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Wen FH, Chiang MC, Huang CC, Hu TH, Chou WC, Chuang LP, Tang ST. Quality of dying and death in intensive care units: family satisfaction. BMJ Support Palliat Care 2024; 13:e1217-e1227. [PMID: 36593102 DOI: 10.1136/spcare-2022-003950] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This cohort study identified patterns/classes of surrogates' assessment of their relative's quality of dying and death (QODD) and to evaluate their associations with family satisfaction with intensive care unit (ICU) care. METHODS We identified QODD classes through latent class analysis of the frequency component of the QODD questionnaire and examined their differences in summary questions on the QODD and scores of the Family Satisfaction in the ICU questionnaire among 309 bereaved surrogates of ICU decedents. RESULTS Four distinct classes (prevalence) were identified: high (41.3%), moderate (20.1%), poor-to-uncertain (21.7%) and worst (16.9%) QODD classes. Characteristics differentiate these QODD classes including physical symptom control, emotional preparedness for death, and amount of life-sustaining treatments (LSTs) received. Patients in the high QODD class had optimal physical symptom control, moderate-to-sufficient emotional preparedness for death and few LSTs received. Patients in the moderate QODD class had adequate physical symptom control, moderate-to-sufficient emotional preparedness for death and the least LSTs received. Patients in the poor-to-uncertain QODD class had inadequate physical symptom control, insufficient-uncertain emotional preparedness for death and some LSTs received. Patients in the worst QODD class had poorest physical symptom control, insufficient-to-moderate emotional preparedness for death and substantial LSTs received. Bereaved surrogates in the worst QODD class scored significantly lower in evaluations of the patient's overall QODD, and satisfaction with ICU care and decision-making process than those in the other classes. CONCLUSIONS The identified distinct QODD classes offer potential actionable direction for improving quality of end-of-life ICU care.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University - Downtown Campus, Taipei, Taiwan
| | - Ming Chu Chiang
- Department of Nursing, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| | - Chung-Chi Huang
- Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Hui Hu
- Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Branch, Kaohsiung, Taiwan
| | - Wen-Chi Chou
- Department of Hematology-Oncology, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Pang Chuang
- Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Siew Tzuh Tang
- School of Nursing, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Hematology-Oncology, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
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Ullrich A, Goldbach S, Hollburg W, Wagener B, Rommel A, Müller M, Kirsch D, Kopplin-Foertsch K, Schulz H, Bokemeyer C, Oechsle K. Specialist palliative care until the very end of life - reports of family caregivers and the multiprofessional team. BMC Palliat Care 2023; 22:153. [PMID: 37814271 PMCID: PMC10563273 DOI: 10.1186/s12904-023-01266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/20/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Specialist palliative care (SPC) includes care for incurably ill patients and their family caregivers at home or on a palliative care ward until the very end of life. However, in the last days of life, patients can rarely express their needs and little is known about SPC outcomes as reported by multiprofessional SPC teams and family caregivers. METHODS Using the Palliative Care Outcome Scale (POS; Score 0-40), proxy assessments of SPC outcomes in the patient's last 3 days of life were performed by SPC teams and primary family caregivers of three home care and three inpatient services. Additional questions were asked about problems solved 'particularly well' or 'inadequately' (last 7 days), which were content analyzed and quantified. RESULTS Proxy assessments by SPC teams were available in 142 patients (of whom 51% had died at home). Family caregiver assessments exist for a subgroup of 60 of these patients. SPC teams (POS total score: mean 13.8, SD 6.3) reported SPC outcomes slightly better than family caregivers (mean 16.7, SD 6.8). The POS items consistently rated as least affected (= 0) by both, SPC teams and family caregivers, were 'not wasted time' (team 99%/family caregivers 87%), 'information' (84%/47%) and 'support' (53%/31%). Items rated as most affected (= 4) were 'patient anxiety' (31%/51%), 'life not worthwhile' (26%/35%) and 'no self-worth' (19%/30%). Both groups indicated more problems solved 'particularly well' than 'inadequately'; the latter concerned mainly clinically well-known challenges during end-of-life care and family caregiver care. CONCLUSIONS This study shows the range and type of symptoms and other concerns reported in the patient's last days. Starting points for further improvements in family caregiver care and psychosocial and spiritual issues were identified.
