[Design and validation of an instrument about quality of the advance care planning for professionals]

Abstract

Objective: To develop a questionnaire aimed to measure the quality of the advance care planning process in healthcare professionals and to assess its psychometric quality.

Method: Instrumental questionnaire validation study.

Scope: primary care centers and outpatients clinics from general hospitals in Ferrol, Ourense, Monforte-Lugo and Health Area V of the Health Service of Asturias.

Participants: physicians and nurses. Phases: (1) design of the first version of the questionnaire using the Delphi technique; (2) construction of the second version of 21 items, after judges' agreement and Kendall's W test; (3) pilot study: internal consistency using Cronbach's alpha and omega coefficient, retest-test by Pearson's correlation coefficient; (4) validation: Barlett's spherity test and Kaiser-Meyer-Olkin measurement, exploratory factor analysis with varimax rotation and study of the dimensions of the questionnaire (number, CCI and correlation), internal consistency using Cronbach's alpha.

Results: Pilot study with 28 professionals. Reliability ɷ=0.917, α=0.841, and test-retest correlation coefficient of 0.785 (95% confidence interval: 0.587-0.894; p<0.001). Validation of the questionnaire (21 items) in 204 professionals. Ítem analysis and exploratory factor analysis (Barlett's test [χ²=1298,789] and KMO=0.808; p<0.001) yielded a five-factor model explaining 64.377% of the total variance, with 18 items grouped into 5 dimensions (information, preferences, behavioral intention, training and communication). Cronbach's alpha of the global questionnaire was 0.841.

Conclusions: The ProPAD-pro questionnaire has showed to be a valid and reliable instrument to assess the quality of the advance care planning process.

Keywords: Advance care planning; Advance directives; Decision making; Directivas anticipadas; Encuestas y cuestionarios; Estudio de validación; Patient preference; Planificación anticipada de atención; Prioridad del paciente; Surveys and questionnaires; Toma de decisiones compartidas; Validation study.