Development and validation of the family decision-making self-efficacy scale

Marie T. Nolan, Mark T. Hughes, Joan Kub, Peter B. Terry, Alan Astrow, Richard E. Thompson, Lora Clawson, Kenneth Texeira, Daniel P. Sulmasy

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Objective: Several studies have reported high levels of distress in family members who have made health care decisions for loved ones at the end of life. A method is needed to assess the readiness of family members to take on this important role. Therefore, the purpose of this study was to develop and validate a scale to measure family member confidence in making decisions with (conscious patient scenario) and for (unconscious patient scenario) a terminally ill loved one.Methods: On the basis of a survey of family members of patients with amyotrophic lateral sclerosis (ALS) enriched by in-depth interviews guided by Self-Efficacy Theory, we developed six themes within family decision making self-efficacy. We then created items reflecting these themes that were refined by a panel of end-of-life research experts. With 30 family members of patients in an outpatient ALS and a pancreatic cancer clinic, we tested the tool for internal consistency using Cronbach's alpha and for consistency from one administration to another using the testretest reliability assessment in a subset of 10 family members. Items with item to total scale score correlations of less than.40 were eliminated.Results: A 26-item scale with two 13-item scenarios resulted, measuring family self-efficacy in decision making for a conscious or unconscious patient with a Cronbach's alphas of.91 and.95, respectively. Testretest reliability was r=.96, p=.002 in the conscious senario and r=.92, p=.009 in the unconscious scenario.Significance of results: The Family Decision-Making Self-Efficacy Scale is valid, reliable, and easily completed in the clinic setting. It may be used in research and clinical care to assess the confidence of family members in their ability to make decisions with or for a terminally ill loved one.

Original languageEnglish (US)
Pages (from-to)315-321
Number of pages7
JournalPalliative and Supportive Care
Issue number3
StatePublished - Sep 2009


  • Decision making
  • End of life
  • Family
  • Scale
  • Self-efficacy

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Psychology
  • Psychiatry and Mental health


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