Evaluating a motivational interviewing-based communication program for nurses in advance care planning: a quasi-experimental study

Abstract

Background

Nurses play a key role in advance care planning; however, communication skills and confidence gaps often limit their engagement. Motivational interviewing, an evidence-based approach that supports patient-centered decision-making, offers promise, but its application in advance care planning training for nurses remains underexplored. This study aimed to evaluate the effectiveness of a motivational interviewing-based advance care planning communication program in enhancing nurses’ knowledge about end-of-life care, attitudes toward advance directives, communication self-efficacy, general communication skills, and communication confidence.

Methods

This study employed a nonequivalent control group pretest–posttest design and was conducted at a university-affiliated hospital in South Korea between July and September 2023. Nurses from nine inpatient wards were included, with 20 nurses from five wards assigned to the control group and 18 nurses from four wards assigned to the intervention group. The intervention group completed a three-week motivational interviewing-based advance care planning communication program, whereas the control group received usual practice with general informational materials about advance care planning. Outcome measures were assessed at baseline and one-week follow-up. Between-group differences in change scores were analyzed using t-tests or Mann–Whitney U tests.

Results

Two nurses in the control group withdrew from participation, resulting in 18 nurses per group. Communication self-efficacy (mean change = 19.17 vs. 2.78; U = 69.00, p = .003) and advance care planning communication confidence (mean change = 1.28 vs. –0.11; t = 2.22, p = .033) improved significantly in the intervention group. No significant differences were observed in knowledge about end-of-life care, attitudes toward advance directives, or general communication skills.

Conclusions

The program partially improved advance care planning communication competencies, particularly self-efficacy and confidence. The results highlight the benefits of integrating motivational interviewing-based principles into advance care planning and clinical training programs. Larger studies with longitudinal follow-up are warranted to confirm the program’s effectiveness and lasting impact on advance care planning engagement.

Trial registration

Clinical Research Information Service (CRIS), KCT0011692. Registered on 09 March 2026. This study was retrospectively registered.

Background

Advance care planning (ACP) enables individuals at any stage of health or illness to discuss and document their future medical care preferences [1, 2]. Through ongoing dialogue between patients, families, significant others, and healthcare providers, ACP aims to promote alignment between medical care and the individual’s values and goals [2, 3]. The process of ACP focuses on clarifying end-of-life care preferences and identifying a proxy decision-maker. These preferences may be documented through an advance directive (AD) to guide future care, depending on the individual and healthcare context [2, 4]. Advance care planning (ACP) improves outcomes for patients as well as caregivers by enhancing end-of-life care quality; promoting adherence to care preferences; reducing unwanted interventions; and supporting caregivers through lowered psychological distress, better alignment with patient wishes, and reduced decisional conflict [5–7]. Although limited, evidence suggests that ACP also benefits the well-being of healthcare providers [8].

Healthcare providers are essential to realizing the benefits of ACP. While physicians usually initiate and lead ACP discussions, nurses’ frequent interactions with patients and families allows them to garner trust and gain a holistic understanding of patients’ needs [9–12]. This unique position enables nurses to have meaningful ACP conversations and support informed decision-making that aligns with patients’ preferences [9, 11, 13, 14]. Nursing organizations and palliative care experts recommend that nurses actively promote person-centered ACP communication so that patients’ values are clearly articulated and incorporated into care decisions [9, 13–15]. However, despite awareness of this responsibility and willingness to engage in ACP [16–18], nurses’ participation remains suboptimal due to several persistent barriers. These include discomfort in discussing sensitive topics, uncertainty about the timing of such conversations, limited role clarity, and insufficient training in conducting end-of-life communication [19–24]. These challenges are more evident among nurses outside specialized palliative or intensive care settings, where formal ACP training is limited and communication confidence remains low, highlighting the need for targeted ACP training and communication-strengthening strategies for nurses in non-specialized settings [19, 25–29].

To address these gaps, motivational interviewing (MI), a patient-centered, collaborative method designed to enhance motivation for behavioral change by exploring and resolving ambivalence, has been identified as a promising approach to improving ACP communication [30, 31]. In the context of ACP, MI provides a structured framework to support patients in navigating complex decision-making and may enhance nurses’ communication self-efficacy, skills, and confidence in facilitating ACP discussions [30, 32–34]. Although MI-based ACP interventions have demonstrated improvements in patient outcomes, including AD completion and ACP engagement [32–35], their integration into nursing education and clinical practice remains limited. Existing ACP training programs tend to emphasize knowledge, attitudes, or confidence [8, 36–39], or focus on participation in ACP conversations [36, 39, 40], with relatively limited emphasis on developing specific communication competencies. High-quality ACP communication requires nuanced skills to elicit patients’ values, address end-of-life care preferences, and facilitate collaborative documentation of care goals [14], which may not be sufficiently addressed through traditional lectures or general end-of-life education in nursing. Therefore, targeted, skills-based programs are needed to support both understanding of ACP and the development of effective communication strategies.

