马来西亚预先护理计划问卷的开发与验证
The development and validation of the advance care planning questionnaire in Malaysia.
作者信息
Lai Pauline Siew Mei, Mohd Mudri Salinah, Chinna Karuthan, Othman Sajaratulnisah
机构信息
Department of Primary Care Medicine, University of Malaya Primary Care Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Social Preventive Medicine, Julius Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
出版信息
BMC Med Ethics. 2016 Oct 18;17(1):61. doi: 10.1186/s12910-016-0147-8.
BACKGROUND
Advance care planning is a voluntary process whereby individual preferences, values and beliefs are used to aid a person in planning for end-of-life care. Currently, there is no local instrument to assess an individual's awareness and attitude towards advance care planning. This study aimed to develop an Advance Care Planning Questionnaire and to determine its validity and reliability among older people in Malaysia.
METHODS
The Advance Care Planning Questionnaire was developed based on literature review. Face and content validity was verified by an expert panel, and piloted among 15 participants. Our study was conducted from October 2013 to February 2014, at an urban primary care clinic in Malaysia. Included were those aged >50 years, who could understand English. A retest was conducted 2 weeks after the first administration.
RESULTS
Participants from the pilot study did not encounter any problems in answering the Advance Care Planning Questionnaire. Hence, no further modifications were made. Flesch reading ease was 71. The final version of the Advance Care Planning Questionnaire consists of 66 items: 30 items were measured on a nominal scale, whilst 36 items were measured on a Likert-like scale; of which we were only able to validate 22 items, as the remaining 14 items were descriptive in nature. A total of 245 eligible participants were approached; of which 230 agreed to participate (response rate = 93.9 %). Factor analysis on the 22 items measured on a Likert-scale revealed four domains: "feelings regarding advance care planning", "justifications for advance care planning", "justifications for not having advance care planning: fate and religion", and "justifications for not having advance care planning: avoid thinking about death". The Cronbach's alpha values for items each domain ranged from 0.637-0.915. In test-retest, kappa values ranged from 0.738-0.947.
CONCLUSIONS
The final Advance Care Planning Questionnaire consisted of 63 items and 4 domains. It was found to be a valid and reliable instrument to assess the awareness and attitude of older people in Malaysia towards advance care planning.
背景
预先护理计划是一个自愿的过程，通过该过程，个人的偏好、价值观和信念被用于帮助个人规划临终护理。目前，当地没有用于评估个人对预先护理计划的认知和态度的工具。本研究旨在开发一份预先护理计划问卷，并确定其在马来西亚老年人中的有效性和可靠性。
方法
预先护理计划问卷是在文献综述的基础上开发的。由一个专家小组验证了表面效度和内容效度，并在15名参与者中进行了预试验。我们的研究于2013年10月至2014年2月在马来西亚的一家城市初级保健诊所进行。纳入的是年龄大于50岁、能理解英语的人。在首次施测2周后进行了重测。
结果
预试验的参与者在回答预先护理计划问卷时没有遇到任何问题。因此，未作进一步修改。弗莱什易读性指数为71。预先护理计划问卷的最终版本包括66个项目：30个项目采用名义量表测量，36个项目采用类李克特量表测量；其中我们仅能验证22个项目，因为其余14个项目本质上是描述性的。总共联系了245名符合条件的参与者；其中230人同意参与（应答率=93.9%）。对用李克特量表测量的22个项目进行的因子分析揭示了四个领域：“对预先护理计划的感受”、“预先护理计划的理由”、“没有预先护理计划的说辞：命运和宗教”以及“没有预先护理计划的说辞：避免思考死亡”。每个领域项目的克朗巴哈α值范围为0.637 - 0.915。在重测中，kappa值范围为0.738 - 0.947。
结论
最终的预先护理计划问卷包括63个项目和4个领域。它被发现是评估马来西亚老年人对预先护理计划的认知和态度的有效且可靠的工具。
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