Validating care and treatment scenarios for measuring decisional conflict regarding future care preferences among...

Area of Science:

• Gerontology
• Health Services Research
• Psychometrics

Background:

• Decisional conflict is a key outcome in advance care planning (ACP) research.
• The Decisional Conflict Scale (DCS) is often used with hypothetical scenarios in ACP studies.
• Validation of these scenarios is crucial for reliable ACP research.

Purpose of the Study:

• To validate hypothetical scenarios for measuring decisional conflict in advance care planning (ACP).
• To assess the comprehensibility, response characteristics, and validity of scenarios related to life-sustaining treatments and care utilization.
• To inform the broader use of these scenarios in ACP studies.

Main Methods:

• Development of three hypothetical scenarios by a multidisciplinary panel and community representatives.
• Survey of 262 older adults using the Decisional Conflict Scale (DCS).
• Analysis of scenario comprehensibility, missing data, sample norms, and validity (structural, convergent, discriminant).

Main Results:

• Two of the three hypothetical scenarios exhibited adequate comprehensibility and response spread.
• Missing response rates were not associated with demographic characteristics.
• Convergent validity was supported by predicted associations between DCS scores and anxiety/ACP engagement.

Conclusions:

• A significant proportion of older adults experienced decisional conflict with the tested scenarios.
• Two scenarios are suitable for use in ACP research, with a third requiring refinement.
• These validated scenarios can enhance the measurement of decisional conflict in advance care planning studies.