Nell Hodgson Woodruff School of Nursing (M.K.S., M.K.H., H.L., N.N.), Emory University, 1520 Clifton Road NE, Atlanta, GA 30322, USA.
Nell Hodgson Woodruff School of Nursing (M.K.S., M.K.H., H.L., N.N.), Emory University, 1520 Clifton Road NE, Atlanta, GA 30322, USA.
J Pain Symptom Manage. 2024 May;67(5):429-440.e2. doi: 10.1016/j.jpainsymman.2024.02.005. Epub 2024 Feb 12.
Reliable and valid measures are critical in accurately assessing outcomes of advance care planning interventions (ACP) for end-of-life (EOL) decision-making.
To develop measures of preparedness for EOL decision-making for patients with end-stage renal disease and their surrogates (an exemplar population).
In this 3-phase study, Phases 1 and 2 included a cross-discipline concept analysis of the preparedness construct, item generation for patient and surrogate scales (82 items), evaluation of content validity and readability, cognitive interviewing, and item reduction. In phase 3, the retained 26 patient and 25 surrogate items were administered to 426 patients and 426 surrogates during a multisite trial of an ACP intervention versus care-as-usual and evaluated internal consistency, 2-week test-retest reliability, and construct validity.
Scales were reduced to 20 patient and 19 surrogate items during phase 3. Cronbach's alphas were 0.86 (patient) and 0.90 (surrogate). There was a strong correlation between preparedness at baseline and two weeks for both scales (r = 0.66-0.69, P < 0.001). Confirmatory factor analysis and item-response analyses suggested unidimensionality. A significant correlation was shown between patient preparedness and patient decisional conflict (r = -0.53, P < 0.001), and surrogate preparedness and surrogate decision-making confidence (r = 0.44, P < 0.001). Among those who received the ACP intervention, the effect size of change was medium: Cohen's d = 0.54, P < 0.001 for patients and d = 0.57, P < 0.001 for surrogates.
The preparedness scales demonstrated strong psychometric properties. Future studies should examine scale performance in other populations.
可靠和有效的测量方法对于准确评估终末期疾病患者及其代理人的临终决策预先护理计划干预（ACP）的结果至关重要。
为终末期肾病患者及其代理人（示范人群）制定临终决策准备的测量方法。
在这项 3 期研究中，第 1 阶段和第 2 阶段包括对准备度结构的跨学科概念分析，为患者和代理人量表生成项目（82 项），评估内容有效性和可读性，认知访谈和项目缩减。在第 3 阶段，保留的 26 项患者和 25 项代理人项目在一项 ACP 干预与常规护理的多地点试验中对 426 名患者和 426 名代理人进行了评估，评估了内部一致性、2 周测试-重测可靠性和构念效度。
在第 3 阶段，量表减少到 20 项患者和 19 项代理人项目。Cronbach's α 为 0.86（患者）和 0.90（代理人）。两个量表的基线和两周的准备度之间存在很强的相关性（r = 0.66-0.69，P < 0.001）。验证性因子分析和项目反应分析表明具有单维性。患者准备度与患者决策冲突之间存在显著相关性（r = -0.53，P < 0.001），代理人准备度与代理人决策信心之间存在显著相关性（r = 0.44，P < 0.001）。在接受 ACP 干预的患者中，变化的效应大小为中等：患者的 Cohen's d = 0.54，P < 0.001，代理人的 d = 0.57，P < 0.001。
准备度量表具有很强的心理测量学特性。未来的研究应在其他人群中检验量表的性能。
