Psychometric Testing of the Hospice Perceptions Instrument (HPI) for Patients and Families in the United States

Though most individuals have heard about hospice care and even rate it favorably, ongoing myths and counterperceptions act as barriers to timely hospice enrollment, furthering disparities in care. However, there are no existing validated measures that assess these counterperceptions, or that examine comprehensive hospice perceptions.

Following previous development of items and content and face validity testing of a Hospice Perceptions Instrument (HPI), this study sought to test and refine the HPI among a general population, convenience sample of 499 individuals recruited from St. Louis, Missouri.

A recruitment flyer including a Qualtrics survey link was sent through a university participant registry database and Midwest community partner listservs and newsletters. Analysis included exploratory factor analysis to determine the HPI's underlying factor structure and Cronbach's alpha and item total correlation to measure reliability and internal consistency.

Following the exploratory factor analysis, a five-factor solution emerged. To reduce repetition and based on theoretical guidance, three thematically related factors were combined, resulting in three factors: (1) services and eligibility; (2) counterperceptions; and (3) dignity and quality. The alpha value for the 33-item scale was 0.859.

The HPI is a useful tool for agencies considering the impact of their public messaging about hospice or for researchers assessing population perceptions of hospice and response to education or public awareness campaigns. Findings demonstrate the HPI is a valid and reliable instrument and resulting factors aligned well with guiding theoretical domains. Further testing is needed across diverse locations, demographics, and cultural groups.