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Effect of Advance Care Planning Education on Advance Care Planning Knowledge among Adults in Nigeria

Abstract

Advance care planning is an important component of person-centred healthcare that enables individuals to consider and communicate their preferences regarding future healthcare decisions, particularly in situations where they may become unable to make or communicate decisions independently. It may involve discussions about treatment preferences, healthcare goals, preferred decision-makers, end-of-life care, and documentation of personal healthcare wishes. Despite its potential importance, awareness and understanding of advance care planning may be limited among adults in Nigeria due to inadequate public education, cultural and religious considerations, misconceptions about end-of-life discussions, limited knowledge of available planning options, and concerns about discussing future illness and death. Advance care planning education provides an opportunity to improve understanding of the purpose, processes, benefits, and ethical considerations associated with advance care planning. Against this background, this study investigates the effect of advance care planning education on advance care planning knowledge among adults in Nigeria. The study will be anchored on the Health Belief Model, Shared Decision-Making Model, and Health Literacy Framework. The Health Belief Model explains how adults' perceptions of future health risks, perceived benefits of advance care planning, perceived barriers, and cues to action may influence their acquisition and application of advance care planning knowledge. The Shared Decision-Making Model emphasizes communication between individuals, families, and healthcare professionals in making informed decisions that reflect patients' values, preferences, and healthcare goals. The Health Literacy Framework emphasizes the ability of individuals to access, understand, evaluate, and use healthcare information when making informed decisions about their health. Collectively, these theoretical perspectives provide a suitable framework for explaining how advance care planning education may influence advance care planning knowledge among adults in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adults aged 18 years and above residing in selected urban and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, and eligible adults. Advance care planning education will be assessed using indicators such as exposure to structured educational sessions, frequency and duration of education, information on advance care planning concepts, healthcare preferences, treatment goals, advance directives where applicable, designation of a preferred healthcare decision-maker, communication of healthcare wishes, family discussions, documentation of preferences, ethical considerations, confidentiality, and the role of healthcare professionals in advance care planning. Advance care planning knowledge will be assessed using indicators such as understanding of the purpose of advance care planning, healthcare decision-making, advance directives, future treatment preferences, surrogate or substitute decision-making, communication of healthcare wishes, documentation, informed consent, patient autonomy, confidentiality, and relevant legal and ethical considerations. Data will be collected using structured questionnaires, validated advance care planning knowledge instruments, educational programme attendance records, and relevant community or healthcare programme documents. Descriptive statistics will be used to summarize participants' characteristics, exposure to advance care planning education, and knowledge scores. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of advance care planning education on advance care planning knowledge. Where a quasi-experimental design is adopted, knowledge scores before and after the educational intervention may be compared to determine changes associated with the programme. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that advance care planning education has a significant positive effect on advance care planning knowledge among adults in Nigeria. Adults exposed to structured and culturally sensitive education are expected to demonstrate improved understanding of advance care planning, healthcare decision-making, treatment preferences, communication of healthcare wishes, and the role of designated decision-makers. Education may also correct misconceptions that advance care planning is only relevant to individuals who are terminally ill or near the end of life. Discussions involving healthcare professionals and family members may improve understanding and encourage individuals to consider and communicate their healthcare preferences before a serious health event occurs. However, cultural and religious beliefs, discomfort with discussions about death, limited health literacy, concerns about family reactions, misconceptions about advance directives, and limited availability of healthcare professionals trained in advance care planning may affect knowledge acquisition. The study therefore expects accessible, culturally appropriate, ethically sensitive, and regularly reinforced advance care planning education to contribute significantly to improved advance care planning knowledge among adults in Nigeria. The study is expected to contribute to the literature on advance care planning education, advance care planning knowledge, patient autonomy, shared decision-making, health literacy, end-of-life care, healthcare communication, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, hospitals, primary healthcare centres, healthcare professionals, palliative care providers, community health workers, religious and community organizations, development partners, and policymakers regarding strategies for improving public understanding of future healthcare planning. The study will also provide evidence-based recommendations for integrating advance care planning education into health promotion and healthcare services, developing culturally appropriate educational materials, strengthening healthcare worker training, encouraging appropriate family discussions, improving public understanding of advance directives and healthcare decision-making, and promoting patient-centred approaches to future healthcare planning across Nigeria.

Keywords: Advance care planning education, advance care planning knowledge, adults, advance directives, healthcare decision-making, patient autonomy, shared decision-making, health literacy, end-of-life care, Nigeria, public health.