = 0.25, p < 0.001) and self-efficacy (r = 0.33, p < 0.001). In the final regression model, self-efficacy had the largest standardised coefficient (β=0.25, p < 0.001); knowledge, master's-level education, organisational ACP implementation, and work setting were also independently associated with practice engagement. Prior ACP training was significant in Model 1 but not in the final model (B = 0.33, p = 0.24). The final model explained 25.5% of the variance in ACP practice engagement. Conclusions: Advance care planning practice among health and social care professionals in Macao remains limited. Although both ACP knowledge and self-efficacy were associated with ACP practice, self-efficacy emerged as the stronger predictor of professionals' engagement in ACP discussions. Implications: Improving ACP uptake in Macao requires skills-based training that combine knowledge acquisition with experiential communication to strengthen professionals' self-efficacy. Organisational support and structured ACP implementation processes are also needed to facilitate sustainable ACP practice.

Source: International Journal of Nursing Studies Advances

DOI: 10.1016/j.ijnsa.2026.100716

Authors: Kuai In Tam, Sok Leng Che, Sok Man Leong

Institution: Kiang Wu Hospital

Language: English

Topic: Palliative Care and End-of-Life Issues

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,930