Learning Objective #1: Theoretically and operationally define four constructs of the transtheoretical model in relation to health care proxy completion

Learning Objective #2: State how findings from the study can inform interventions to increase health care proxy completion rates

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A health care proxy (HCP) is a document a person can complete that appoints another person to make health care decisions for them when they can no longer make decisions for themselves. Despite the fact that state laws and federal legislation have been in place for more than ten years, low rates of health care proxy completion persist. This paper describes the application of the transtheoretical model (TTM) to health care proxy completion. The study was undertaken to develop a model to help us understand when people are ready to make a decision about completing a HCP (stages of change), how they weigh the pros and cons of that decision (decisional balance), what strategies help them make that decision (processes of change), and their confidence in their decision (self-efficacy). Classic test theory was used to guide the development of the respective scales, beginning with the critical step of defining the target behavior, health care proxy completion, then designing the scales and obtaining expert review. Preliminary measures were tested on a convenience sample of the target population. The results were used to revise the measures before conducting psychometric testing in a sample of 500 individuals, 18-years and older who were members of a large managed health care organization. The findings from this study will be used to develop stage-based interventions for use by nurses and other health professionals for increasing the rate of health care proxy completion.