Authors: (including presenting author): :
Hwang LM, Chan CH, Lee A, Cheung KW, Wong PL
Affiliation: :
Palliative Home Care Team, Nursing Services Division, New Territories West Cluster
Keyword 1: :
Advance Medical Directive (AMD)
Keyword 2: :
Advance Care Planning (ACP)
Keyword 3: :
ADLST Ordinance
Keyword 4: :
Communication skills
Keyword 5: :
End-of-life (EOL) care
Introduction: :
The Advance Decision on Life-sustaining Treatment (ADLST) Ordinance, gazetted on 29 November 2024, strengthens patient autonomy in end-of-life care decisions in Hong Kong. Recognizing nurses' pivotal role in these sensitive discussions, the New Territories West Cluster (NTWC) developed "Navigating Advance Medical Directives (AMD): Essential Skills for Nurses" to equip frontline staff with necessary communication and ethical decision-making skills. This training initiative aligns with the Hospital Authority's "People-centred Care" values, addressing critical service gaps while ensuring compliance with the new ordinance.
Objectives: :
This program aims to empower nurses to facilitate high-quality advance care planning (ACP) by: 1.Building a strong understanding of the ADLST Ordinance’s legal and ethical frameworks, including updated documentation requirements; 2.Developing advanced communication and advocacy skills for compassionate ACP/AMD discussions; and 3.Promoting a culture of patient autonomy by ensuring end-of-life wishes are properly documented and respected.
Methodology: :
This training program targeted experienced nurses with over 3 years of clinical practice. The comprehensive curriculum covered: the ADLST Ordinance's legislative background, core ethical principles (autonomy, beneficence, non-maleficence, justice), AMD and DNACPR definitions/requirements, comparative analysis of legacy versus updated documentation systems, and practical workflows for document administration. The program employed a blended learning approach combining didactic instruction with interactive workshops and simulated clinical scenarios through role-playing exercises. Quantitative assessments via pre- and post-training questionnaires evaluated improvements in participants' domain knowledge, self-reported confidence levels, and applied communication competencies.
Result & Outcome: :
In 2025, two training sessions for 51 nurses achieved: o 4.85/5 satisfaction scores
o 38-42% knowledge test score improvements o 92% reported higher confidence in ACP discussions The role-play exercises effectively enhanced communication skills for AMD/ACP conversations.
Post-training, nurses demonstrated stronger competencies in: o Explaining updated documents o Guiding end-of-life decisions o Maintaining legal compliance The program successfully built NTWC's capacity for patient-centered, legally sound end-of-life care.
