Tan Gwendoline Wan Hua, Quek Ginny Si Min, Lum Nathaniel Jun Xian, Low Lian Leng, Loo Yu Xian
Department of Post-Acute and Continuing Care, SingHealth Community Hospitals, 10 Hospital Boulevard Singapore, Singapore, 168582, Singapore.
Department of Family Medicine and Continuing Care, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
BMC Palliat Care. 2025 Jan 10;24(1):11. doi: 10.1186/s12904-024-01640-y.
Singapore has an ageing population. End-of-life care and advance care planning are becoming increasingly important. To assess advance care planning engagement, valid tools are required. The primary objective of the study is to validate the 15-, 9- and 4-item versions of the ACP Engagement Survey in Singapore.
10 inpatients in a Singapore community hospital were purposively sampled for a cognitive debriefing interview on the ACP Engagement Survey. We recruited patients 21 years and older, who were able to understand and speak English, without a diagnosis of dementia, and who were not admitted under the palliative care service. Next, 150 inpatients and caregivers were recruited using convenience sampling across 2 Singapore community hospitals to complete the 15-item ACP Engagement Survey. We assessed content validity, internal consistency with Cronbach's alpha, construct validity with hypotheses testing and test-retest reliability using intraclass correlation coefficients.
The ACPES scores were significantly higher for those who reported yes for pre-planning activities such as making a will, making a lasting power of attorney, telling one's doctor about end-of-life care preferences, and telling family or loved ones about end-of-life care preferences. Cronbach's alpha was 0.945 for the 15-item version, 0.915 for the 9-item version, and 0.912 for the 4-item version. Intraclass correlation coefficient was 0.933 for the 15-item version, 0.938 for the 9-item version and 0.865 for the 4-item version.
This study provided good psychometric support for the validity of the 15-item, 9-item and 4-item versions of the ACP Engagement Survey in Singapore.
SingHealth Centralised Institutional Review Board (CIRB) approved this study (reference 2022/2025).
新加坡人口老龄化。临终关怀和预立医疗照护计划变得越来越重要。为了评估预立医疗照护计划的参与情况，需要有效的工具。本研究的主要目的是验证新加坡版15项、9项和4项的预立医疗照护计划参与度调查问卷。
在新加坡一家社区医院，有目的地抽取了10名住院患者，就预立医疗照护计划参与度调查问卷进行认知性访谈。我们招募了21岁及以上、能够理解并说英语、未被诊断为痴呆症且不是在姑息治疗服务下入院的患者。接下来，通过便利抽样在新加坡两家社区医院招募了150名住院患者和护理人员，以完成15项的预立医疗照护计划参与度调查问卷。我们评估了内容效度、使用克朗巴哈系数评估内部一致性、通过假设检验评估结构效度以及使用组内相关系数评估重测信度。
对于那些报告进行了诸如立遗嘱、指定持久授权书、告知医生自己的临终护理偏好以及告知家人或亲人自己的临终护理偏好等预先规划活动的人，预立医疗照护计划参与度调查问卷的得分显著更高。15项版本的克朗巴哈系数为0.945，9项版本为0.915，4项版本为0.912。15项版本的组内相关系数为0.933，9项版本为0.938，4项版本为0.865。
本研究为新加坡版15项、9项和4项的预立医疗照护计划参与度调查问卷的效度提供了良好的心理测量学支持。
新加坡健康集团中央机构审查委员会（CIRB）批准了本研究（参考编号2022/2025）。
