Development and psychometric properties of the general public's attitudes toward advance care directives scale in Portugal.

Abstract

Background: To date, no instrument in Portugal has evaluated the attitudes of the population about advance care directives. This paper describes the development and testing of the General Public’s Attitudes Toward Advance Care Directives (GPATACD) Scale.Design and Methods: Methodological study. The development of the instrument was based on a literature review, updated in 2018. Face and content validity were verified by an expert panel and piloted among six participants. Data were collected in an online survey of 1024 Portuguese adults. The obtained data were analyzed using Varimax rotation, while the reliability was evaluated by calculating Cronbach’s alpha.Results: The scale achieves good Item-Content Validity Index (I-CVI) values, between 0.89 and 1.00, and scale-CVI values of 0.91. A principal component analysis generated four dimensions with 26 items as a final scale, with overall Cronbach’s alpha of 0.848.Conclusions: The findings demonstrate that the scale is valid and reliable as a vehicle for assessment of the general public’s attitudes toward advance care directives.Significance for public healthPublic education to disseminate the concept of ACD is needed to raise its awareness. Being asked to complete ACD and receiving information about ACD were found to predict ACD completion.7 What is clear, however, is that passing out information in the form of booklets and asking people if they have ACD is not sufficient to provide the depth of information the population needs to make decisions.33 Nurses are proven patient advocates and have communication skills ideal for ACD education. They encourage people to think unthinkable things, facilitate ACD discussions and reflection upon decisions, and help appoint surrogates. These strategies can be further developed with training programs providing opportunities to practice specific communication skills through role-play with the use of appropriate decision aids. The involvement of health professionals, patients, providers, and community stakeholders might also be required to design an efficient caregiving system for delivering ACD and EOL care.