Psychometric evaluation of the Korean version of the Advance Care Planning Practice Scale among nurses

Abstract

This study translated the Advance Care Planning Practice Scale into Korean and evaluated its psychometric properties using a sample of Korean nurses. This was a methodological study. The Advance Care Planning Practice Scale was translated using a forward–backward procedure and expert review. Data were collected from nurses working in hospitals, public health centers, and long-term care facilities in South Korea, who completed a structured online questionnaire. A total of 200 nurses were included in the study. Construct validity was assessed using confirmatory factor analysis with the weighted least squares mean- and variance-adjusted estimator for ordinal data. Convergent validity was examined through the associations with end-of-life care-related knowledge, known-groups validity according to advance care planning education, and discriminant validity through associations with age and educational attainment. Reliability was assessed using Cronbach’s α and intraclass correlation coefficients. The hypothesized single-factor model showed strong factor loadings (0.79–0.86) but mixed model fit (CFI = 0.981, TLI = 0.944, and RMSEA = 0.256 [90% CI: 0.178–0.344]). A modified model allowing the residuals of Items 1 and 3 to correlate showed strong factor loadings (0.72–0.89) and significantly improved fit (Δχ²(1) = 21.55, p < 0.001; CFI = 0.998, TLI = 0.987, and RMSEA = 0.125 [90% CI: 0.019–0.260]), although the RMSEA remained elevated. Advance Care Planning Practice Scale scores showed a weak positive correlation with knowledge ( r = 0.184, p = 0.009). Nurses with advance care planning education experience had higher scores than those without such experience (4.29 vs. 3.42, p = 0.018, Cohen’s d = 0.43), supporting known-groups validity. Nonsignificant associations with age and educational attainment were consistent with the discriminant validity hypothesis. Internal consistency was high (Cronbach’s α = 0.850; composite reliability = 0.854 for the original model and 0.888 for the modified model), and test–retest reliability was moderate (intraclass correlation coefficient = 0.577). The Korean Advance Care Planning Practice Scale may be a useful brief tool for assessing self-reported advance care planning practice among Korean nurses and may support related research and education. However, its single-factor structure remains provisional pending cross-validation in an independent sample, ideally with an extended item set. Further evaluation of its temporal stability is also warranted.