Page 249 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology Nursing students’ views on advance directives

on AHDs was incorporated, emphasizing the legal, ethical, obstinacy, and funeral practices, in line with the provisions
and practical aspects related to AHDs. The curriculum was of Italian Law No. 219/2017.
designed to enhance students’ knowledge, foster positive The instrument collected sociodemographic
attitudes, and develop communication skills relevant to information, including age, gender, and previous exposure
end-of-life care. to end-of-life care discussions. It also assessed students’

2.4. Data collection knowledge regarding the legal and ethical aspects of
AHDs, as well as their attitudes toward advance directives
Data were collected using structured, anonymous and communication with healthcare professionals. In
questionnaires administered immediately before (pre- addition, it explored personal preferences related to end-
test) and after (post-test) the educational intervention. The of-life decisions, such as willingness to donate organs and
survey instrument included sections on sociodemographic the choice between cremation and traditional burial.
characteristics (e.g., age, gender, and previous exposure
to end-of-life care discussions) as well as knowledge of The adoption of the VIDAS AHD module enabled a
AHDs and relevant legal frameworks. Data collection culturally sensitive, legally coherent, and methodologically
was conducted using the VIDAS AHD Module, ensuring standardized evaluation, ensuring the reliability of
alignment with standardized national guidelines on end- both pre- and post-intervention measurements. This
of-life care documentation. approach provided a comprehensive understanding of the
educational intervention’s impact on students’ awareness
2.5. Ethical statement and attitudes toward end-of-life care planning. While the
questionnaire was based on the VIDAS module and the
The study received ethical approval from the Humanitas official AHD template, no formal psychometric validation
University Ethics Committee in Milan (Protocol CLI_ (e.g., reliability testing or factor analysis) was performed.
RIC_14). All participants provided informed consent, and
confidentiality was maintained in accordance with the 2.8. Statistical analysis
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Declaration of Helsinki. Data privacy and participant
anonymity were strictly ensured throughout the research Descriptive statistics (e.g., mean, standard deviation,
median, and interquartile range) were used to characterize
process.
the sample and summarize pre- and post-intervention
2.6. Study procedures responses. McNemar’s test was applied to paired
binary variables (e.g., willingness to donate organs and
Before the intervention, an introductory session was held preference for life-sustaining treatments), and odds ratios
to explain the study objectives, ethical considerations, and were calculated to explore directional tendencies. Only
methodological procedures to all potential participants. participants who provided complete and valid responses
Clear instructions were provided regarding voluntary for both the pre- and post-intervention phases were
participation, data protection, and the right to withdraw included in each pairwise comparison. Consequently, the
at any time without academic penalty. This initial briefing number of observations analyzed with McNemar’s test
ensured informed and voluntary participation while varied by item and was sometimes lower than the total
helping establish a climate of academic integrity and sample size (n = 39), which ensured methodological rigor
trust. Participants then completed the pre-intervention while preserving internal validity.
questionnaire, attended the educational sessions,
and subsequently completed the post-intervention A consistency index (range: 0–7) was computed
assessment. by summing the number of identical responses across
seven dichotomous items administered pre- and post-
2.7. Evaluation instruments intervention. Although not derived from a validated scale,

For the evaluation of students’ knowledge, attitudes, and the index was constructed based on item-level concordance,
perceptions regarding AHDs, the study employed the a method commonly employed in preference-sensitive
official Italian AHD Module, made available through research to describe decision stability. The index should
the Ministry of Health and municipal services, in be interpreted as an exploratory tool intended to describe
accordance with national guidelines for end-of-life care trends in response stability rather than as a validated
documentation. This structured and standardized outcome measure.
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questionnaire was specifically designed to explore Pearson’s correlation coefficient was used to explore
individual preferences concerning end-of-life care, the association between consistency (index score) and age,
therapeutic choices, and personal attitudes toward critical as both were continuous variables. Gender was dummy-
issues such as organ donation, the refusal of therapeutic coded (0 = female, 1 = male) and included in the correlation

Volume 9 Issue 3 (2025) 241 doi: 10.36922/EJMO025250263