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 alpha = 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 \textless .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. CONCLUSION: The final ACP-SE scale included 17 items and demonstrated high internal consistency.
Subject
*Self Efficacy; Adult; advance care planning; Advance Care Planning; Advance Care Planning/*organization & administration; Attitude of Health Personnel; Attitudes; Chronic Disease; Communication; Cross Sectional Studies; Cross-Sectional Studies; end-of-life care; Exploratory Research; family medicine; Family/*psychology; Female; Health Knowledge; Human; Humans; Instrument Construction; Instrument Validation; Male; Middle Aged; Physician-Patient Relations; Physicians; Physicians – Psychosocial Factors; Practice; Reliability and Validity; scale development; Scales; self-efficacy; Self-Efficacy – Evaluation; Surveys and Questionnaires/*standards; Terminal Care/psychology; Validation Studies
The current study applied Holland's RIASEC typology to develop a Physician Skills Inventory. We identified the transferable skills and abilities that are critical to effective performance in medicine and had 140 physicians in 25 different specialties rate the importance of those skills. Principal component analysis of their responses produced three major components that aligned with the RIASEC code of Investigative-Realistic-Social (IRS) for physicians. The investigative type fit with problem-solving skills, the realistic type fit with psychomotor skills, and the social type fit with counseling skills. The Physician Skills Inventory may be used in helping medical students profile their skills for further development or remediation and for matching their skills to the requirements of different specialties.