Barriers and facilitators to nurse-led advance care planning and palliative care practice change in primary healthcare: a qualitative study.

Primary care settings are ideal for initiating advance care planning (ACP) conversations and assessing palliative and supportive care needs. However, time constraints and a lack of confidence to sensitively and efficiently initiate such discussions are noted barriers. The Advance Project implemented a national multicomponent training package to support Australian general practice nurses (GPNs) to work with GPs to initiate ACP and palliative care conversations in their practice. This paper reports on semistructured interviews conducted with 20 GPNs to explore barriers and facilitators to implementing the Advance Project model. Participants identified a range of factors that affected implementation, including lack of time, limited support from colleagues, lack of knowledge about systems and funding processes in general practice and a need for better alignment of the Advance Project resources and practices with general practice information management platforms. Barriers related to professional roles, particularly the lack of clarity and/or limitations in the scope of practice of GPNs, highlighted the importance of defining and supporting the roles that different primary health practice staff could play to support implementation of the model. The findings underline the need for complementary training in the Advance Project model for GPs and practice managers to enable a team-based approach to implementation.

"I can do it": does confidence and perceived ability in learning new ICT skills predict pre-service health professionals' attitude towards engaging in e-healthcare?

BACKGROUND: There are many factors affecting health professionals' willingness to engage in e-health. One of these factors is whether health professionals perceive themselves to be able to learn new skills, and have the confidence in mastering these new Information and Communication Technology (ICT) skills. OBJECTIVE: This study examined how health students' confidence and perceived ability for learning new ICT skills affect their attitude towards engaging in e-health. METHODS: A survey was conducted to explore students' attitude towards using e-health and their perceived self-efficacy and confidence to learn new ICT skills. Multiple regression analysis was used to examine the relationship between confidence and self-efficacy, and attitude towards engaging in e-health controlling for participants' age, gender, and prior IT learning experience. RESULTS: The three scales measuring attitude, confidence and self-efficacy showed good internal consistency with respective Cronbach's Alpha scores of 0.835, 0.761 and 0.762. Multiple regression analysis showed a significant relationship between confidence, self-efficacy and prior IT learning experiences with attitude towards e-health after adjusting for the effect of each other (F3,350=17.20,p<0.001). CONCLUSION: Self-efficacy and confidence in learning new ICT skills together with previous ICT training either at or outside their university studies are significant factors associated with students' attitude towards using e-health. Enhancing students' level of self-efficacy in learning new ICT skills may be the key to the success of implementation of e-health initiatives.