Building on these needs, we developed a communication-focused ACP training program designed to train nurses in MI principles. We evaluated the effects of this MI-based ACP (MI-ACP) communication program on hospital nurses’ ACP-related competencies. Specifically, we examined whether the program improves knowledge about end-of-life care, attitudes toward ADs, communication self-efficacy (i.e., perceived confidence in communication performance), general communication skills (i.e., interpersonal communication competence), and confidence in conducting ACP discussions among nurses exposed to the program compared with those who did not receive the training. We hypothesized that nurses exposed to the MI-ACP program would demonstrate greater improvements across all outcome measures, particularly in communication self-efficacy, general communication skills, and ACP-specific communication confidence. The findings may inform the integration of MI-ACP programs into nursing education and strengthen ACP practices in clinical settings.

Methods

Design and setting

A nonequivalent control group pretest–posttest (quasi-experimental) design was used to examine the effectiveness of the MI-ACP communication program. Participants were assigned at the ward level to minimize contamination; therefore, the study was considered a quasi-experimental design. The study was conducted at a university-affiliated tertiary hospital in South Korea between July and September 2023.

Participants

Nurses were recruited via convenience sampling from nine inpatient wards, including medical units (nephrology, infectious diseases, general internal medicine, pulmonology, gastroenterology, and neurology) and surgical units (cardiothoracic surgery), after obtaining managerial approval. Twenty nurses from five wards were assigned to the control group, while 18 nurses from four wards were assigned to the intervention group at the ward level using a random number function. These wards represent general inpatient settings where nurses may have varying levels of exposure to ACP discussions.

Based on the following inclusion criteria, a total of 38 nurses from these nine wards were considered eligible for study participation: (1) being a registered nurse currently employed in an inpatient unit; (2) having at least one year of clinical experience; and (3) willing to participate. The exclusion criteria were as follows: (1) having less than one year of clinical experience; (2) having work experience in palliative care; (3) having a history of a serious medical condition (e.g., advanced cardiovascular disease or cancer, including cancer survivors); (4) having a formal certification in communication or counseling; or (5) having undergone MI training.

Sample size

The required sample size was estimated using G*Power 3.1.9.2 [41], assuming a two-tailed test with α = 0.05, power (1-β) = 0.80, and a large effect size (d) = 0.80. The calculation indicated a minimum of 52 participants (26 per group). Considering a 10% dropout rate, the target sample size was set at 58 participants. However, due to institutional constraints, only 38 nurses were enrolled. Two participants in the control group withdrew, resulting in a final sample of 36 nurses (18 per group). A post hoc power analysis based on the observed difference in communication self-efficacy indicated a power of approximately 0.88 at α = 0.05.

Intervention

The MI-ACP communication program consisted of three weekly sessions, each lasting four hours, and was developed through expert validation and pilot feasibility testing. It was designed as a structured, skills-based intervention to enhance nurses’ competence in ACP communication using MI principles. The program followed a progressive learning approach from conceptual understanding to skill development and application. The educational design integrated didactic instruction with experiential learning strategies to support the acquisition and practical use of MI-based communication skills in ACP contexts.

The first session introduced foundational concepts of ACP and core MI principles, including OARS (open-ended questions, affirmations, reflective listening, and summaries) techniques and strategies for addressing ambivalence [31]. The second and third sessions focused on the development and application of communication skills through demonstration, scenario-based practice, and iterative feedback and reflection. Through these processes, participants refined MI-consistent communication techniques, including empathy, active listening, and value-based conversations, and developed the ability to apply these skills in complex ACP situations. These educational strategies are supported by prior literature indicating that experiential and interactive learning approaches, such as role-play, feedback, and scenario-based practice, are effective in enhancing communication competence, self-efficacy, and reflective practice in healthcare education [36, 37, 39, 40]. Detailed session content and activities are presented in Table 1.

Table 1.

