Development and Validation of a Questionnaire to Detect Behavior Change in Multiple Advance Care Planning Behaviors

Abstract

IntroductionAdvance directives have traditionally been considered the gold standard for advance care planning. However, recent evidence suggests that advance care planning involves a series of multiple discrete behaviors for which people are in varying stages of behavior change. The goal of our study was to develop and validate a survey to measure the full advance care planning process.MethodsThe Advance Care Planning Engagement Survey assesses “Process Measures” of factors known from Behavior Change Theory to affect behavior (knowledge, contemplation, self-efficacy, and readiness, using 5-point Likert scales) and “Action Measures” (yes/no) of multiple behaviors related to surrogate decision makers, values and quality of life, flexibility for surrogate decision making, and informed decision making. We administered surveys at baseline and 1 week later to 50 diverse, older adults from San Francisco hospitals. Internal consistency reliability of Process Measures was assessed using Cronbach's alpha (only continuous variables) and test-retest reliability of Process and Action Measures was examined using intraclass correlations. For discriminant validity, we compared Process and Action Measure scores between this cohort and 20 healthy college students (mean age 23.2 years, SD 2.7).ResultsMean age was 69.3 (SD 10.5) and 42% were non-White. The survey took a mean of 21.4 minutes (±6.2) to administer. The survey had good internal consistency (Process Measures Cronbach's alpha, 0.94) and test-retest reliability (Process Measures intraclass correlation, 0.70; Action Measures, 0.87). Both Process and Action Measure scores were higher in the older than younger group, p<.001.ConclusionA new Advance Care Planning Engagement Survey that measures behavior change (knowledge, contemplation, self-efficacy, and readiness) and multiple advance care planning actions demonstrates good reliability and validity. Further research is needed to assess whether survey scores improve in response to advance care planning interventions and whether scores are associated with receipt of care consistent with one's wishes.

Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

“…21 The group visits involve 2 sessions of 2 hours each, 1 month apart, co-facilitated by a geriatrician and a social worker. Table 1 provides an overview of the GMV structure, facilitator considerations, session format, and documentation and billing details.…”

Advance Care Planning in the Elderly

“…The surrogate needs to be asked to assume the responsibility and to agree to his or her role, and there needs to be communication and documentation of the surrogate as a medical power of attorney in the medical record. 26,28 In some cases, it may be appropriate for clinicians to facilitate a family meeting or conference call to assist patients in identifying and communicating their wishes with a surrogate and others they wish to be involved.…”

Am I Dying Doctor?": How End-Of-Life Care is Portrayed in Television Medical Dramas

“…Previous research showed that the behaviour change theory is important in motivating individuals to engage in ACP [9]. According to this theory, willingness to engage in ACP behaviour is determined by knowledge and beliefs about ACP and expectations about treatment outcomes [9][10][11].…”

“…According to this theory, willingness to engage in ACP behaviour is determined by knowledge and beliefs about ACP and expectations about treatment outcomes [9][10][11]. Increased public awareness of the importance of timely end-of-life discussions may facilitate patients' and loved ones' willingness to be engaged in end-of-life care discussions and may improve patient empowerment [12,13].…”