Physicians and nurses’ knowledge and attitudes towards advance directives for cancer patients in Saudi Arabia

Background: Advance Directives (ADs) empowers patients to make end-of-life needs should they lose their capacity to make medical decisions. This study aimed to investigate physicians’ and nurses’ knowledge and attitudes toward Advance Directives (ADs) for cancer patients.

Methods: A cross-sectional study was conducted using a newly developed Knowledge and Attitudes toward Advance Directives (KAADs) scale. The study was carried out among a sample of physicians and nurses in three specialized area providing care for cancer patients at a tertiary care hospital. Main outcome variables were the total scores of knowledge and attitudes toward ADs.

Results: A total of 111 physicians and 170 nurses participated in this study. Most physicians were men (95, 80.5%), whereas most nurses were women (147, 86.5%). The mean (standard deviation; SD) total knowledge score was 6.8 (4.0) for physicians and 9.1 (3.0) for nurses (p < 0.001). There was a significant difference in the total knowledge score between nurses and physicians, with an adjusted mean difference of 1.54 (95% confidence interval [CI]; 0.08–2.97). Significant independent predictors of knowledge of ADs were female sex (1.60, 95% CI; 0.27–3.13) and edu- cation level (master’s versus bachelor’s: 1.26, 95% CI; 0.30–2.33 and Ph.D. versus bachelor’s: 2.22, 95% CI; 0.16–4.52). Nurses’ attitudes appeared to be significantly more positive than those of physicians, and the mean total attitude score (SD) was 19.5 for nurses (6.2) and 15.1 (8.1) for phy- sicians (p < 0.001). The adjusted mean difference (95% CI) for nurses versus physicians was 3.71 (0.57–6.98). All participants showed a high level of knowledge of ADs; however, nurses showed considerably more positive attitudes than physicians.

Conclusion: There was a significant disparity of advance directives knowledge between nurses and physicians in favor of nurses. Moreover, nurses have significant positive attitudes than physicians do. The results of this study should motivate hospital policy stakeholders to assert physicians and nurses’ responsibilities to patients regarding advance directives.

Author(s): Isamme AlFayyad

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