Structure and session components of the motivational interviewing-based advance care planning (MI-ACP) communication program, including content, learning activities, and duration

Session	Content	Activities	Duration
1	• Foundational introduction to ACP and MI • Program overview, ACP concepts • Introduction to MI (spirit, OARS, ambivalence, A-O-A) • Watching videos of cases • Questions and answers	Lecture PPT Video Handouts	240 min
2	• Practical training in MI skills • Demonstration of MI skills • Scenario-based case practice • Pair practice and feedback	Practice Demonstration Discussion	240 min
3	• Advanced training and integration • Role-play based on prepared scenarios • Team-based role-play (nurse, patient/family, observer) • Feedback and reflection • Reenactment of scenarios after incorporating feedback • Experience sharing	Role-play Feedback Reflection	240 min

Abbreviations: ACP Advance care planning, A-O-A Ask-Offer-Ask, MI Motivational interviewing, OARS Open-ended questions, affirmations, reflections, summaries, PPT PowerPoint slides

The control group did not receive the MI-ACP communication program and continued with usual practice. They were provided with general informational materials about ACP without structured training.

Interventionist training

The interventionist (the principal investigator) underwent comprehensive MI training between March and June 2022. This included a 45-h graduate-level course (lectures and practice sessions) led by a domestic MI expert, 30 h of basic and advanced MI workshops hosted by the Korean Motivational Interviewing Association, and an 8-h certified international program. Using the Motivational Interviewing Training for New Trainers handbook and DVD [42], the interventionist further practiced and refined MI techniques before program delivery.

Outcome measures

Knowledge about end-of-life care was assessed using the End-of-Life Care Decision Inventory (EOL-CDI) [43], comprising 21 items (seven on end-of-life care and 14 on AD). Responses were scored as “1” for “Yes” and “0” for “No” or “Don’t know,” with the total scores ranging from 0 to 21 and higher scores indicating greater knowledge. The psychometric properties of EOL-CDI, supported by clinical nurses’ data, had a Kuder − Richardson-20 value of 0.81 [43].

Attitudes toward ADs were assessed using the Korean version of the 16-item Advance Directive Attitude Survey [44, 45]. The items are rated on a 4-point Likert scale, and the total score ranges from 16 to 64, with higher scores reflecting more positive attitudes toward ADs. The psychometric properties of the instrument have been verified among low-income chronically ill older adults, with a Cronbach’s alpha of 0.80 [44]. The reliability of the original version has been confirmed among medical inpatients (Cronbach’s alpha = 0.74) [45] and emergency and palliative care nurses (Cronbach’s alpha = 0.79) [46].

Communication self-efficacy, defined as an individual’s perceived confidence in their ability to perform communication tasks, was assessed using the Korean version of the Self-Efficacy Questionnaire (KSE-12) [47, 48]. The 12-item tool is rated from 1 (“very uncertain”) to 10 (“very certain”), with total scores ranging from 12 to 120 and higher scores indicating greater communication self-efficacy. The questionnaire’s psychometric properties have been confirmed among nursing students, with a Cronbach’s alpha of 0.98 [48].

Communication skills, defined as interpersonal communication competence across a range of contexts, were assessed using the Korean version of the Global Interpersonal Communication Competence Scale [49, 50]. The scale comprises 15 items rated on a 5-point Likert scale. The total score ranges from 15 to 75, with higher scores indicating better communication skills. The scale’s psychometric properties have been verified among college students, demonstrating a Cronbach’s alpha of 0.72 [49]. Its reliability has been confirmed among nurses, with a Cronbach’s alpha of 0.89 [46].

ACP communication confidence was measured using a Visual Analogue Scale. Scores range from 0 to 10, with higher scores indicating greater confidence in ACP communication. All outcomes were measured at baseline and one-week post-intervention.

Data collection

Data collection was conducted separately for the control and intervention groups. Control group participants completed the baseline survey in late July 2023 and the follow-up survey three weeks later. Intervention group participants completed the baseline survey in late August 2023 and the follow-up survey within seven days after completing the program.

Statistical analysis

All data were analyzed using IBM SPSS Statistics 22.0 for Windows (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize sample characteristics and outcome variables. Group differences at baseline were examined using independent samples t-tests for continuous variables and Chi-square or Fisher’s exact tests for categorical variables, as appropriate. The normality of continuous variables was assessed prior to analysis. Between-group comparisons of change scores (from baseline to post-intervention) were conducted using independent samples t-tests for attitudes toward ADs, communication skills, and ACP communication confidence, and Mann–Whitney U tests for knowledge about end-of-life care and communication self-efficacy, depending on the distribution of data. A two-tailed significance level of p < 0.05 was applied for all analyses.

