Knowledge, attitudes, and practices regarding advance care planning among emergency department healthcare providers in China: a multicenter cross-sectional study

Background: Emergency departments frequently treat critically ill and end-of-life patients; therefore, healthcare providers' knowledge of advance care planning (ACP) and their communication skills are crucial for identifying patients' care preferences. This study aims to investigate the current status of ACP knowledge, attitudes, and practice intentions among healthcare providers in Chinese emergency departments, together with the factors influencing them. Methods: This study conducted a multicenter, cross-sectional online survey in December 2024 among physicians and nurses in the emergency departments of 54 secondary and tertiary public general hospitals in Anhui Province, China. Descriptive statistics were used to analyze the levels of knowledge, attitudes, and practice intentions regarding ACP; Pearson correlation analysis was used to explore the relationships among these three factors; and independent-samples t-tests, one-way ANOVA, and multiple linear regression analysis were used to identify relevant influencing factors. Results: Of 720 submitted questionnaires, 686 valid responses were included in the final analysis. The mean scores for ACP knowledge, attitudes, and practice intentions were 7.25 ± 5.37, 73.91 ± 25.24, and 21.56 ± 10.31, respectively. Multiple linear regression analysis indicated that gender, age, years of experience in the emergency department, educational attainment, exposure to ACP-related information, palliative/hospice care education, and experience with end-of-life care correlated with ACP knowledge; age, years of experience in the emergency department, occupation, exposure to ACP-related information, and experience with end-of-life care correlated with ACP attitudes; and age, hospital grade, and exposure to ACP-related information correlated with ACP practice intentions. Conclusion: Emergency department healthcare providers recognized the value of ACP, but their ACP-related knowledge and practice intentions remained limited. Emergency-specific training, standardized communication and referral procedures, and clearer legal and ethical safeguards are needed to support feasible ACP-related practice in emergency settings.