# Assessment of Resident Physicians’ Knowledge, Attitudes, and Practices Concerning Advance Care Planning: A Cross-Sectional Study

## TL;DR

This study finds that resident physicians have limited practical knowledge of advance care planning laws and documentation despite positive attitudes and some training.

## Contribution

Quantifies knowledge gaps and practical barriers in ACP among resident physicians using a cross-sectional survey approach.

## Key findings

- 61.1% of residents had ACP training but many lacked knowledge of state laws and documentation.
- Only 33.3% routinely involved families in ACP discussions despite high willingness to engage.
- Residents felt less competent in helping patients complete advance directives compared to other ACP topics.

## Abstract

Background

Advance Care Planning (ACP) is an essential component of patient-centered care, particularly in end-of-life contexts. This study aimed to assess the knowledge, attitudes, and practices related to ACP among resident physicians at St. Mary’s Hospital, St. Louis, USA, with a focus on perceived skillfulness, comfort level, cultural and religious influences, and perceived barriers to ACP discussions.

Methods

A cross-sectional quantitative study was conducted using an online questionnaire distributed to all Internal Medicine and Family Medicine residents at St. Mary’s Hospital. Of the 48 invited residents, 36 completed the survey. Data were analyzed using descriptive statistics via Excel (Microsoft® Corp., Redmond, WA, USA). Ethical exemption was granted by the Institutional Review Board.

Results

While 61.1% (n = 22) of respondents reported prior training and knowledge of ACP, a significant proportion lacked awareness of state laws and documentation procedures for advance directives. Despite encountering more than five patients weekly, 94.4% (n = 34) had ACP discussions with only one to two patients. Although 86.1% (n = 31) expressed a positive attitude and willingness to engage in ACP discussions, only 33.3% (n = 12) routinely involved family members. Cultural background influenced ACP communication for 41.7% (n = 15) of residents, while 72.2% (n = 26) reported no influence from their religious background. Most residents felt skillful and comfortable discussing core ACP topics, particularly cardiopulmonary resuscitation (CPR), Intensive Care Unit (ICU) admission, and disease prognosis. However, assisting patients in completing advance directives remained a notable area of lower perceived competence. Comfort levels were highest in areas where residents also felt most skilled.

Conclusion

The findings highlight a gap between theoretical knowledge and practical application of ACP, particularly in legal aspects and documentation. Despite positive attitudes and self-reported competence in communication, limited engagement with patients and families indicates a need for more targeted training, especially in legal frameworks and documentation procedures. Enhancing these areas could better equip residents to conduct meaningful and comprehensive ACP discussions.