Abstract：
BACKGROUND: Advance care planning (ACP) is critical among primary care patients with cognitive impairment, but few interventions have tested ACP with this population.
OBJECTIVE: Describe the development and evaluation of a tool for assessing ACP fidelity within the context of cognitive impairment, including inter-rater reliability, convergent validity, and overall fidelity using clinical trial data.
METHODS: SHARE is a multicomponent intervention inclusive of facilitated ACP conversations. From a two group, single blind, randomized controlled trial, recorded ACP conversations were rated for fidelity. 145 primary care patients and their care partners were randomized to receive the intervention. Participating patients were 80+ years, had a care partner, and indications of cognitive impairment. An ACP Fidelity Checklist was developed with three subscales: Meeting Set-Up; ACP Meeting Topics; and Communication Skills. Scores were converted to percentages (100% = perfect fidelity) with a target of ≥80% fidelity. A post-ACP meeting report completed by ACP facilitators was used to assess convergent validity of the checklist. Intra-class correlation (ICC) was to evaluate inter-rater reliability.
RESULTS: ACP conversations averaged 33.6 minutes (SD = 14.1). The mean fidelity score across N = 91 rated meetings was 82.9%, with a range of 77.3%-90.6% for subscales. 63.7% of meetings achieved a rating of ≥80%. Cognitive function was positively associated with patient participation (rho = .59, P < 0.001). For checklist items, ICC scores ranged from 0.43-0.96. Post-ACP meeting form scores were correlated with the checklist Meeting Topics subscale (r = 0.36, P = 0.001).
CONCLUSIONS: Assessing the fidelity of ACP conversations involving primary care patients living with cognitive impairment and their care partners is feasible.
OBJECTIVE: Describe the development and evaluation of a tool for assessing ACP fidelity within the context of cognitive impairment, including inter-rater reliability, convergent validity, and overall fidelity using clinical trial data.
METHODS: SHARE is a multicomponent intervention inclusive of facilitated ACP conversations. From a two group, single blind, randomized controlled trial, recorded ACP conversations were rated for fidelity. 145 primary care patients and their care partners were randomized to receive the intervention. Participating patients were 80+ years, had a care partner, and indications of cognitive impairment. An ACP Fidelity Checklist was developed with three subscales: Meeting Set-Up; ACP Meeting Topics; and Communication Skills. Scores were converted to percentages (100% = perfect fidelity) with a target of ≥80% fidelity. A post-ACP meeting report completed by ACP facilitators was used to assess convergent validity of the checklist. Intra-class correlation (ICC) was to evaluate inter-rater reliability.
RESULTS: ACP conversations averaged 33.6 minutes (SD = 14.1). The mean fidelity score across N = 91 rated meetings was 82.9%, with a range of 77.3%-90.6% for subscales. 63.7% of meetings achieved a rating of ≥80%. Cognitive function was positively associated with patient participation (rho = .59, P < 0.001). For checklist items, ICC scores ranged from 0.43-0.96. Post-ACP meeting form scores were correlated with the checklist Meeting Topics subscale (r = 0.36, P = 0.001).
CONCLUSIONS: Assessing the fidelity of ACP conversations involving primary care patients living with cognitive impairment and their care partners is feasible.
摘要：
背景：高级护理计划（ACP）在认知障碍的初级保健患者中至关重要，但是很少有干预措施对该人群进行ACP测试。
目的：描述在认知障碍背景下评估ACP保真度的工具的开发和评估，包括评估者间的可靠性，收敛有效性，和使用临床试验数据的总体保真度。
方法：SHARE是一种多成分干预，包括促进ACP对话。从两组中，单盲,随机对照试验,记录的ACP对话被评定为保真度。145名初级保健患者及其护理伙伴随机接受干预。参与的患者为80岁以上，有一个护理伙伴，和认知障碍的迹象。ACP保真度清单由三个子量表开发：会议设置；ACP会议主题；和沟通技巧。分数转换为百分比（100％=完美的保真度），目标保真度≥80％。ACP主持人完成的ACP会议后报告用于评估清单的趋同有效性。类内相关(ICC)是评估评估者间的可靠性。
结果：ACP对话平均33.6分钟（SD=14.1）。N=91次评级会议的平均保真度得分为82.9%，分量表的范围为77.3%-90.6%。63.7%的会议达到≥80%的评级。认知功能与患者参与呈正相关（rho=.59，p<.001）。对于检查表项目，ICC评分范围为0.43-0.96。ACP会议后表格得分与检查表会议主题子量表相关（r=.36，p=.001）。
结论：评估包括患有认知障碍的初级护理患者及其护理伙伴的ACP对话的保真度是可行的。
目的：描述在认知障碍背景下评估ACP保真度的工具的开发和评估，包括评估者间的可靠性，收敛有效性，和使用临床试验数据的总体保真度。
方法：SHARE是一种多成分干预，包括促进ACP对话。从两组中，单盲,随机对照试验,记录的ACP对话被评定为保真度。145名初级保健患者及其护理伙伴随机接受干预。参与的患者为80岁以上，有一个护理伙伴，和认知障碍的迹象。ACP保真度清单由三个子量表开发：会议设置；ACP会议主题；和沟通技巧。分数转换为百分比（100％=完美的保真度），目标保真度≥80％。ACP主持人完成的ACP会议后报告用于评估清单的趋同有效性。类内相关(ICC)是评估评估者间的可靠性。
结果：ACP对话平均33.6分钟（SD=14.1）。N=91次评级会议的平均保真度得分为82.9%，分量表的范围为77.3%-90.6%。63.7%的会议达到≥80%的评级。认知功能与患者参与呈正相关（rho=.59，p<.001）。对于检查表项目，ICC评分范围为0.43-0.96。ACP会议后表格得分与检查表会议主题子量表相关（r=.36，p=.001）。
结论：评估包括患有认知障碍的初级护理患者及其护理伙伴的ACP对话的保真度是可行的。
