PSYCHOMETRIC PROPERTIES OF THE KOREAN VERSION OF THE ADVANCE CARE PLANNING ENGAGEMENT SURVEY.

ABSTRACTIntroductionThe Advance Care Planning (ACP) Engagement Survey, initially developed in English, was designed to assess behaviour related to the ACP process. Although ACP is widely recognised globally, its adoption and practice differ considerably among countries, primarily due to unique cultural and policy‐related factors. Therefore, ensuring appropriate translation and cultural validation of the tool is critical for its effective use in varied contexts. This study aimed to translate and culturally adapt the ACP Engagement Survey for use with Korean older people and to examine its psychometric properties.MethodsThis study used a cross‐sectional survey design that was implemented in two phases. In phase 1, the ACP Engagement Survey underwent translation and cross‐cultural adaptation from English to Korean by: (1) forward and backward translation, (2) committee review and (3) pretesting. In phase 2, psychometric properties of the finalised Korean version were examined via factor analysis, assessment of construct validity and analysis of internal consistency. The study sample comprised 235 community‐dwelling older people with a mean age of 71.1 years.ResultsThe final Korean version of the ACP Engagement Survey (K‐ACP‐ES 12) was composed of 12 items across three factors: readiness, contemplation and self‐efficacy. Hypothesis testing demonstrated construct validity of the K‐ACP‐ES 12 by a statistically significant correlation with the AD Knowledge Scale (r = 0.26, p < 0.001). In addition, the Korean version showed acceptable reliability, with a Cronbach's alpha of 0.93.ConclusionsThe K‐ACP‐ES 12 demonstrated good reliability, acceptable structural validity and supported hypothesis‐testing construct validity. Evaluating a patient's engagement in ACP is essential for assessing ACP quality, which constitutes a principal outcome of the ACP process. The findings highlight the necessity of tailoring and validating measurement tools within specific cultural and policy contexts to ensure accurate assessment of ACP outcomes and enhance the instrument's utility across varied populations.Implications for PracticeThe findings underscore the importance of tailoring and validating measurement tools within specific cultural and policy contexts to ensure accurate assessment of ACP outcomes and to enhance the instrument's applicability in both research and practice across diverse population.

Measuring Advance Care Planning: Optimizing the Advance Care Planning Engagement Survey (TH307C)

Brief English and Spanish Survey Detects Change in Response to Advance Care Planning Interventions

Although clinical guidelines recommend that people showing signs of cognitive decline engage in Advance Care Planning (ACP) while they still have decision-making capacity, too often this opportunity to clarify values and treatment preferences is missed among patients and their families. In reflection of the paucity of empirical data on factors influencing how this planning process begins for families experiencing cognitive decline, this study explored facilitators and barriers to ACP among adult children of parents showing signs of early- to mid-stage dementia, with a particular focus on relationship quality. Among this sample (N = 315), relationship quality positively and significantly predicted advance care planning engagement (r = .349, p < .001). Financial burden weakly and positively predicted ACP engagement (r = .123, p <.05), while both psychological burden (-.614, p < .001) and financial burden (-.290, p < .001) negatively and significantly predicted relationship quality. This study validates the use of the ACP Engagement Survey (ACPES) adapted for surrogates among adult children of people experiencing cognitive decline and contributes to a scarce literature on the impact of relationship quality on ACP engagement.

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.

