Background Preferences for end-of-life care and attitudes toward discussing advance care planning (ACP) vary depending on cultural influences. There is no instrument to measure decision balance for readiness to participate in ACP under Chinese cultural with adequate psychometric properties.

Aim The purpose of this study was to develop a theoretically based, psychometrically robust instrument to assess decision balance for readiness to participate in advance care planning among cancer patients.

Methods Three hundred and sixty-seven inpatient participants were recruited from oncology wards of ten hospitals in Taiwan, and a structured questionnaire was applied to collect data through self-report questionnaires.

Results Findings on the validity and reliability of the Decision Balance Scale (DBS) were as follows. Two domains were extracted that related to DBS (53.03% total variance explained), namely the domains of pros and cons. Items for each item demonstrated high factor loading (>.55). The CFA results were supportive of the factor structure which was logical connexion the conceptual framework of the questionnaires initial were developed, The CFA analysis offer statistical test for goodness of model fit—χ²/df (3.13), RMSEA (0.08), GFI (0.91), CFI (0.93), and RMR (0.04). Content validity was support by expert panel, Construct validity was evaluated by hypothesis testing and the findings supported construct validity. The internal consistency coefficients of the two subscales were 0.88 and 0.87.

Discussion and conclusion The findings provided strong evidence for reliability and validity of DBS for readiness to participate in ACP among cancer patients.