The Social Work PhD Program is pleased to announce that PhD candidate Peiyuan Zhang will be defending her dissertation on Tuesday, 5/27 at 12pm. Peiyuan's project, titled "Developing and Evaluating an Advance Care Planning Implementation Quality Assessment Tool" is summarized below.
Her committee is chaired by Dr. John Cagle and includes Drs. Joan Davitt, Paul Sacco, Nancy Kusmaul, and Kathleen Unroe.
If you are interested in attending the public presentation of this study, please contact Jen Canapp, JCANAPP@ssw.umaryland.edu, (prior to 5/23) or Bethany Lee, BLEE@ssw.umaryland.edu, for additional information.
Best wishes, Peiyuan!
"Developing and Evaluating an Advance Care Planning Implementation Quality Assessment Tool"
Approximately 1.2 million people resided in over 15,000 nursing homes in the U.S., where nearly 30% of older adults spend their final days. The high volume of deaths has made improving end-of-life care in nursing homes a national priority. However, the lack of a universally recognized standard for advance care planning implementation contributed to inconsistent practices and suboptimal outcomes. This study aimed to develop and evaluate an ACP implementation quality assessment tool (ACP-QAT) in nursing homes.
Paper 1 conducted a systematic review of influential factors of ACP implementation in nursing homes and identified 19 studies. A thematic analysis of the selected studies following Donabedian’s model of quality of care was conducted and 11 subthemes under two major themes emerged: (1) nursing home structural support in ACP, including regulations incorporating ACP into admission, role clarity, and resource availability, and (2) standardized implementation processes. As a result, a drafted ACP-QAT, consisting of 13 binary items, was created.
Paper 2 revised the drafted ACP-QAT using a Delphi consensus approach. Eighteen clinical experts from different professional backgrounds participated in the study. The first round involved 5 focus groups on the Delphi panelists’ opinions, then the tool was iteratively revised and presented back to panelists in surveys with response options (1=endorse, 2=would endorse with modification, and 3=not endorse). The revised tool reached the consensus after two rounds of rating (interquartile range=0, median =1). The final ACP-QAT included 19 binary items under the Structural Support Subscale (8 items) and the Implementation Procedures Subscale (11 items).
Paper 3 examined psychometric properties of the ACP-QAT. It demonstrated excellent internal consistency reliability with Kuder-Richardson Formula20 coefficients for both subscales and full scale (Structural Support Subscale: 0.92, Implementation Procedures Subscale: 0.96, Full Scale: 0.91). Inter-rater reliability at the total score level was almost perfect (ICC=.80). The tool also demonstrated acceptable convergent validity (r=0.81, p<.001), and known-group validity, χ2(2)=62.7, p<.001.
This tool is among the first rigorously developed measures designed to evaluate the quality of ACP implementation in nursing homes. By offering a structured framework, it has strong potential to advance both research and practice in ACP and end-of-life care.
Committee Chair
John Cagle
Committee Member
Joan Davitt
Committee Member
Nancy Kusmaul
Committee Member
Paul Sacco
Committee Member
Kathleen Unroe