Background: Patients with cardiovascular diseases (CVDs) have high mortality rates, and the progress is uncertain. Advance care planning (ACP) can help these patients and their caregivers prepare for expected or unexpected end-of-life situations effectively. However, the implementation of ACP is suboptimal in this population, resulting in unnecessary suffering of patients and their caregivers and increased health costs. Different versions of the Advance Care Planning Engagement Survey (ACPES) have been used to assess ACP engagement. However, the comprehensive psychometric properties of the ACPES-9 have not been tested in South Korea. Aim: To test the reliability and validity of the ACPES-9 in patients with CVDs. Hypothesis: The reliability of the ACPES-9 is supported by Cronbach’s alpha ≥ .70, and the validity is supported by meeting the cut points of good model fit indices (chi-square test: not significant, CFI ≥ .95, TLI ≥ .95, SRMR &lt; .05, and RMSEA &lt; .07) with factor loadings &gt; .40 in confirmatory factor analysis (CFA) and significant associations of ACP engagement with registration of advance directive (AD) and the intention. Methods: In this cross-sectional study, data on ACP engagement (ACPES-9) and registration of ADs and the intention and sociodemographic characteristics (sample characteristics questionnaire) were collected from 4 hospitals or public health centers (N = 105, mean age: 66.3) between February and March, 2023. Cronbach’s alpha was used to test the reliability. Confirmatory factor analysis and independent t-tests were used to test the validity. Results: Cronbach’s alphas for the total scale and self-efficacy and readiness dimensions were .93, .82, and .97, respectively. In CFA with two factors, all indices of model fit were acceptable: chi-square test = 21.76, p = .151; CFI = .995; TLI = .989; SRMR = .024; RMSEA = .059). All factor loadings were &gt; .65. Patients who registered AD (35.3 vs. 24.3, p &lt; .001) or had the intention (28.9 vs. 20.6, p &lt; .001) had higher scores of the ACPES-9 than their counterparts, respectively. Conclusions: The findings demonstrate that the ACPES-9 was a reliable and valid instrument by supporting the hypothesis. Healthcare providers can use this instrument to assess and manage ACP engagement in patients with CVDs.

Low Engagement of Advance Care Planning Among Patients Who Had a Stroke or Transient Ischemic Attack.

The importance of supporting advance care planning (ACP) by healthcare professionals is recognized worldwide, and assessing the outcomes, such as people's understanding and readiness for ACP, using an appropriate instrument is essential. We, therefore, developed a Japanese version of the Advance Care Planning Engagement Survey (ACP Engagement Survey; 15 items, 9 items, and 4 items), an international scale for assessing the progress of the ACP, and examined its validity and reliability. The ACP Engagement Survey was translated into Japanese, back-translated, and culturally adapted, and the final version was reviewed by the author of the original version. Data on basic demographic information and ACP-related experiences were simultaneously collected as external criteria in an online survey of older adults with chronic diseases. The Cronbach's alpha was calculated to assess its internal consistency, and a retest was performed three days later to calculate the intra-class correlation coefficients (ICCs). A total of 200 respondents (mean age 70; 9.5% female) were included in the analysis. None of the items showed a ceiling effect, but several items did exhibit a floor effect. The factor structure was the same 2-factor structure as the original version, and both factors exhibited a high cumulative contribution rate. The Cronbach's alphas were 0.94 (15-item version), 0.91 (9-item version), and 0.95 (4-item version), and ICCs were of 0.88 (15-item version), 0.9 (9-item version), and 0.84 (4-item version). The Japanese version of the ACP Engagement Survey was confirmed to have very good reliability regarding both internal consistency and test-retest reliability. Together with the result of the item analysis, we can conclude that the Japanese version of the ACP Engagement Survey is sufficiently reliable to be utilized in interventional studies, and it has acceptable content validity, construct validity, and criterion-related validity.

BackgroundTo better assess the outcomes of advance care planning (ACP) as an ongoing process, it is necessary to use a validated and reliable measure reflecting the full range of processes...

BackgroundAlthough advance care planning (ACP) is fairly well understood, significant barriers to patient participation remain. As a result, tools to assess patient behaviour are required. The objective of this study was to improve the measurement of patient engagement in ACP by detecting existing survey design issues and establishing content and response process validity for a new survey entitled Behaviours in Advance Care Planning and ACtions Survey (BACPACS).MethodsWe based our new tool on that of an existing ACP engagement survey. Initial item reduction was carried out using behavior change theories by content and design experts to help reduce response burden and clarify questions. Thirty-two patients with chronic diseases (cancer, heart failure or renal failure) were recruited for the think aloud cognitive interviewing with the new, shortened survey evaluating patient engagement with ACP. Of these, n = 27 had data eligible for analysis (n = 8 in round 1 and n = 19 in rounds 2 and 3). Interviews were audio-recorded and analyzed using the constant comparison method. Three reviewers independently listened to the interviews, summarized findings and discussed discrepancies until consensus was achieved.ResultsItem reduction from key content expert review and conversation analysis helped decrease number of items from 116 in the original ACP Engagement Survey to 24–38 in the new BACPACS depending on branching of responses. For the think aloud study, three rounds of interviews were needed until saturation for patient clarity was achieved. The understanding of ACP as a construct, survey response options, instructions and terminology pertaining to patient engagement in ACP warranted further clarification.ConclusionsConversation analysis, content expert review and think aloud cognitive interviewing were useful in refining the new survey instrument entitled BACPACS. We found evidence for both content and response process validity for this new tool.

