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Knowledge, Attitudes, and Practice Behaviors of Oncology Advanced Practice Nurses Regarding Advanced Care Planning for Patients With Cancer

Guiyun Zhou
Jill C. Stoltzfus
Arlene D. Houldin
Susan M. Parks
Beth Ann Swan
ONF 2010, 37(6), E400-E410 DOI: 10.1188/10.ONF.E400-E410

Purpose/Objectives: To establish initial reliability and validity of a Web-based survey focused on oncology advanced practice nurses' (APNs') knowledge, attitudes, and practice behaviors regarding advanced care planning, and to obtain preliminary understanding of APNs' knowledge, attitudes, and practice behaviors and perceived barriers to advanced care planning.

Design: Descriptive, cross-sectional, pilot survey study.

Setting: The eastern United States.

Sample: 300 oncology APNs.

Methods: Guided by the Theory of Planned Behavior, a knowledge, attitudes, and practice behaviors survey was developed and reviewed for content validity. The survey was distributed to 300 APNs via e-mail and sent again to the 89 APNs who responded to the initial survey. Exploratory factor analysis was used to examine the construct validity and test-retest reliability of the survey's attitudinal and practice behavior portions.

Main Research Variables: Respondents' demographics, knowledge, attitudes, practice behaviors, and perceived barriers to advanced care planning practice.

Findings: Exploratory factor analysis yielded a five-factor solution from the survey's attitudes and practice behavior portions with internal consistency using Cronbach alpha. Respondents achieved an average of 67% correct answers in the 12-item knowledge section and scored positively in attitudes toward advanced care planning. Their practice behavior scores were marginally positive. The most common reported barriers were from patients' and families' as well as physicians' reluctance to discuss advanced care planning.

Conclusions: The attitudinal and practice behaviors portions of the survey demonstrated preliminary construct validity and test-retest reliability. Regarding advanced care planning, respondents were moderately knowledgeable, but their advanced care planning practice was not routine.

Implications for Nursing: Validly assessing oncology APNs' knowledge, attitudes, and practice behaviors regarding advanced care planning will enable more tailored approaches to improve end-of-life care outcomes.

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