Advance Care Planning Practice Preference Scale

Abstract

The Advance Care Planning (ACP) Practice Preference Scale (Yang, Wang, & Wang, 2023), also known as the ACP Practice Preference Scale, is an original inventory/questionnaire developed to assess the advance care planning practice preferences among clinical nurses. This instrument aims to facilitate the creation of targeted educational interventions for ACP. The development process involved a thorough literature review, in-depth semi-structured interviews, and focus interviews. Following two rounds of Delphi expert consultation, the scale was administered to a sample of clinical nurses. Item analysis and factor analysis supported a final version consisting of 24 items, which can be interpreted within either a 6-factor or a 3-factor model. Comprehensive results regarding the scale’s reliability and validity have been reported.

Keywords

Advance Care Planning Practice Preferences, Behavioral Attitudes, Behavioral Belief, Clinical Nurses, Clinical Nursing, Compliance Motivation, Control Belief, Normative Belief, Perceived Behavioral Control, Perceived Intensity, Result Evaluation, Subjective Norms, Clinical Practice, Health Personnel Attitudes, Hospice, Nurses, Nursing, Preferences, Treatment Planning, Health Care Personnel Measures.

Authors

Yang, Zhen; Wang, Huan; Wang, Aiping

Purpose

This scale assesses advance care planning practice preferences among clinical nurses.

Validity

Content validity: The Delphi expert consultation yielded a 100% expert response rate. The Item-Content Validity Index (I-CVI) ranged from 0.857 to 1.000, and the Scale-Content Validity Index (S-CVI) was 0.958, indicating strong content validity.

Construct validity: Factor analysis results provide support for the structural validity of the measure.

Convergent and Discriminant validity:

• First-order factor model: The Average Variance Extracted (AVE) values ranged from 0.594 to 0.794, and the Composite Reliability (CR) values ranged from 0.846 to 0.934. The square root of AVE values ranged from 0.771 to 0.868, all of which were greater than the correlation coefficients between the corresponding factors, demonstrating both convergent and discriminant validity.

• Second-order factor model: The AVE values ranged from 0.537 to 0.580, and the CR values ranged from 0.887 to 0.919. The square root of AVE values ranged from 0.733 to 0.762, all of which were greater than the correlation coefficients between the corresponding factors, further supporting convergent and discriminant validity.

Reliability

Internal consistency:

• Six-factor model: Cronbach’s α coefficients ranged from 0.703 to 0.904 across the various constructs, indicating good internal consistency.

• Three-factor model: Cronbach’s α coefficients ranged from 0.765 to 0.863, also demonstrating good internal consistency.

Split-half reliability:

• Six-factor model: Split-half reliability coefficients ranged from 0.624 to 0.903.

• Three-factor model: Split-half reliability coefficients ranged from 0.653 to 0.680.

Test–retest reliability: Using a 2-week interval for retesting:

• Six-factor model: Test–retest reliability coefficients ranged from 0.771 to 0.910.

• Three-factor model: Test–retest reliability coefficients ranged from 0.769 to 0.962.

Factor Analysis

Both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted. From an initial pool of 78 items, item analysis led to the retention of 24 items.

• Exploratory Factor Analysis (EFA): The first-order factor model extracted from EFA explained 77.933% of the total variance, while the second-order factor model explained 57.305% of the total variance.

• Confirmatory Factor Analysis (CFA):

  • Second-order factor model: The fit indices were as follows: χ2/df = 1.492, GFI = 0.920, AGFI = 0.902, RMSEA = 0.038, TLI = 0.950, CFI = 0.956, IFI = 0.956, PGFI = 0.745, PNFI = 0.773, indicating a good model fit.

  • Six-factor model: χ2/df = 1.512.

  • Three-factor model: χ2/df = 1.778.

Instrument: Advance Care Planning Practice Preference Scale

• Test Type: Original

• Format: Items are rated using a Likert five-point scoring system.

• Language Available: Chinese

• Population Group: Human (Male and Female)

• Age Group: Adulthood (18 years & older), Young Adulthood (18-29 years), Thirties (30-39 years)

• Population Details: The study was conducted in China, and the respondents were clinical nurses.

• Test Methodology: The development and validation of the scale involved various methodological approaches including Test Validity (Construct Validity, Content Validity, Convergent Validity, Discriminant Validity), Test Reliability (Internal Consistency, Split-Half Reliability, Test-Retest Reliability), and Factor Analysis (Confirmatory Factor Analysis, Exploratory Factor Analysis).

Authors

• Author ORCID Identifier: Yang, Zhen – 0000-0002-6197-6168

• Affiliation:

  • Yang, Zhen: First Affiliated Hospital of China Medical University

  • Wang, Huan: First Affiliated Hospital of China Medical University

  • Wang, Aiping: First Affiliated Hospital of China Medical University

• Email: [email protected]

• Correspondence Address: Wang, Aiping: First Affiliated Hospital of China Medical University, Department of Public Service, No.155, Nanjing North Street, Heping District, Liaoning Province, Shenyang, China, [email protected]

Files

No file is available.

Permissions & Fee and Test Year

• Permissions: Contact Corresponding Author

• Commercial: No

• Fee: No

• Test Year: 2023

References

Yang, Z., Wang, H., & Wang, A. (2023). Development and validation of the advance care planning practice preference scale for clinical nurses. Journal of Advanced Nursing, 79(7), 2695–2708. https://doi.org/10.1111/jan.15641

Items of the Advance Care Planning Practice Preference Scale

• Number of items: This is a 24-item measure.

• Test Items Available: No data is Available.

• Factors and Subscales:

  • Six-factor model: Behavioral belief, Result evaluation, Normative belief, Compliance motivation, Control belief, Perceived intensity.

  • Three-factor model: Behavioral attitudes, Subjective norms, Perceived behavioral control.