The advance care planning readiness scale: Development and validation of a measure of willingness to discuss and acceptance of end-of-life care in gynecologic cancer patients

Objective: The objective of this article was to develop and validate a scale that assesses the readiness of gynecologic oncology patients to engage in advance care planning. Methods: The Advance Care Planning Readiness Scale (ACPRS) was validated across 3 independent samples of gynecologic oncology patients. In step I, patients underwent cognitive interviewing to determine if the scale items were comprehensible and applicable to patients. Based on this, modifications to the scale (addition, removal, and merger of items) were completed. In step II, the revised scale was administered to a new sample of patients to assess scale reliability and validity. An exploratory factor analysis determined if the scale loaded onto unique factors. In step III, the revised scale was administered to a third sample of patients, and a confirmatory factor analysis was conducted to test the factor structure proposed in step II. Associations between ACPRS score and completion of advance directives were evaluated. Results: Based on patients' responses, the original ACPRS used in step I was modified to the ACPRS used in step II. The final 8-item ACPRS is a valid, reliable (Cronbach > = 0.81) scale and has 2 primary factors. Women with medical power of attorney documents and living wills had higher ACPRS total scores than those who did not have these advance directives (P = 0.0030). Women with do-not-resuscitate (DNR) orders had higher ACPRS total scores than women without DNRs (P = 0.0176). Conclusions: The ACPRS is a valid and reliable 8-item scale that assesses the readiness of gynecologic oncology patients to discuss advance care planning issues.