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.
Keywords: Advance care planning; Communication confidence; Communication self-efficacy; Motivational interviewing; Nurses; Professional development.
© 2026. The Author(s).