Identifying Predictors of Knowledge, Attitude and Practice Intentions Regarding Advance Care Planning Among Medical...

This study aimed to explore latent categories of nursing and medical students' knowledge, attitude and practice intentions regarding advance care planning (ACP), and to identify the factors influencing these categories. It sought to provide an evidence base for developing personalized, precision-targeted advance care planning educational interventions.

From October to December 2023, a stratified cluster random sampling method was employed to select a sample of 1006 undergraduate students in clinical medicine and nursing (Years 1-4) from a medical university in eastern China. A total of 935 valid questionnaires were recovered. Research instruments included a self-developed demographic questionnaire, the advance care planning knowledge, attitude and practice intentions Questionnaire, the Death Attitude Profile-Revised, and the Meaning in Life Questionnaire. Latent profile analysis determined the optimal number of categories; logistic regression identified factors influencing different advance care planning knowledge, attitude and practice intentions categories; a nomogram was constructed using R software, and predictive performance was evaluated using area under the curve (AUC), Hosmer-Lemeshow test, and 1000-bootstrap calibration curves.

Latent profile analysis identified two latent categories: a "collaborative" group (33.6% of the sample) and a "lagging" group (66.4% of the sample). The collaborative group scored higher than the lagging group across all dimensions of advance care planning knowledge, attitude and practice intentions questionnaire. Logistic regression analysis indicated: palliative care training (OR = 1.5, 1.028-2.190), resuscitation experience (OR = 0.64, 0.424-0.966), clinical medicine student (OR = 0.537, 0.376-0.766), urban student (OR = 0.626, 0.419-0.935), high death escape scores, low natural acceptance scores, and low meaning in life questionnaire scores were more likely to be classified as "lagging type". Senior students (OR = 7.217, 4.089-12.737) and those with positive major attitude (OR = 3.572, 1.228-10.386) were more likely to be classified as "collaborative type". The nomogram demonstrated good discriminatory ability (AUC = 0.864; 95% CI 0.841-0.887; Brier score = 0.14) and high calibration (χ² = 13.845, p = 0.086; calibration slope = 0.97).

The established nomogram model identified the influencing factors of the knowledge, attitude and practice Intentions level of advance care planning among medical undergraduates, providing empirical evidence for the educational intervention of advance care planning for nursing and medical undergraduates. Universities needed to carry out refined advance care planning education in a targeted manner based on the different characteristics of students.

To strengthen the validity of the research, it was planned, conducted and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.

All participants contributed to the conducting of this study by completing self-reported questionnaires.