Development and cross-cultural validation of the advance care planning knowledge index

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Yvonne Hsiung and In-Fun Li

Mackay Medical College, Taiwan

: J Nurs Patient Care

Abstract

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Two cross-cultural studies were conducted to develop and validate a measure, Advance Care Planning Knowledge Index (ACPKI). Specific aims were to assess prior illness experiences and medical information gained to affect end-of-life decision-making. Through item development and refinement, the original scale were reduced from a 32-item ACP knowledge and experience scale among Chinese-American immigrants residing in greater Chicago area (n=211). With satisfactory content validity, internal consistencies of ACP experience (6 items, α=0.67) and ACP knowledge (7 items, α=0.84), the Exploratory Factor Analysis (EFA) discovered 2 factors. Overseas Chinese scored high on the ACPKI were found highly positively correlated with socio-economic status, American acculturation, attitudes toward life-sustaining treatment and palliative care usage. Further cross-cultural EFA and confirmatory factor analysis yielded the same 2-factor structure among hospitalized Taiwanese patients from various areas (n=508). However, in this Taiwanese sample, 3 items related to self-illness and 3 items of self-rated understanding of ACP were suggestively removed from each subscale for better internal consistencies (α=0.69 and 0.84, respectively) and a better model fit (0.92). An individual’s knowledge construct specifically related to life-sustaining treatment, advance directives documents and the communicative process of ACP appeared to be two dimensional (AVE=67.33, AGFI=0.998). We created a data-driven and efficient tool, the 7-item ACPKI with sound psychometric properties. Future research is necessary to replicate studies for temporal stability across heterogeneous samples and structure confirmation. The potential usefulness of the index as outcome measures for ACP intervention programs is discussed.

Biography

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Yvonne Hsiung has received her PhD in Palliative Care Nursing. Her research, teaching and clinical experiences mostly focused on the health promotion, community education and cultural advance care planning among minority groups in the Greater Chicago Area. Currently she is at Mackay Medical College teaching courses about oncology nursing, palliative care, medical ethics, spiritual nursing care, life and death education.

E-mail: yvonnebear@mmc.edu.tw