Measurement instruments in advance care planning: A systematic review of psychometric properties

The use of accurate and targeted measurement instruments is critical for better understanding and supporting participation in advance care planning. However, it remains unclear which instruments are available and if they are psychometrically sound.

To systematically review existing measurement instruments within the framework of advance care planning and to evaluate their psychometric properties.

Systematic review of measurement instruments.

A literature search was conducted in five databases (CINAHL, PsycInfo, PubMed, Scopus, and Web of Science), from inception to January 2025. Studies aiming to develop, validate, or adapt a measurement instrument in advance care planning were included. The psychometric properties of reported instruments were thoroughly appraised using a consistent set of criteria, and those demonstrating the most robust properties for each population were highlighted.

A total of 50 studies and 27 instruments were identified. Of these instruments, 14 (51.9 %) were designed for care recipients, 13 (48.1 %) for healthcare professionals, 4 (14.8 %) for caregivers, and 1 (3.7 %) for the general population. Notably, 5 instruments (18.5 %) were designed for use across multiple target populations. The instruments primarily assessed attitudes, readiness, and knowledge. Internal consistency was the most frequently examined psychometric property and generally demonstrated acceptable values. However, many studies did not assess dimensional structure, and among those that did, the results were often unsatisfactory. The Advance Care Planning Engagement Survey and the Advance Care Planning Self-Efficacy Scale emerged as the most promising instruments for assessing, respectively, care recipients' engagement in advance care planning and healthcare professionals' self-efficacy in implementing advance care planning.

This review provides a comprehensive reference for selecting psychometrically sound instruments suited to specific populations, measurement aspects, and health contexts. It highlights key gaps in the assessment of advance care planning, including the lack of tools for caregivers and the general population, limited cross-cultural validation, and insufficient psychometric support. By identifying these shortcomings, the review lays the groundwork for future research aiming at enhancing the evaluation and implementation of advance care planning practices.

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