BackgroundMost older adults in the U.S. visit the emergency department (ED) in their final 6 months of life, providing an opportunity to engage patients in advance care planning (ACP) conversations (ie, a process to formulate and communicate preferences for end-of-life care). While many report ACP engagement, the link between self-reported engagement and pre-existing ACP documentation in the ED, where ACP documentation is especially critical, remains unclear.MethodsThis cross-sectional study is a secondary analysis of the VIDEO-ED trial, a multi-site randomized controlled study evaluating a video-supported ACP intervention in the ED. Patients aged ≥65 years and adults with serious illness (ie, illnesses with a 1-year prognosis) were prospectively enrolled. ACP engagement was measured using the validated ACP Engagement Survey. Medical records were reviewed for ACP documentation, including clinician-documented ACP and advance directives.ResultsAmong 570 participants (median age: 73.0 years, IQR: 68.0-79.0), higher ACP engagement scores were associated with greater clinician-documented ACP (OR: 1.47, 95% CI: 1.09-1.98, P = 0.01) and advance directives (OR: 1.40, 95% CI: 1.15-1.71, P < 0.01). Readiness to sign official documents naming a medical decision-maker was particularly predictive of ACP documentation (OR: 1.42, 95% CI: 1.03-1.97, P = 0.03).ConclusionsOn ED presentation, patient-reported ACP engagement correlated with the presence of pre-existing ACP documentation in the EHR. The ACP Engagement Survey may help identify older adults less likely to have documented ACP, guiding targeted interventions in the ED.

ABSTRACTAimTo explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community‐dwelling older adults.DesignA cross‐sectional study was conducted with 262 community‐dwelling older Australians across metropolitan, regional and rural communities between August and October 2022.MethodsValidated self‐reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36). Data analysis included descriptive statistics, bivariate association analysis, general linear modelling and path analysis.ResultsAnxiety and decisional conflict were directly associated with advance care planning engagement even after controlling for potential effects of demographic characteristics, health literacy and overall health status. The model, including age, gender, country of birth, language spoken at home, education, overall health status, anxiety, depression, decisional conflict and interaction between anxiety and decisional conflict, explained 24.3% of the variance in their advance care planning engagement. Decisional conflict mediated the association between anxiety and advance care planning engagement.ConclusionIncreased anxiety and decisional conflict were associated with reduced advance care planning engagement directly, even among community‐dwelling older adults with higher levels of education and health literacy. Increased anxiety was associated with reduced advance care planning engagement indirectly via increased decisional conflict. Healthcare professionals should assess community‐dwelling older adults' anxiety and implement interventions to manage their anxiety and decisional conflict, as these may facilitate their engagement in advance care planning.ImpactUnderstanding factors associated with advance care planning engagement among community‐dwelling older adults may inform strategies facilitating their future engagement in advance care planning. Findings from this study may be used as evidence for future implementation to facilitate the engagement of community‐dwelling older adults in advance care planning.Reporting MethodThe STROBE statement checklist was used as a guide to writing the manuscript.Patient or Public ContributionThe study was advertised publicly through social media (e.g. Twitter and Facebook) and newsletters (e.g. Advance Care Planning Australia, Centre for Volunteering, Palliative Care Australia and a large home care service provider with approximately 7000 older clients receiving support or services) to recruit participants. People aged 65 years and older living independently in the Australian community who could communicate in English were invited to participate and answer the questionnaire.

