Care staff's self-efficacy regarding end of life communication in long term care facilities: Results of a cross-sectional study in 6 European countries (PACE)

  • M. T
  • B.D. O
  • M. K
  • et al.
ISSN: 1477-030X
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Research aims: Communicating about end-of-life (EOL) matters is an essential part of providing care to older people in long term care facilities (LTCFs). When care staff do not feel competent to discuss these issues, they could fail in starting conversations about EOL issues. However, not much is known about whether LTCF staff feel competent to engage in EOL conversations. This research compares among 6 European countries the care staff's level of self-efficacy regarding EOL communication in LTCFs. This study also assesses which country, facility and staff characteristics are related to care staff's self-efficacy regarding EOL communication. Study population: In total 2275 care staff members in 305 LTCFs participated in the research project, of whom 1680 in 290 LTCFs filled in all questions on self-efficacy and were included in the current study. Study design and methods: A cross-sectional survey of care staff (nurses and care assistants) was conducted in a random sample of representative LTCFs in Belgium, England, Finland, Italy, the Netherlands and Poland. Staff rated their self-efficacy on a scale of 0-7 (cannot do at all-certain can do) on the communication subscale of the Self-efficacy in End-of-Life Care survey, which comprises 8 statements regarding EOL communication. Method of statistical analysis: Generalized estimating equations were used to account for clustering of data on facility level. Results and interpretation: The proportion of staff with a mean selfefficacy score >5 was 76.4% in the Netherlands, ranged between 55.9% and 60.0% in Belgium, Poland, England and Finland and was only 29.6% in Italy. Factors related to higher self-efficacy scores included: staff >50 years of age, working as a nurse (compared to care assistant), completed higher secondary or tertiary education, formal training in palliative care, >10 years working in resident care, working in a facility with onsite nurses and offsite physicians, working in a facility with guidelines on palliative care and working in the Netherlands or England. In general perceived self-efficacy seems to be a precursor to actually performing a certain practice. LTCFs could improve staff's self-efficacy and practices on EOL communication by providing education and supporting staff with guidelines regarding palliative care.




M., T. K., B.D., O.-P., M., K., L., V. D. B., T., S., L., D., … H.R.W., P. (2018). Care staff’s self-efficacy regarding end of life communication in long term care facilities: Results of a cross-sectional study in 6 European countries (PACE). Palliative Medicine, 32(1), 23. Retrieved from

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