How Hong Kong nurses can help patients make end-of-life treatment choices, with the right training
Advance directives provide an opportunity for seriously ill patients, such as those with advanced cancer, to make clear their willingness to receive life-sustaining treatments when they approach death, before they become mentally or physically incapable to do so. Nevertheless, the use of advance directives is rare in Hong Kong.
Indeed, a telephone survey conducted by our team last year revealed that fewer than one-fifth of Hong Kong people have heard of such directives.
Health care professionals play an important role in publicising the use of advance directives. They can help to introduce the concept to the public, facilitate discussions between patients and their family members for decision-making, and provide guidance based on the patients’ wishes.
To do this, health care professionals must have excellent communication skills. A patient-centred approach in training would help to enhance their ability to be more perceptive about patients’ feelings during discussions on treatment options. This will help to build rapport and trust between the patient and the health care professional.
Family members should also be involved in the discussion on treatment options. This helps them gain a better understanding of the patients’ wishes, which can head off potential conflicts in the future when decisions have to be made.
Given their rich experience in working with patients, nurses are in a good position to facilitate the dialogue on advance care planning between health care professionals and patients. In view of this, we recommend training programmes to sharpen the communication skills of nurses.
In such training, role-play workshops may be included. Value-based, rather than procedure-based, educational sessions can help nurses understand the values and preferences of seriously ill patients.
Indeed, the extent to which patients value quantity of life versus quality of life could affect their preferences in life-sustaining treatments. It is hoped that tailor-made training on advance care planning will enable health care professionals to help patients make informed decisions, and reduce their suffering by increasing their autonomy to refuse unnecessary medical treatments when they approach death.
Carmen W.H. Chan, professor, and Nancy H.Y. Ng, doctor of nursing student, The Nethersole School of Nursing, Chinese University of Hong Kong