Validating care and treatment scenarios for measuring decisional conflict regarding future care preferences among older adults

Craig Sinclair, Ling Yeoh, Ava Karusoo-Musumeci, Kirsten A. Auret, Josephine M. Clayton, Michelle Hilgeman, Elizabeth Halcomb, Ron Sinclair, Angelita Martini, Anne Meller, Rebecca Walton, Li Wei, Tiet Hanh Dao-Tran, Susan Kurrle, Tracy Comans

Research output: Contribution to journalArticlepeer-review


Objective: Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision-making contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life-sustaining treatments and care utilisation to inform their broader use in ACP studies. Methods: Three hypothetical scenarios were developed by a panel of multidisciplinary researchers, clinicians and community representatives. A convenience sample of 262 older adults were surveyed. Analyses investigated comprehensibility, missing data properties, sample norms, structural, convergent and discriminant validity. Results: Response characteristics suggested that two of the scenarios had adequate comprehensibility and response spread. Missing response rates were unrelated to demographic characteristics. Predicted associations between DCS scores and anxiety (r's =.31–.37, p <.001), and ACP engagement (r's = −.41 to −.37, p <.001) indicated convergent validity. Conclusion: A substantial proportion of older adults reported clinically significant levels of decisional conflict when responding to a range of hypothetical scenarios about care or treatment. Two scenarios showed acceptable comprehensibility and response characteristics. A third scenario may be suitable following further refinement. Patient or Public Contribution: The scenarios tested here were designed in collaboration with a community representative and were further piloted with two groups of community members with relevant lived experiences; four people with life-limiting conditions and five current or former care partners.

Original languageEnglish
Article numbere14010
JournalHealth Expectations
Issue number2
Publication statusPublished - Apr 2024


Dive into the research topics of 'Validating care and treatment scenarios for measuring decisional conflict regarding future care preferences among older adults'. Together they form a unique fingerprint.

Cite this