Refining an Advance Care Planning Implementation Assessment Tool for Nursing Homes (ACP-QAT): A Delphi Study.

IF 2 3区医学 Q2 GERONTOLOGY

Journal of Applied Gerontology Pub Date : 2026-11-01 Epub Date: 2025-12-13 DOI:10.1177/07334648251404132

Peiyuan Zhang, Nancy Kusmaul, Joan Davitt, Paul Sacco, Kathleen T Unroe, Kaipeng Wang, John G Cagle

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引用次数: 0

Abstract

Advance care planning (ACP) can improve end-of-life care, yet practices in U.S. nursing homes (NHs)-where nearly 30% of older adults die-remain inconsistent. This study aimed to revise the Advance Care Planning Implementation Quality Assessment Tool (ACP-QAT) to measure NH-level ACP implementation quality through Delphi method. In Round 1, five focus groups provided feedback on each item, followed by iterative revisions and Delphi surveys. Panelists rated items as endorse, endorse with modification, or not endorse. Deductive content analysis summarized revisions, and consensus was defined as interquartile range = 0, median = 1, and ≥75% agreement. Eighteen interdisciplinary clinical experts (mean experience = 23 years; 83% female; 89% White) participated. Six main categories for revision were identified (e.g., defining ACP scope, specifying processes, clarifying team collaboration, specific training, and improving documentation) resulted in 10 revisions to items and all achieved consensus. ACP-QAT is the first tool to assess ACP implementation quality in NHs and may guide policy and practice.

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完善养老院预先护理计划实施评估工具（ACP-QAT）：一项德尔菲研究。

提前护理计划（ACP）可以改善临终关怀，但在美国养老院（NHs）的实践中，近30%的老年人死亡仍然不一致。本研究旨在修订预先护理计划实施质量评估工具（ACP- qat），通过德尔菲法测量nhh水平的ACP实施质量。在第一轮中，五个焦点小组对每个项目提供反馈，随后进行迭代修订和德尔菲调查。小组成员将项目评为认可、修改认可或不认可。演绎内容分析总结了修订，一致性定义为四分位数范围= 0，中位数= 1，一致性≥75%。18位跨学科临床专家（平均经验23年，83%为女性，89%为白人）参与。确定了六个主要的修订类别（例如，定义ACP范围、指定过程、澄清团队协作、特定培训和改进文档），对项目进行了10次修订，并达成了一致意见。ACP- qat是评估NHs ACP实施质量的第一个工具，可以指导政策和实践。

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来源期刊

Journal of Applied Gerontology GERONTOLOGY-

CiteScore

5.10

自引率

13.30%

发文量

202

期刊介绍： The Journal of Applied Gerontology (JAG) is the official journal of the Southern Gerontological Society. It features articles that focus on research applications intended to improve the quality of life of older persons or to enhance our understanding of age-related issues that will eventually lead to such outcomes. We construe application broadly and encourage contributions across a range of applications toward those foci, including interventions, methodology, policy, and theory. Manuscripts from all disciplines represented in gerontology are welcome. Because the circulation and intended audience of JAG is global, contributions from international authors are encouraged.