title: Development of a Scale to Assess Physician Advance Care Planning Self-Efficacy.
abstract: BACKGROUND
  Although patients prefer that physicians initiate advance care planning (ACP) conversations, few physicians regularly do so. Physicians may be reluctant to initiate ACP conversations because they lack self-efficacy in their skills. Yet, no validated scale on self-efficacy for ACP exists. Our objective was to develop a scale that measures physicians' ACP self-efficacy (ACP-SE) and to investigate the validity of the tool.
  
  
  METHODS
  Electronic questionnaires were administered to a random sample of family medicine physicians (n = 188). Exploratory factor analysis was performed to determine whether the scale was multidimensional. An initial assessment of the scale's validity was also conducted.
  
  
  RESULTS
  The exploratory factor analysis indicated that a single factor was appropriate using all 17 items. A single, unidimensional scale was created by averaging the 17 items, yielding good internal consistency (Cronbach α = 0.95). The average scale score was 3.94 (standard deviation = 0.71) on a scale from 1 to 5. The scale was moderately correlated with a global single-item measure of self-efficacy for ACP ( r = .79, P < .001), and the scale differentiated between physician groups based on how much ACP they were doing, how recently they had an ACP conversation, formal training on ACP, and knowledge of ACP. In a multivariate analysis, the ACP-SE scale was a strong predictor of the percentage of patients with chronic life-limiting diseases with whom the physician discussed ACP.
  
  
  CONCLUSIONS
  The final ACP-SE scale included 17 items and demonstrated high internal consistency.
authors.affiliation: 1 Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Baughman
authors.affiliation: 2 Nursing Research, University Hospitals Portage Medical Center, University Hospitals Portage Medical Center, Ravenna, OH, USA.|3 College of Nursing, Kent State University, Kent, OH, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Ludwick
authors.affiliation: 4 Department of Health Policy and Management, College of Public Health, Kent State University, Kent, OH, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fischbein
authors.affiliation: 1 Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.|5 Family Practice Center, Summa Barberton Hospital, Barberton, OH, USA.|6 HMC Hospice of the Western Reserve, Cleveland, OH, USA.
authors.forename: Kenelm
authors.initials: K
authors.lastname: McCormick
authors.affiliation: 1 Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
authors.forename: James
authors.initials: J
authors.lastname: Meeker
authors.affiliation: 1 Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
authors.forename: Mike
authors.initials: M
authors.lastname: Hewit
authors.affiliation: 1 Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.|7 Summa Health System Senior and Post-Acute Services, Akron, OH, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Drost
authors.affiliation: 1 Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Kropp
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D020377:Self Efficacy; D011795:Surveys and Questionnaires / Q000592:standards*; D013727:Terminal Care / Q000523:psychology
keywords: advance care planning; end-of-life care; family medicine; scale development; self-efficacy