Advance care planning communication training workshop for professional care workers in Japan: A mixed-method approach

Advance care planning (ACP) is a process of communication between individuals and care teams. ACP enables individuals to make informed decisions regarding their future healthcare and support when their capacity to express or discuss personal choices becomes restricted. In this study, we aimed to develop and implement an ACP educational program for Japanese professional care workers and describe changes in their attitudes and practices post-implementation. We developed an ACP educational program. Eighty-two professional care workers from 5 prefectures participated from January to September 2019. We conducted pre- and post-tests, post-program interviews, and written interviews 3 months post-program. Changes in knowledge and attitudes were statistically analyzed, and interviews were analyzed using qualitative content analysis. The program helped participants improve their knowledge of substitute decision-making by families, withdrawal of tube feeding, and living wills. Participants experienced reduced difficulty in caring for dying patients. The qualitative analysis of post-program interviews identified the following 7 themes: foundational knowledge of ACP, attentive interviewing, inferring clients' preferences from informal conversation, rapport-building, consensus-building among stakeholders, merits of initiating ACP discussions by professional care workers, and skill in explaining the concept of a living will. The written interviews conducted after 3 months identified the following 4 themes: discussion opportunities, discussion skills, self-determination and substitute decision-making, and thinking about death as a personal matter. These qualitative analyses reinforced and explained the quantitative survey results. The ACP educational program presented herein helps improve the education of professional care workers and disseminates ACP.