Measuring Advance Care Planning: Optimizing the Advance Care Planning Engagement Survey - PubMed (original) (raw)

Multicenter Study

Measuring Advance Care Planning: Optimizing the Advance Care Planning Engagement Survey

Rebecca L Sudore et al. J Pain Symptom Manage. 2017 Apr.

Abstract

Context: A validated 82-item Advance Care Planning (ACP) Engagement Survey measures a broad range of behaviors. However, concise surveys are needed.

Objectives: The objective of this study was to validate shorter versions of the survey.

Methods: The survey included 57 process (e.g., readiness) and 25 action items (e.g., discussions). For item reduction, we systematically eliminated questions based on face validity, item nonresponse, redundancy, ceiling effects, and factor analysis. We assessed internal consistency (Cronbach's alpha) and construct validity with cross-sectional correlations and the ability of the progressively shorter survey versions to detect change one week after exposure to an ACP intervention (Pearson correlation coefficients).

Results: Five hundred one participants (four Canadian and three US sites) were included in item reduction (mean age 69 years [±10], 41% nonwhite). Because of high correlations between readiness and action items, all action items were removed. Because of high correlations and ceiling effects, two process items were removed. Successive factor analysis then created 55-, 34-, 15-, nine-, and four-item versions; 664 participants (from three US ACP clinical trials) were included in validity analysis (age 65 years [±8], 72% nonwhite, 34% Spanish speaking). Cronbach's alphas were high for all versions (four items 0.84-55 items 0.97). Compared with the original survey, cross-sectional correlations were high (four items 0.85; 55 items 0.97) as were delta correlations (four items 0.68; 55 items 0.93).

Conclusion: Shorter versions of the ACP Engagement Survey are valid, internally consistent, and able to detect change across a broad range of ACP behaviors for English and Spanish speakers. Shorter ACP surveys can efficiently measure broad ACP behaviors in research and clinical settings.

Keywords: Advance care planning; psychometrics; surveys and questionnaires.

Published by Elsevier Inc.

PubMed Disclaimer

Figures

Figure 1

Figure 1

Methods for Creating and Validating Shorter Versions of the ACP Engagement Survey

References

    1. IOM Report: Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. 2014 Sep; Accessed July 2016. http://iom.nationalacademies.org/Reports/2014/Dying-In-America-Improving....
    1. Klingler C, In der Schmitten J, Marckmann G. Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations. Palliat Med. 2016 May;30(5):423–433. -PMC -PubMed
    1. Silveira MJ, Kim SY, Langa KM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med. 2010 Apr 1;362(13):1211–1218. -PMC -PubMed
    1. Hammes BJ, Rooney BL, Gundrum JD. A comparative, retrospective, observational study of the prevalence, availability, and specificity of advance care plans in a county that implemented an advance care planning microsystem. J Am Geriatr Soc. 2010 Jul;58(7):1249–1255. -PubMed
    1. Sudore RL, Fried TR. Redefining the “planning” in advance care planning: preparing for end-of-life decision making. Ann Intern Med. 2010 Aug 17;153(4):256–261. -PMC -PubMed

Publication types

MeSH terms

Grants and funding

LinkOut - more resources