The development, refinement, and the psychometric testing of the Attitude Toward Advanced Directive Survey in implantable cardioverter defibrillator patients

Date of Completion

January 2010


Health Sciences, Medicine and Surgery|Health Sciences, Nursing|Psychology, Experimental




Sudden Cardiac Arrest (SCA) is the leading cause of natural death in the U.S. and the chances of surviving an incident are less than 20%. Implantable cardioverter defibrillators (ICD) have been the treatment of choice for those who experienced or are at risk for SCA. Many patients who receive these devices suffer from progressive co-morbid and cardiac conditions, which may significantly decrease their quality of life. These ill and debilitated patients may not want the additional survival provided by an ICD and want to withdraw the ICD therapy. The Attitude Toward Advanced Directive Survey was developed to assess a patients level of knowledge and barriers that prevent them from completing advanced directives would be timesaving and informative to the healthcare provider. The purpose of this study is to develop and evaluate the psychometric properties of the Attitude Toward Advanced Directives Survey and investigate the reliability and validity from its use among ICD patients. ^ A convenience sample of 200 patients who have an ICD participated in this study. Psychometric testing of the Attitude Toward Advanced Directive Survey provided evidence to support the validity and reliability of the survey. Moderate to strong factor intercorrelations and conceptual meaningfulness lead to the combination of 5 factors. The 5 factors were: Factor 1: Communication Barriers, Factor 2: Informed Confidence, Factor 3: Timing of discussion, Factor 4: Patient-Family relationship, Factor 5: Patient-Provider relationship. Reliability coefficient alpha ranged from 0.67–0.95 for the factors and 0.75 for the total scale. Stability reliability of the survey was analyzed through test-retest of the survey with a respond rate of 34%, n=68 and revealed a significant positive correlation (r=0.62; p<.001) between first and second testing.^ The participants of the Attitude Toward Advanced Directive Survey reported demonstrated communication barriers, poor understanding of their medical condition/treatments, and are not comfortable discussing advanced directives with their families. They would like to discuss advanced directives when they are first diagnosed and at every visit since they are comfortable discussing advanced directives with their healthcare provider. This survey has the potential to be used in clinical practice and future research. ^