The readiness of knowledge, attitude and confidence and associated factors of implementing living wills among healthcare professionals in Shenzhen: a cross-sectional study.

BACKGROUND: On January 1st, 2023, Shenzhen became the first city to legalize living wills in China. However, less was known about the readiness of healthcare professionals (HCPs) to implement Article 78 of the Shenzhen Special Economic Zone Medical Regulations. Our team aimed to timely examine the HCPs' readiness in Shenzhen, including their knowledge, attitude and confidence as well as associated factors. METHODS: A cross-sectional study was conducted among 685 doctors and nurses across 16 hospitals using convenience sampling between February and March 2023 in Shenzhen, China. A validated, self-designed electronic questionnaire consisting of 22 items was used to assess knowledge, attitude, confidence, and related factors. The scale-level content validity index (S-CVI) for these three dimensions was 94.4%, 96.7%, and 93.3%, respectively. The internal consistency reliability (Cronbach's α) for the three dimensions was 0.693, 0.944, and 0.890, respectively. RESULTS: Only 315 participants (46.0%) demonstrated adequate knowledge (score ≥ 9), with an average correct rate of 65.4%. Most participants had a positive attitude (644/685, 94.0%), and 596 (87.0%) scored ≥ 16 on confidence. However, many lacked confidence in validating living wills (350/685, 51.1%), mitigating legal risks (322/685, 47.0%), and adhering to ethical principles (161/685, 23.5%). HCPs who had cared for terminally ill patients were more likely to have better knowledge (OR = 1.391, 95% CI: 1.013-1.910), attitude (OR = 2.564, 95% CI: 1.316-4.997), and confidence (OR = 1.703, 95% CI: 1.086-2.670). Those with a bachelor's (OR = 3.348, 95% CI: 1.613-6.951) or master's degree (OR = 2.645, 95% CI: 1.080-6.477) showed more positive attitudes. Prior training improved confidence (OR = 3.035, 95% CI: 1.080-8.529). Most participants preferred doctors (556/685, 81.17%), family members (513/685, 74.89%), and lawyers (511/685, 74.6%) to discuss living wills, while fewer preferred nurses (321/685, 46.86%) or social workers (241/685, 35.18%). CONCLUSION: HCPs generally supported living wills but lacked legal and ethical confidence for implementation. Targeted training integrating medical, legal, ethical, and cultural components is urgently needed to promote patient autonomy and support policy implementation in Shenzhen.