Reliability and Validity of the Traditional Chinese Version of the Advance Care Planning Engagement Survey: A Pilot Evaluation in Taiwanese Outpatients

Abstract

Objective: The Advance Care Planning Engagement Survey (ACP-ES) has proven effective in evaluating individuals’ engagement in advance care planning (ACP). However, a Traditional Chinese version of ACP-ES (ACPES-TC) has not yet been developed. Therefore, this study aimed to translate and preliminarily validate the ACPES-TC in the Taiwanese context. Material and Methods: A forward and backward translation process was conducted. The translated questionnaire was confirmed by clinical and academic experts. The ACPES-TC was then evaluated for its reliability and validity with participants in the community and from an outpatient clinic in a medical center in Northern Taiwan. The participants comprised healthy people aged 20 to 30 years and patients ≥55 years old, recruited from September 17 to October 28, 2019. Results: Seventy people were recruited, including 20 people aged 20 to 30 years in the community and 50 patients ≥ 55 years old from clinics. The ACPES-TC scores are significantly higher among those of older age, having financial independence, and under long-term medication ( p < .05). The patients’ preference for health-related decision-making is significantly correlated with the ACPES-TC score; the point-biserial correlation coefficient is 0.46 ( p < .001). The discriminant and criterion-related validities are verified. The ACPES-TC demonstrated a good internal consistency (Cronbach's α .97), acceptable one-week test-retest reliability (overall intraclass correlation coefficient 0.86), and low practice effect between the test and retest (Cohen's d .43). Conclusion: The overall reliability and validity of the ACPES-TC are fair, which could be used to evaluate the patients’ engagement in ACP in Taiwan. However, further studies with a full-scale psychometric evaluation are needed.

Older Adults' Behavioral Intentions Toward Advance Care Planning Based on Theory of Reasoned Action

“…This may be related to financially dependent older adults feeling they have no decision-making power and are dependent on their families. Numerous studies have demonstrated a positive relationship between the financial autonomy of older adults and their autonomy in retirement planning, including end-of-life care planning 24,25 . A cross-sectional survey of 921 adults aged over 55 years found that ACP engagement was highly correlated with financial planning 6 .…”

“…Numerous studies have demonstrated a positive relationship between the financial autonomy of older adults and their autonomy in retirement planning, including end-of-life care planning. 24,25 A cross-sectional survey of 921 adults aged over 55 years found that ACP engagement was highly correlated with financial planning. 6 The researchers speculated that this relationship is attributable to lawyers providing ACP-related information to older adults during financial planning, or older adults who planned for retirement were also more likely to be willing to implement ACP.…”

Psychometric Properties of the Advance Care Planning Engagement Survey-9 in Cardiovascular and Metabolic Diseases

“…The ACPES has been used to assess ACP engagement among people with or without chronic diseases in Western and Eastern countries, including the United States, Canada, Taiwan, China, and Japan. [14][15][16][17] In Canada and the United States, the 4-, 9-, 15-, 34-, and 55-item versions showed acceptable levels of Cronbach α and factor loadings. 14 However, all items in the 4-item version were regarding only readiness, but not self-efficacy.…”

“…There are several instruments assessing ACP engagement, including the Advance Care Planning Engagement Survey (ACPES), the Behaviors in Advance Care Planning and Actions Survey, and the Advance Care Planning Questionnaire 12-14 . Among them, the ACPES compared with other instruments has been the most commonly used, and the psychometric properties have been the most commonly examined and supported among several populations in several countries 14-17 . Furthermore, unlike the other instruments, the ACPES has several versions with 4 to 55 items to provide health care providers and researchers flexibility depending on the purpose.…”

“…[12][13][14] Among them, the ACPES compared with other instruments has been the most commonly used, and the psychometric properties have been the most commonly examined and supported among several populations in several countries. [14][15][16][17] Furthermore, unlike the other instruments, the ACPES has several versions with 4 to 55 items to provide health care providers and researchers flexibility depending on the purpose. The ACPES has been used to assess ACP engagement among people with or without chronic diseases in Western and Eastern countries, including the United States, Canada, Taiwan, China, and Japan.…”