Ethical considerations

This study was approved by the Institutional Review Board of Gachon University (IRB No. 1044396–202207-HR-148–01). All participants were informed about the study purpose and procedures, as well as the confidential and voluntary nature of participation. All participants provided written informed consent, and the study was conducted in accordance with the Declaration of Helsinki [51].

Results

The flow of participant recruitment, cluster assignment, and data collection is presented in Fig. 1.

Fig. 1.

Flow chart of participant selection and study procedure

Participant characteristics

Table 2 shows the demographic and AD-related characteristics of 36 nurses that were enrolled and assigned to the intervention (n = 18) and control (n = 18) groups. The two groups did not differ significantly in terms of demographic characteristics, except for sex, with the intervention group having more male nurses than the control group (p = 0.019). Regarding the study variables, the two groups differed significantly only in terms of attitudes toward ADs. The intervention group demonstrated a more positive attitude toward ADs (49.78 ± 4.10) than the control group (46.39 ± 4.78; U = 78.50, p = 0.007).

Table 2.

Participant characteristics (N = 36)

Variable	Total	Control (n = 18)	Intervention (n = 18)	t, U, or χ2	p
	Mean ± SD or n (%)
Age, years	26.78 ± 3.61	25.67 ± 2.54	27.89 ± 4.21	1.92	.064
Career, months	43.28 ± 38.00	33.78 ± 26.27	52.78 ± 45.75	1.53	.136
Sex, female	30 (83.3)	18 (100)	12 (66.7)		.019a
Marital status, married	2 (5.6)	1 (5.6)	1 (5.6)		1.000a
Religion, yes	12 (33.3)	5 (27.8)	7 (38.9)	0.67	.881
Education level				5.03	.169
Associate degree	1 (2.8)	1 (5.6)	0 (0.0)
Bachelor’s degree	31 (86.1)	16 (88.9)	15 (83.3)
≥ Master’s degree	4 (11.1)	1 (5.6)	3 (16.7)
Educational experience of ADs, yes	15 (41.7)	7 (38.9)	8 (44.4)		1.000a
Need for an AD				4.49	.344
Not needed	1 (2.8)	0 (0.0)	1 (5.6)
Moderately needed	11 (30.6)	4 (22.2)	7 (38.9)
Urgently needed	8 (22.2)	4 (22.2)	4 (22.2)
Knowledge about EOL care	16.08 ± 1.57	16.11 ± 1.61	16.06 ± 1.59	−0.10	.917
Attitudes toward ADs	48.08 ± 4.71	46.39 ± 4.78	49.78 ± 4.10	78.5b	.007
Communication self-efficacy	81.64 ± 14.27	85.78 ± 12.35	77.50 ± 15.18	1.80	.082
Communication skills	56.64 ± 7.04	57.44 ± 7.64	55.83 ± 6.50	0.68	.500
ACP communication confidence	6.58 ± 1.63	6.39 ± 1.46	6.78 ± 1.80	0.71	.482

Abbreviations: ACP Advance care planning, AD Advance directive, EOL End-of-life, SD Standard deviation

^aFisher’s exact test

^bMann–Whitney U test

Effects of the MI-based ACP communication program

Table 3 presents the between-group analysis results. The intervention group demonstrated a significant improvement in communication self-efficacy (19.17 ± 18.58) compared with the control group (2.78 ± 11.11; U = 69.00, Z = −2.95, p = 0.003). Additionally, ACP communication confidence increased significantly in the intervention group (1.28 ± 1.97), while it slightly decreased in the control group (−0.11 ± 1.78; t = 2.22, p = 0.033). Although the intervention group showed a greater change in knowledge (1.83 ± 1.72) than the control group (0.72 ± 2.52), the difference was not statistically significant (U = 118.50, Z = −1.40, p = 0.171). The change in attitudes toward ADs in the two groups was not significantly different (intervention: 3.22 ± 4.39; control: 3.11 ± 4.35; U = 156.00, Z = −0.19, p = 0.864). Similarly, the change in communication skills in the two groups did not differ significantly (intervention: 4.78 ± 6.26; control: 2.61 ± 6.95; t = 0.98, p = 0.333).

Table 3.

