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Psychometric analysis of an advance directive
H R Alpert1, H Hoijtink, G S Fischer
1Division of Medical Ethics, Harvard Medical School, Boston, Massachusetts 02115, USA.
Medical Care
|October 1, 1996
Summary
The Medical Directive demonstrates strong construct and external validity, confirming its reliability as a tool for assessing patient preferences for medical treatments across diverse populations. This advance directive form is a dependable instrument for research.
Area of Science:
- Medical Ethics
- Health Services Research
- Psychometrics
Background:
- Advance directive forms are crucial clinical assessment instruments requiring rigorous validation.
- Previous research established test-retest reliability, content validity, and criterion-related validity for the Medical Directive in outpatients.
- The current study aimed to further investigate the construct and external validity of the Medical Directive.
Purpose of the Study:
- To assess the construct validity of the Medical Directive by examining relationships between treatment preferences, illness scenarios, and goals of care.
- To evaluate the external validity of the Medical Directive across different populations: outpatients, physicians, and the general public.
- To confirm the reliability and validity of the Medical Directive as a psychometric instrument for advance care planning.
Main Methods:
- Surveyed 495 outpatients, 513 physicians, and 102 general public members using the Medical Directive.
- Recorded preferences for 11 treatments across 4-6 illness scenarios.
- Employed Mokken modeling for scale development and Kuder-Richardson-20, Friedman's procedure, and Kruskal-Wallis tests for reliability and validity analyses.
Main Results:
- Mokken modeling indicated a well-fitting psychometric scale for receptiveness-to-treatment and desirability across all respondent groups.
- High inter-item reliability was confirmed with Kuder-Richardson-20 scores ranging from .93 to .98.
- Treatment desirability correlated with invasiveness; receptiveness related to prognosis, disability, and physicians' goals of care.
Conclusions:
- The Medical Directive exhibits strong construct validity, demonstrating coherent relationships between treatment preferences, illness scenarios, and care goals.
- External validity is supported by findings across outpatient, physician, and general public samples.
- The Medical Directive provides a highly reliable scale for empirical research on life-sustaining treatment preferences.
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