Abstract

Background: Delayed advance care planning and costs of aggressive life sustaining treatments at end of life significantly contribute to the economic burden of healthcare in the United States. Dying trajectories, in most chronic conditions, have terminal prognostic uncertainties that do not address advance care planning by clinicians in a timely manner. Clinician and nursing barriers include perceptions of inappropriate timing, lack of skills in end-of-life communication and viewing readiness as a behavior rather than a death attitude. The purpose of this study is to develop and validate the measurement of psychological preparedness for ACP to aid in the understanding of readiness for AD completion.

Methods: A community sample of 543 participants was recruited for exploratory and confirmatory analysis of the Advance Planning Preparedness Scale (APPS). Psychometric properties were analyzed with structural equation modeling in a general population with chronic illness. Criterion validity was assessed with questionnaires measuring social desirability, health anxiety, readiness, uncertainty, acceptance, and struggle with illness.

Results: Confirmatory factor analysis developed a 35 item pool result ing in a five factor explained 53% of the cumulative variance of APP. Cronbach α = 0.96 for the total scale and for the five subscales psychological comfort (α = 0.87), desire to know (α = 0.88), thinking (α = 0.84) , willingness (α = 0.82) and existential reflection (α = 0.79) with a possible common factor (α = 0.84). Model fit of the modified second order APPS(35) was good χ2(521) = 1140.18, p=0.000, χ2/df = 2.19, RMSEA= .048 and CFI=.92. Multiple regression indicated significant predictors of being very likely to complete AD in 30 days included routine discussion (OR .08, p<.001), preparedness (OR 4.08, p=.03) and uncertainty (OR 4.37, p=.02). These predictors explained 33% of the variance. When social desirability was controlled for acceptance and EOL discussion predicted 40% of the variance of preparedness (R2=.40, F (3,140)=31.61, p<.001).

Conclusions: Results support the use of APPS as a valid and reliable instrument to measure the influence of psychological attitudes on individuals with chronic illness preparedness to complete advance directives. In future research, APPS-35 can be utilized in diverse populations to understand preparedness as a psychological attitude that influences EoL communication and advance directive completion.

Description

This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 30493578; ProQuest document ID: 2833416519. The author still retains copyright.

Author Details

Renee McLeod-Sordjan, PhD, DNP, APRN-BC, HEC-C, FNYAM, FAME, FAAN

Sigma Membership

Alpha Alpha Nu at-Large

Type

Dissertation

Format Type

Text-based Document

Study Design/Type

Other

Research Approach

Other

Keywords:

Advance Care Planning, Readiness, Advance Directives, Thanatology

Advisors

Sun, Yiyuan||Donohue-Porter, Patricia||Brown, Virginia

Degree

PhD

Degree Grantor

Adelphi University

Degree Year

2023

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2023-07-21

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