Assessing the implementation level of advance care planning– the first comprehensive fidelity scale

Abstract

Abstract Background Many studies report that the implementation of advance care planning (ACP) is low, but we lack an instrument to actually measure this. Implementation fidelity can be such a tool and refers to the degree to which an intervention or program is delivered as intended. This method has rarely been used in trials where ACP is the intervention, and if so, only studying parts of fidelity.Methods We developed and employed the first comprehensive fidelity-scale to measure ACP practice in hospital units. The scale was used in a cluster randomized controlled trial to measure baseline implementation of ACP in the routine care for acutely admitted patients in 12 geriatric units. The scale consists of 22 items that are scored from 1 to 5, where 1 equals no implementation, and 5 equals full implementation. Data was analyzed using descriptive statistics and calculation of interrater reliability.Results The mean score was 1,16 for the total scale. The few items that had a higher score were the item on program philosophy, which was known to devoted professional individuals, but not owned by entire units. Furthermore, parts of what would constitute good quality of the intervention where in place in some units, but do not represent a systematic practice. As a measure of interrater reliability, the intra-class correlation coefficient was 0,99.Conclusions The level of implementation of ACP was generally low. Our novel fidelity scale shows promising preliminary psychometric properties and may prove to be a useful tool to guide the implementation strategy to accelerate the implementation of ACP in health care.