Kristen E Pecanac1, Roger L Brown2, Jay Steingrub3, Wendy Anderson4, Michael A Matthay5, Douglas B White6. 1. School of Nursing, University of Wisconsin, Madison, USA. Electronic address: Lund2@wisc.edu. 2. School of Nursing, University of Wisconsin, Madison, USA. 3. Baystate Medical Center, University of Massachusetts Medical School-Baystate, Springfield, USA. 4. Division of Palliative Medicine, University of California, San Francisco, USA. 5. Cardiovascular Research Institute, University of California, San Francisco, USA. 6. Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA.
Abstract
OBJECTIVE: To assess the psychometric properties of the 16-item Decisional Conflict Scale (DCS) in surrogate decision makers. METHODS: With a sample of 472 surrogates from intensive care units in five academic medical centers across the United States, we performed the analysis in five phases to 1) model the congeneric structure with confirmatory factor analysis and assess 2) internal consistency reliability, 3) the unidimensional or global assessment, 4) factorial invariance across surrogate gender, and 5) individual item influence on the domains. RESULTS: The congeneric model fit the data, with all factor loadings (0.577-0.955) statistically significant at p < 0.05. All subdomains had acceptable internal consistency (0.751-0.981). The bifactor model supported the sub-domains or the global construct as appropriate measurement models. The DCS demonstrated invariance for use across surrogate genders. The most difficult item for surrogates to complete was "This decision is easy for me to make" [MNSQ Infit/Outfit: 2.37/3.27] and the easiest item was "I have enough advice to make a choice" [0.70/0.67]. CONCLUSIONS: Overall, the DCS demonstrated good fit, and can be considered a valid and reliable tool to use with the surrogate population. PRACTICE IMPLICATIONS: Measuring surrogate decisional conflict could be especially useful to determine how to improve the decision-making process.
OBJECTIVE: To assess the psychometric properties of the 16-item Decisional Conflict Scale (DCS) in surrogate decision makers. METHODS: With a sample of 472 surrogates from intensive care units in five academic medical centers across the United States, we performed the analysis in five phases to 1) model the congeneric structure with confirmatory factor analysis and assess 2) internal consistency reliability, 3) the unidimensional or global assessment, 4) factorial invariance across surrogate gender, and 5) individual item influence on the domains. RESULTS: The congeneric model fit the data, with all factor loadings (0.577-0.955) statistically significant at p < 0.05. All subdomains had acceptable internal consistency (0.751-0.981). The bifactor model supported the sub-domains or the global construct as appropriate measurement models. The DCS demonstrated invariance for use across surrogate genders. The most difficult item for surrogates to complete was "This decision is easy for me to make" [MNSQ Infit/Outfit: 2.37/3.27] and the easiest item was "I have enough advice to make a choice" [0.70/0.67]. CONCLUSIONS: Overall, the DCS demonstrated good fit, and can be considered a valid and reliable tool to use with the surrogate population. PRACTICE IMPLICATIONS: Measuring surrogate decisional conflict could be especially useful to determine how to improve the decision-making process.
Authors: Rohit Devnani; James E Slaven; Gabriel T Bosslet; Kianna Montz; Lev Inger; Emily S Burke; Alexia M Torke Journal: J Gen Intern Med Date: 2017-08-24 Impact factor: 5.128
Authors: Margaret H Barlet; Peter A Ubel; Kevin P Weinfurt; Hannah C Glass; Kathryn I Pollak; Debra H Brandon; Monica E Lemmon Journal: J Pediatr Date: 2022-02-26 Impact factor: 6.314