Increasing dose of esketamine for supplemental analgesia after complex spinal fusion surgery: a randomized and double-blind trial.

Advance care planning (ACP) enables individuals at any stage of health or illness to discuss and document their future medical care preferences [, ]. 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 [, ]. 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 [, ]. 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 [–]. Although limited, evidence suggests that ACP also benefits the well-being of healthcare providers []. 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 [–]. This unique position enables nurses to have meaningful ACP conversations and support informed decision-making that aligns with patients’ preferences [, , , ]. 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 [, –]. However, despite awareness of this responsibility and willingness to engage in ACP [–], 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 [–]. 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 [, –]. 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 [, ]. 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 [, –]. Although MI-based ACP interventions have demonstrated improvements in patient outcomes, including AD completion and ACP engagement [–], their integration into nursing education and clinical practice remains limited. Existing ACP training programs tend to emphasize knowledge, attitudes, or confidence [, –], or focus on participation in ACP conversations [, , ], 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 [], 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.