Cagle John G, Reiff Jenni S, Smith Ambrym, Echavarria Diane, Scerpella Danny, Zhang Talan, Roth David L, Hanna Valecia, Boyd Cynthia M, Hussain Naaz A, Wolff Jennifer L
School of Social Work (J.G.C.), University of Maryland, Baltimore, Maryland, USA.
Department of Health Policy and Management (J.S.R., D.E., D.S., V.H., J.L.W.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Pain Symptom Manage. 2024 Aug;68(2):180-189. doi: 10.1016/j.jpainsymman.2024.05.002. Epub 2024 May 15.
Advance care planning (ACP) is critical among primary care patients with cognitive impairment, but few interventions have tested ACP with this population.
Describe the development and evaluation of a tool for assessing ACP fidelity within the context of cognitive impairment, including inter-rater reliability, convergent validity, and overall fidelity using clinical trial data.
SHARE is a multicomponent intervention inclusive of facilitated ACP conversations. From a two group, single blind, randomized controlled trial, recorded ACP conversations were rated for fidelity. 145 primary care patients and their care partners were randomized to receive the intervention. Participating patients were 80+ years, had a care partner, and indications of cognitive impairment. An ACP Fidelity Checklist was developed with three subscales: Meeting Set-Up; ACP Meeting Topics; and Communication Skills. Scores were converted to percentages (100% = perfect fidelity) with a target of ≥80% fidelity. A post-ACP meeting report completed by ACP facilitators was used to assess convergent validity of the checklist. Intra-class correlation (ICC) was to evaluate inter-rater reliability.
ACP conversations averaged 33.6 minutes (SD = 14.1). The mean fidelity score across N = 91 rated meetings was 82.9%, with a range of 77.3%-90.6% for subscales. 63.7% of meetings achieved a rating of ≥80%. Cognitive function was positively associated with patient participation (rho = .59, P < 0.001). For checklist items, ICC scores ranged from 0.43-0.96. Post-ACP meeting form scores were correlated with the checklist Meeting Topics subscale (r = 0.36, P = 0.001).
Assessing the fidelity of ACP conversations involving primary care patients living with cognitive impairment and their care partners is feasible.
在患有认知障碍的初级保健患者中，预先护理计划（ACP）至关重要，但很少有干预措施针对这一人群测试过ACP。
描述一种在认知障碍背景下评估ACP保真度的工具的开发和评估，包括评分者间信度、收敛效度，并使用临床试验数据评估总体保真度。
SHARE是一项多成分干预措施，包括促进ACP对话。在一项两组、单盲、随机对照试验中，对记录的ACP对话进行保真度评分。145名初级保健患者及其护理伙伴被随机分配接受干预。参与的患者年龄在80岁及以上，有护理伙伴，并有认知障碍迹象。开发了一份ACP保真度检查表，包括三个子量表：会议设置；ACP会议主题；以及沟通技巧。分数转换为百分比（100% = 完美保真度），目标是保真度≥80%。由ACP促进者完成的ACP会议后报告用于评估检查表的收敛效度。组内相关系数（ICC）用于评估评分者间信度。
ACP对话平均时长为33.6分钟（标准差 = 14.1）。在N = 91次评分会议中，平均保真度得分为82.9%，子量表的得分范围为77.3% - 90.6%。63.7%的会议评分≥80%。认知功能与患者参与呈正相关（rho = 0.59，P < 0.001）。对于检查表项目，ICC分数范围为0.43 - 0.96。ACP会议后表格分数与检查表会议主题子量表相关（r = 0.36，P = 0.001）。
评估涉及患有认知障碍的初级保健患者及其护理伙伴的ACP对话的保真度是可行的。