Effects of the MI-ACP communication program on nurses’ ACP-related perspectives and competencies (N = 36)

Variable	Group	Baseline	Follow-up	Difference (follow-up –baseline)	Between-group test (t or U)	p
		Mean ± Standard Deviation
Knowledge about EOL care	Control	16.11 ± 1.61	16.83 ± 1.72	0.72 ± 2.52	118.50a	.171
	Intervention	16.06 ± 1.59	17.89 ± 1.41	1.83 ± 1.72
Attitudes toward ADs	Control	46.39 ± 4.78	49.50 ± 3.90	3.11 ± 4.35	156.00a	.864
	Intervention	49.78 ± 4.10	53.00 ± 5.27	3.22 ± 4.39
Communication self-efficacy	Control	85.78 ± 12.35	88.56 ± 15.10	2.78 ± 11.11	69.00a	.003
	Intervention	77.50 ± 15.18	96.67 ± 15.35	19.17 ± 18.58
Communication skills	Control	57.44 ± 7.64	60.06 ± 7.76	2.61 ± 6.95	0.98	.333
	Intervention	55.83 ± 6.50	60.61 ± 8.67	4.78 ± 6.26
ACP communication confidence	Control	6.39 ± 1.46	6.28 ± 1.41	− 0.11 ± 1.78	2.22	.033
	Intervention	6.78 ± 1.80	8.06 ± 1.35	1.28 ± 1.97

Abbreviations: ACP Advance care planning, AD Advance directive, EOL End-of-life, M Mean, MI Motivational interviewing

^aMann–Whitney U test

Discussion

To the best of our knowledge, this study is the first to evaluate the effects of a communication-focused MI-ACP program on nurses’ ACP-related competencies, including knowledge about end-of-life care, attitudes toward ADs, communication self-efficacy, general communication skills, and ACP-specific communication confidence. The findings partially support the effectiveness of the program. Significant improvements were observed in communication self-efficacy and ACP communication confidence. However, no significant changes were noted in knowledge about end-of-life care, attitudes toward ADs, or general communication skills.

Communication barriers remain a major obstacle in the effective implementation of ACP [24, 36, 52]. Nevertheless, most nurses receive limited formal training in evidence-based communication approaches, such as MI [30, 32]. This represents a missed opportunity to equip nurses with practical skills for sensitive end-of-life discussions. Prior ACP interventions have largely targeted patient outcomes, such as increased AD documentation or ACP participation [32–34], with less emphasis on building nurses’ communication competence. While many ACP training programs emphasize knowledge acquisition, attitude change, or confidence building [37, 38, 40, 53, 54], few have specifically targeted the application of communication skills through interactive methods [36]. A recent review identified low confidence, role ambiguity, and limited competence as key barriers to ACP engagement among community nurses, noting that professional experience and targeted training in ACP or palliative care support could contribute to more effective ACP implementation [29]. Various ACP training interventions, including simulation-based approaches, have been shown to improve knowledge, attitudes, self-efficacy, and practice while reducing barriers among healthcare providers [37, 39, 53].

Conversely, our MI-ACP communication program specifically emphasized the application of communication skills using MI-based interactive methods, such as lectures, case studies, scenario-based role-plays, and structural feedback [32, 35]. This approach is known to bridge theoretical knowledge and practical skills [39, 54]. Moreover, it directly addressed known barriers to ACP participation, such as low confidence and limited communication competence [14, 16, 21, 55]. Consistent with the findings of previous studies [32, 36, 56, 57], our program significantly enhanced nurses’ communication self-efficacy and ACP communication confidence, which could strengthen nurses’ readiness to engage in ACP conversations. Although the participants lacked prior palliative care experience and opportunities to engage in ACP in daily practice—factors likely constraining knowledge and attitude change [29]—the program’s experiential focus effectively enhanced communication self-efficacy and ACP-specific communication confidence. Prior interprofessional ACP training involving standardized patient encounters has shown similar results, with large effect sizes maintained up to six months post-intervention [56, 57]. Nurses’ self-efficacy—rather than their factual ACP knowledge—was significantly associated with the frequency of ACP discussions and completion of ADs, underscoring the crucial role of confidence in facilitating ACP engagement [58, 59].

