Development of a Scale to Assess Physician Advance Care Planning Self-Efficacy
Development of a Scale to Assess Physician Advance Care Planning Self-Efficacy
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DOI：
10.1177/1049909115625612
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发表时间：
2017-06-01
影响因子：
1.9
通讯作者：
Kropp, Denise
中科院分区：
文献类型：
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作者：
Baughman, Kristin R.;Ludwick, Ruth;Kropp, Denise
背景：尽管患者更希望医生发起预先护理计划 (ACP) 对话，但很少有医生定期这样做。医生可能不愿意发起 ACP 对话，因为他们缺乏技能的自我效能感。然而，目前还没有经过验证的 ACP 自我效能量表。我们的目标是开发一个衡量医生 ACP 自我效能感 (ACP-SE) 的量表并调查该工具的有效性。方法：对家庭医学医生的随机样本（n = 188）进行电子问卷调查。进行探索性因素分析以确定量表是否是多维的。还对量表的有效性进行了初步评估。结果：探索性因素分析表明，单一因素适用于所有 17 个项目。通过对 17 个项目进行平均，创建了一个单一的一维量表，产生了良好的内部一致性（Cronbach = 0.95）。量表的平均得分为 3.94（标准差 = 0.71），分值范围为 1 到 5。该量表与 ACP 自我效能的全球单项测量中度相关（r = .79，P < .001），并且该量表根据医生进行 ACP 的程度、最近进行 ACP 对话的时间、ACP 的正式培训以及 ACP 的知识来区分不同的医生组。在多变量分析中，ACP-SE 量表是医生与医生讨论 ACP 的慢性生命限制性疾病患者百分比的有力预测因子。结论：最终的 ACP-SE 量表包括 17 个项目，并表现出较高的内部一致性。
Background: Although patients prefer that physicians initiate advance care planning (ACP) conversations, few physicians regularly do so. Physicians may be reluctant to initiate ACP conversations because they lack self-efficacy in their skills. Yet, no validated scale on self-efficacy for ACP exists. Our objective was to develop a scale that measures physicians' ACP self-efficacy (ACP-SE) and to investigate the validity of the tool.Methods: Electronic questionnaires were administered to a random sample of family medicine physicians (n = 188). Exploratory factor analysis was performed to determine whether the scale was multidimensional. An initial assessment of the scale's validity was also conducted.Results: The exploratory factor analysis indicated that a single factor was appropriate using all 17 items. A single, unidimensional scale was created by averaging the 17 items, yielding good internal consistency (Cronbach = 0.95). The average scale score was 3.94 (standard deviation = 0.71) on a scale from 1 to 5. The scale was moderately correlated with a global single-item measure of self-efficacy for ACP (r = .79, P < .001), and the scale differentiated between physician groups based on how much ACP they were doing, how recently they had an ACP conversation, formal training on ACP, and knowledge of ACP. In a multivariate analysis, the ACP-SE scale was a strong predictor of the percentage of patients with chronic life-limiting diseases with whom the physician discussed ACP.Conclusion: The final ACP-SE scale included 17 items and demonstrated high internal consistency.