End-of-Life Law for Clinicians: Improving health professionals' legal knowledge and confidence in practice
An article written by Dr Rachel Feeney and Ms Penny Neller
End-of-life law governs decision-making at the end of life, the provision of palliative care and advance care planning. Importantly, these laws safeguard the interests of patients and protect health professionals acting within the law. However, there is evidence that health professionals have important knowledge gaps in this area, and many are not confident applying the law in clinical practice.
There is a lack of dedicated training on end-of-life law as well as research about this type of training. Now in its 7th year, ELLC is a national training program funded by the Australian Department of Health and Aged Care to deliver free education to health professionals about the law on end-of-life decision-making. Topics covered in the online modules include capacity and consent, Advance Care Directives, substitute decision-making, withholding and withdrawing treatment, pain relief, and voluntary assisted dying.
We examined the impact of the End of Life Law for Clinicians (ELLC) online training modules on Australian health professionals' knowledge of key concepts of end-of-life law and self-reported confidence in applying the law in clinical practice. Our findings were recently published in BMC Palliative Care. [1]
Study summary and findings
Study participants
ELLC participants completed online pre- and post-training surveys that directly assessed legal knowledge (using 10 questions) and measured self-reported confidence in applying the law (using a 4-point rating scale where 1 was 'not at all confident' and 4 was 'very confident'). Data was collected between 31 January 2019 and 31 October 2022 from 136 participants, including nurses (45%), doctors (34%), allied and other health professionals (12%), medical students (7%), and non-health professionals (2%). Participants' most common work settings were hospitals (46%) and residential aged care facilities (10%). 11% were students with no current work setting. Participants reported an average of 17 years of clinical practice. 82% of participants had not undertaken any other education or training about end-of-life law in the last 12 months.
Improved knowledge and confidence after ELLC training
A key finding of this study was that training completion increased health professionals' legal knowledge and confidence in applying the law in clinical practice. Following training, legal knowledge scores significantly increased overall (average increase of 2.3 correct answers from 10) and across each domain of end-of-life law assessed. On average, training participants were more confident in applying the law in practice after training (median = 3.0, 'confident') than before training (median = 2.0, 'not confident').
These results are not only statistically significant but large enough to be meaningful in a clinical setting, demonstrating the effectiveness of the ELLC training, and its unique contribution to improving clinical practice.
Though ELLC fills an identified gap in current education and training, study participants demonstrated some remaining knowledge gaps after training, with only 9% correctly answering all knowledge questions. This suggests that health professionals who require a very high level of proficiency in end-of-life law (including doctors, who often carry the legal responsibility for end-of-life decision-making), may benefit from further education and training in this area. Education and training should be ongoing, ensuring that health professionals' legal knowledge remains current given ongoing changes to the law (e.g., concerning voluntary assisted dying).
Useful links
Author
Dr Rachel Feeney
Postdoctoral Research Fellow, Project Research Coordinator
Queensland University of Technology
Ms Penny Neller
Project Manager
National Palliative Care Projects
Reference
- Feeney R, Willmott L, Neller P, Then SN, Yates P, White B. Online modules to improve health professionals' end-of-life law knowledge and confidence: A pre-post survey study. BMC Palliat Care. 2023 Oct 31;22(1):165.