Psychometric properties of Persian Version of Advance Care Planning Questionnaire among Older Adults in Iran

Abstract

Abstract Introduction: advanced age is associated with life-threatening conditions at the end of life. Many of these patients at the end of their lives cannot make decisions because of the variable status of the level of consciousness. When these individuals are able to make decisions and identify their care priorities, in a process called advanced care planning, they plan about their preferences for end-of-life care. Accordingly, a local or native instrument is required for investigating ACP of the elderly. This study was performed to determine the reliability and validity of the Persian version of the advanced care planning questionnaire of the elderly referring to healthcare centers in Tehran city. Method: this methodological study was performed in five hospitals of Tehran in 2021-2022. A total of 390 eligible elderlies were included. After receiving the permission from the instrument developer, double back translation, face validity was done using face-to-face interview with 10 elderlies, while the qualitative content validity was performed through surveying 10 experts in palliative care. The construct validity was performed using exploratory factor analysis and confirmatory factor analysis. Internal consistency was captured using Cronbach alpha coefficient, and stability was performed using test-retest method to evaluate the reliability of the instrument. Results: the face validity of the instrument was performed with minor changes in the wording of item 12. The content validity ratio for all of the items was above 0.79, and no item was eliminated. In the explorative factor analysis with 230 entities, four factors of “feelings regarding advance care planning”, "justifications for advance care planning”, “justifications for not having advance care planning: fate and religion”, and “justifications for not having advance care planning: avoid thinking about death” were extracted. CFA with 160 elder patient showed that the four-factor model extracted from EFA has a good fit of the data (RMSEA: 0.04; NFI: 0.97 CFI: .99; IFI: .99; RFI: .96; AGFI: .87; GFI 0/90; standardized RMR: 0.02). To assess internal consistency Cronbach alpha coefficient for the questionnaire was confirmed within the range of 0.72-0.94, while stability with intra-cluster correlation coefficient was confirmed within the range of 0.85-0.96. Conclusion: the results indicated that the Persian version of the advance care planning questionnaire has desirable psychometric properties for measuring the advanced care planning of the elderly. In addition, healthcare providers can employ this questionnaire in healthcare systems as well as research in Iran.