Advance care planning (ACP) is a cornerstone of self-determination for the type of care provided at the end of life. Despite many national efforts to improve American adults' engagement in ACP, statistics indicate low engagement. Low engagement, especially among racial and ethnic minority populations, immigrants, people with lower socioeconomic status, young adults, rural residents, or non-English speakers, is common. Advance care planning engagement among Muslims living in the United States has been minimally studied. The purpose of this study was to explore Muslims' engagement in ACP. A cross-sectional descriptive design was used. Participants were recruited from Islamic organizations through convenience and snowball sampling. Engagement in ACP was measured by the Advance Care Planning Engagement Survey. A sample of 148 Muslims (18-79 years of age) participated in the study. The average engagement scores ranged from 1.97 to 2.09, with about two-thirds in the precontemplation stage. Significant differences in engagement scores were found according to health condition and end of life experiences. Results suggest a need for further collaborative efforts by health care providers, policymakers, and researchers to mitigate the disparities in ACP engagement in the American Muslim community.

BackgroundWeb-based advance care planning (ACP) programs may support patients in thinking about and discussing their preferences for future treatment and care. However, they are not widely available, and only a limited number of programs are evidence based.ObjectiveWe aimed to develop and evaluate an evidence-based, interactive web-based ACP program that guides users through the process of thinking about, discussing, and recording of preferences for treatment and care.MethodsThe program “Explore your preferences for treatment and care” was developed, pilot-tested on feasibility, and subsequently evaluated; engagement in ACP was assessed before program completion and 2 months after program completion using the ACP Engagement Survey (score 1-5) among 147 persons with chronic disease. Usability (score 0-100) and user satisfaction (score 1-5) were also assessed.ResultsACP engagement increased from 2.8 before program completion to 3.0 two months after program completion (P<.001); contemplation about ACP increased from 2.6 to 2.8 (P=.003), and readiness for ACP increased from 2.2 to 2.5 (P<.001). No changes were found for knowledge about ACP (3.0-3.2; P=.07) and self-efficacy for ACP (3.8-3.8; P=.25). The program was perceived as usable (mean 70, SD 13), attractive (mean 3.8, SD 0.7), and comprehensible (mean 4.2, SD 0.6).ConclusionsWe developed an evidence-based, interactive web-based ACP program in cocreation with patients, relatives, and health care professionals. Before-and-after evaluation showed that the program can support people in taking first steps in ACP and in reflecting on preferences for treatment and care, by guiding them through the process of ACP using a stepwise approach. Participants perceived the program as usable and understandable, and they were satisfied with the program and with the amount of information. Health care professionals may use the program as a tool to start ACP discussions with their patients. The program may increase awareness of ACP.

Purpose: Evaluate the impact of an advance care planning (ACP) educational session utilizing PREPARE for Your Care for South Dakota farm and ranch women and its ability to increase engagement in ACP and documentation of medical wishes in the form of an advance directive.&#x0D; Sample: A convenience sample of women (n = 23) represented members of the farm and ranch community in South Dakota who were participating in the Power of Women as AgVocates Conference. Inclusion criteria for this study included being 18 years old or older, female, and conference participation. Exclusion criteria included men and those under the age of 18.&#x0D; Method: This was a cross-sectional investigation, consisting of three phases, and included comparisons of the same sample population before and after an ACP intervention at different time intervals (baseline, 1 week after the educational session and 3 months after the educational session). Increased engagement in ACP was evaluated using a pre-test, post-test design and utilized the 15-item Advance Care Planning Engagement Survey. Demographic information including age and highest level of education completed was collected.&#x0D; Findings: In total, 23 women participated in education session. The median age range was 35-44 years of age. There were statistically significant increases in self-efficacy and readiness to complete ACP reported by participants. The objectives of this education session were met. Per the participants, this was an effective format for ACP. Advance directive completion rates did not increase.&#x0D; Conclusions: The use of PREPARE for Your Care during an education session on ACP can increase self-efficacy and readiness to engage in ACP. The format of this program is appropriate for future use in community settings with the farm and ranch population.&#x0D; Keywords: Advance Care Planning, farm and ranch womenDOI: http://doi.org/10.14574/ojrnhc.v20i2.632