Page 251 - EJMO-9-3

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

Table 1. Preferences for life‑sustaining treatments Table 2. Pre/post changes in post‑mortem dispositions
Treatment Odds ratio p‑value Interpretation Variable Pre→post (b) Post→pre (c) p‑value Odds ratio
Resuscitation 2.50 0.450 Slight post-intervention increase a Organ donation 0 3 0.248 0.00
Dialysis 2.00 0.683 Non-significant variation a Body donation 3 3 1.000 1.00
Sedation 1.00 1.000 No change observed a Cremation 3 4 1.000 0.75
Notes: Odds ratio values indicate the likelihood of post-intervention Burial 0 2 0.480 0.00
endorsement relative to pre-intervention responses. No statistically Notes: The number of observations included in each comparison is
a
significant difference. Life-sustaining treatments were evaluated in the based only on participants with paired valid responses. This explains
context of irreversible clinical conditions. Only items with a sufficient the variability in the total n across items. “b” indicates the number
number of paired binary responses (pre/post) are included. Data of participants who changed their response from “Yes” (pre) to “No”
are based on 3 -year nursing students (n=39) who completed both (post), whereas “c” denotes number of participants who changed their
rd
assessments. response from “No” (pre) to “Yes” (post).
body donation and cremation—while attitudes toward Table 3. Logistic regression predicting organ donation
organ donation and traditional burial remained largely post‑intervention
unchanged. McNemar’s test revealed no statistically
significant changes in students’ post-mortem decisions Variable Estimate (β) Standard error z‑value p‑value
following the educational module: preferences for organ Intercept –5.734 4.793 –1.196 0.232
donation (p=0.248), body donation (p=1.000), cremation Age –0.0028 0.00174 –1.634 0.102
(p=1.000), and traditional burial (p=0.480) did not reach Consistency +1.984 1.225 +1.620 0.105
significance. Although some response trends shifted, Note: No statistically significant predictors at P=0.05. However,
no variable met the threshold for statistical significance consistency showed a near-significant trend.
(Table 2).

3.6. Consistency and predictive modeling The observed increase in the preference to refuse non-
beneficial treatments aligns with previous findings that
The consistency index ranged from 3 to 7, with most activate learning strategies in enhancing self-efficacy. 18,25
students showing a high level of decision stability. Pearson’s By engaging students in case discussions and role-plays,
correlation revealed a weak positive association between the intervention appears to have strengthened their ability
consistency and age (r = 0.23), suggesting that older to support patient autonomy, a crucial mediator of clinical
participants may demonstrate more stable preferences. behavior.
Gender was excluded from the analysis due to insufficient
variability. Systematic evaluations further demonstrate that
palliative care education not only improves immediate
A binary logistic regression (Table 3) was conducted learning outcomes but also fosters long-term retention
to predict willingness to donate organs post-intervention. of competencies. For example, Gupta et al. reported
26
Although no predictor reached statistical significance, that Indian nurses who completed the End-of-Life Care
higher consistency was associated with an increased Nursing Education Consortium program maintained
likelihood of organ donation (β = 1.98, p=0.105), whereas significant gains in knowledge, attitudes, and practices
age showed a mild negative trend (β = –0.0028, p=0.102), up to 18 months post-training. Similarly, Hökkä et al.
27
and gender did not contribute significantly (β = –0.134, found that pedagogical strategies—particularly interactive
p=0.811). methods such as simulations and small-group discussions—
Thematic analysis of open-ended responses revealed were associated with sustained improvements among
recurring themes, including requests for “no resuscitation,” nursing and medical students. These findings suggest
preferences for “organ donation,” and references to that integrating AHD content longitudinally throughout
“spiritual needs.” These responses reflect students’ evolving the nursing curriculum, rather than concentrating it in a
ethical reflections and are illustrated through frequency single standalone module, could promote more enduring
graphs. competence.
The slight decline in willingness to donate organs
4. Discussion observed in this study (from 94.9% to 92.3%) diverges
The present study suggests that a targeted oncology from previous research that reported stable or increased
palliative care module may meaningfully influence intent after organ-donation education. 28,29 One possible
nursing students’ knowledge and attitudes toward AHDs. interpretation is that exposure to values-clarification

Volume 9 Issue 3 (2025) 243 doi: 10.36922/EJMO025250263