Project title

Evaluating the impact of innovative simulation-based education on Advance Medical Directive uptake and inclusive end-of-life communication among healthcare and non-healthcare professionals

Country

Hong Kong

Background

End-of-life planning in Hong Kong faces persistent structural and cultural barriers. Despite the legal significance of Advance Medical Directives (AMDs), completion rates remain below 1% and many clinicians report low confidence communicating prognoses or navigating ethically complex discussions. Sociocultural taboos often prevent open conversations about death, while treatment decisions commonly default to family wishes, rather than patient autonomy.

Marginalised communities, especially LGBTQ+ individuals, face additional challenges due to a lack of legal relationship recognition, exclusion in clinical decision-making, and mistrust arising from discrimination within healthcare settings. These systemic issues highlight the urgent need for educational models that strengthen AMD knowledge, communication skills, and inclusive care practices.

Against this backdrop, the Advance Medical Directive Simulation (AMDS) course was developed as a pioneering, high-fidelity simulation-based education programme. It brings together healthcare professionals and laypersons as co-learners to explore realistic end-of-life scenarios, ethical dilemmas, relational conflicts, and identity-related barriers.

Summary

Unlike traditional training that separates providers and patients, the AMDS course places healthcare professionals and laypersons (including members of the LGBTQ+ community) in the same learning environment. Participants engage in high-fidelity, role-play simulations of emotionally charged end-of-life scenarios – such as family disputes over treatment and the exclusion of non-traditional partners.

Using a prospective, mixed-methods approach, the study will assess changes in participants’ knowledge, attitudes, and behaviours. The bidirectional learning format allows clinicians to gain direct insight into the real-life experiences of patients, while the other participants gain the confidence and vocabulary to engage meaningfully in their own care planning.

This study evaluates the effectiveness of the Advance Medical Directive Simulation (AMDS) course, a pioneering intervention designed to bridge the gap between medical ethics and real-world practice.

Outcome

The study aims to:

  1. Provide empirical evidence on the effectiveness of simulation-based education in ethically-complex and emotionally-charged scenarios.
  2. Demonstrate measurable improvements in AMD knowledge, intention to complete an AMD, confidence in end-of-life discussions, and inclusive care practices.
  3. Develop a scalable educational model suitable for incorporation into university curricula, CME/CNE programmes, and community-based training.
  4. Strengthen clinician–patient communication by reducing uncertainty, navigating family conflict, and promoting autonomy-respecting decisions.
  5. Advance inclusive practice, particularly for LGBTQ+ individuals who face structural vulnerabilities in healthcare settings.
  6. Support implementation of Hong Kong’s newly enacted Advance Decisions on Life-Sustaining Treatment Ordinance by translating legal provisions into practice-relevant skills.