The absence of significant changes in knowledge about end-of-life care and attitudes toward ADs may reflect high baseline scores, suggesting possible ceiling effects. Pre-intervention knowledge scores in this study (intervention group: 16.06; control group: 16.11) were higher than those in a prior study involving more diverse nurse participants (13.43) [60]. We also observed favorable attitudes toward ADs at baseline, comparable to those reported among nurses in China and South Korea in previous studies [46, 61]. However, this finding should be interpreted with caution. The post hoc power analysis in this study was conducted based on the observed effect size for communication self-efficacy, and therefore does not necessarily reflect the statistical power for other outcome variables. Given the relatively small sample size, insufficient statistical power may have contributed to the lack of significant differences in knowledge and attitudes. Additionally, the intervention’s brief duration—three 4-h sessions—may have been insufficient to induce meaningful cognitive shifts. Longer, repeated exposure to ACP training has shown greater efficacy in fostering knowledge acquisition and sustained attitude change [37, 53, 62]. Limited palliative care experience and scarce opportunities to apply ACP in practice likely constrained knowledge retention and attitude change. Similarly, a previous scoping review noted that experience and practice opportunities are crucial for developing competence [29].

Our findings align with evidence that ACP training programs often improve perceived competence, particularly self-efficacy, more effectively than knowledge acquisition [63, 64]. In nursing home settings, ACP training led to significant improvements in staff self-efficacy; nonetheless, no measurable knowledge gains were observed [63]. While enhanced self-efficacy is a critical first step, prior research cautions that confidence alone may not consistently translate into increased ACP engagement if knowledge gaps or structural barriers persist [23, 36, 46, 63]. Comprehensive ACP training should target cognitive (knowledge and understanding) and skill-based (communication techniques and confidence) components to fully empower nurses in ACP practice [37, 40].

Practical implications

Integrating MI principles into ACP training may empower nurses to engage more actively and effectively in ACP discussions. The core principles of MI—acceptance, empathy, and eliciting patient values—align closely with the goals of ACP and likely contribute to increased communication confidence [31]. The observed gains in self-efficacy are consistent with Bandura’s (1997) self-efficacy theory [65], which posits that skill-building and confidence enhancement increase the likelihood of behavioral change. Embedding such training in nursing curricula and professional development may help overcome persistent communication barriers.

Limitations

Despite promising results, this study has several limitations. First, the final sample size was smaller than the a priori estimate, which may have limited the statistical power to detect differences across some outcome variables. Second, the use of a quasi-experimental design without full randomization increases the risk of selection bias. Third, all measures were self-reported and assessed shortly after the intervention, precluding conclusions about long-term retention or behavioral changes. In addition, actual changes in ACP practices were not directly measured, limiting our ability to determine whether improvements in self-efficacy translated into real-world clinical behavior. Fourth, the intensity and duration of the training program—three 4-h sessions—may present challenges for implementation in busy clinical settings and limit administrative support for broader adoption. Fifth, as a single-site study, generalizability of the findings is limited.

Future studies should employ randomized, multi-site designs with larger and more diverse samples, incorporate objective behavioral measures, and include longitudinal follow-up. In addition, more flexible and scalable training formats, such as shorter sessions or blended learning approaches, should be explored to enhance feasibility and sustainability in real-world healthcare settings. Future studies should also examine whether improvements in communication self-efficacy lead to actual changes in ACP practices in clinical settings.

Conclusions

This communication-focused MI-ACP program significantly enhanced nurses’ communication self-efficacy and ACP-specific communication confidence, addressing a key barrier to ACP engagement. While related knowledge and attitudes were unchanged, the targeted, skill-based approach effectively strengthened nurses’ perceived competence in navigating sensitive ACP conversations. Broader implementation—coupled with extended and repeated training—may enhance cognitive abilities and skills, ultimately improving the quality of ACP delivery in clinical practice.

Abbreviations

ACP

Advance care planning

AD

Advance directive

EOL-CDI

End-of-Life Care Decision Inventory

KSE-12

Korean version of the Self-Efficacy Questionnaire

MI

Motivational interviewing

MI-ACP

Motivational interviewing-based advance care planning

OARS

Open-ended questions, affirmations, reflective listening, summaries

Authors’ contributions

Mi Yeong Kim: Conceptualization, methodology, investigation, data curation, formal analysis, project administration, and writing—original draft JinShil Kim: Conceptualization, methodology, interpretation, validation, visualization, supervision, and writing—original draft.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of Institutional Review Board of Gachon University, approval number (IRB No. 1044396–202207-HR-148–01). All participants provided written informed consent prior to participation. This study was conducted in accordance with the principles of the Declaration of Helsinki [51].

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.