Abstract
Background: Engaging in end-of-life care considerations is beneficial when the time is right. The purpose of this study is to provide a valid instrument to assess peoples readiness for end-of-life conversations before they are initiated.Materials and Methods: A community sample was recruited in study one for exploratory factor analysis of a 13-item questionnaire. In study two, psychometric properties were analyzed with structural equation modeling in a population affected by cancer. Convergent and discriminant validity were assessed with questionnaires measuring distress, depression, anxiety, fear of progression, and distress of death and dying.Results: In study one (N = 349) exploratory factor analysis resulted in three subscales readiness (α = 0.84), communication (α = 0.76), and values (α = 0.56) with a possible common factor (α = 0.84) for a community sample. In study two (N = 84) the three-factor solution with 13 items was not supported for cancer patients. Factor structure was adapted to 12 items with one common factor readiness (α = 0.87). Model fit was good: χ2(50) = 59.18, p>0.05 (Satorra-Bentler-correction = 1.27), with χ2/df = 1.184, rRMSEA = 0.053 (90%-CI[0.000;0.100]), and rSRMR = 0.072. Convergent validity was supported by moderate correlations to trait gratitude, ratings of readiness to provide a living will or talk with family about the end of life. Divergent validity was supported by no or small correlation with distress, depression, general and death anxiety and fear of progression, respectively.Conclusions: Results support usage of the REOLC Scale in different settings with adapted factor structure. The questionnaire is interpreted as valid and reliable instrument to assess objective readiness for end-of-life conversations.
Highlights
Independent of health, death, and dying are inevitable parts of life, but preparation for this last challenge is often poor
The purpose of this study is to develop and validate an evaluated method to assess readiness to engage in end-of-life conversations for a community sample and a population affected by cancer, respectively
Participants reported to be in pre-contemplation for completion of living will (44.41%) and talking to family about their end-of-life wishes (42.94%), respectively
Summary
Independent of health, death, and dying are inevitable parts of life, but preparation for this last challenge is often poor. Readiness for End-of-Life Conversations (REOLC) Scale (Steinhauser et al, 2011; Banner et al, 2019). Wishes are more likely to be honored, quality of life, satisfaction and illness adaptation increase, hospice care is received earlier and more frequently (Detering et al, 2010; Wright et al, 2010; Abba et al, 2013; Bischoff et al, 2013; Brown et al, 2017). The purpose of this study is to provide a valid instrument to assess peoples readiness for end-of-life conversations before they are initiated
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