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

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.