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Affiliation(s)
- Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany.
| | - Sven Goldbach
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Wiebke Hollburg
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Bettina Wagener
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Annette Rommel
- Specialist outpatient palliative care team 'Das Palliativteam', Hamburg, Germany
| | - Marten Müller
- Palliative care ward, Asklepios Hospital Rissen, Hamburg, Germany
| | - Denise Kirsch
- Specialist outpatient palliative care team 'PCT Hamburg-West', Hamburg, Germany
| | | | - Holger Schulz
- Department of Medical Psychology, University Medical Center Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany
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Roshan HM, Ebadi A, Karimi L, Barasteh S. Translation and psychometric evaluation of the Persian version of "good death inventory- short Form" from the perspective of family-members of cancer patients. BMC Psychol 2023; 11:261. [PMID: 37660187 PMCID: PMC10475178 DOI: 10.1186/s40359-023-01305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023] Open
Abstract
INTRODUCTION Achieving good death is among the objectives of palliative care in patients with cancer. There should be an instrument for evaluating the quality of palliative care provided by family members at the end of life. This study was done to assess the psychometric properties of good death inventory- short form according to the perspective of family of patients with cancer. METHOD This methodological study was done in 2022 at two hospitals in Tehran. The translation was done via forward-backward method. Face validity was examined through cognitive interviewing with 10 family members. The content validation, were used by assessment the opinions of 10 palliative care specialists. The construct validity was explored through exploratory factor analysis and examination of convergent validation with care evaluation scale 2.0, as well as inspection of correlation by answering two general questions of satisfaction with treatment and end of life quality of life. The scale's reliability, internal consistency was calculated using Cronbach's alpha coefficient and stability via test-retest. RESULTS Overall, 204 family members of patients with cancer were included. In the exploratory factor analysis, three factors of peace, hope, and value as well as quality of care were extracted with cumulative variance of 41.8%.A significant and suitable correlation between the total scores of the participants Good death inventory-short form and care evaluation scale2.0 (r = 0.459, P < 0.001) and general satisfaction with end-of-life care (r = 0.423, p < 0.001) as well as the patient's general quality of life (r = 0.539, p < 0.001). The Cronbach's alpha coefficient for the questionnaire was found 0.842, and the stability was confirmed with Intra cluster correlation coefficient = 0.851. CONCLUSION the Persian version of good death inventory-short form is a valid and reliable questionnaire which can investigate the factors associated with good death according to patients' family members' perspective.
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Affiliation(s)
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Leila Karimi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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An E, Tilly A, Mah K, Lewin W, Chandrakumar M, Baguio A, Jaffer N, Chikasema M, Thambo L, Ntizimira C, Namisango E, Hales S, Zimmermann C, Wolofsky K, Goombs M, Rodin G. Protocol for the development and multisite validation of the Quality of Dying and Death-Revised Global Version scale. BMJ Open 2022; 12:e064508. [PMID: 35879006 PMCID: PMC9328109 DOI: 10.1136/bmjopen-2022-064508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Evaluating the quality of dying and death is essential to ensure high-quality end-of-life care. The Quality of Dying and Death (QODD) scale is the best-validated measure of the construct, but many items are not relevant to participants, particularly in low-resource settings. The aim of this multisite cross-sectional study is to develop and validate the QODD-Revised Global Version (QODD-RGV), to enhance ease of completion and relevance in higher-resource and lower-resource settings. METHODS AND ANALYSIS This study will be a two-arm, multisite evaluation of the cultural relevance, reliability and validity of the QODD-RGV across four participating North American hospices and a palliative care site in Malawi, Africa. Bereaved caregivers and healthcare providers of patients who died at a participating North American hospice and bereaved caregivers of patients who died of cancer at the Malawian palliative care site will complete the QODD-RGV and validation measures. Cognitive interviews with subsets of North American and Malawian caregivers will assess the perceived relevance of the scale items. Psychometric evaluations will include internal consistency and convergent and concurrent validity. ETHICS AND DISSEMINATION The North American arm received approval from the University Health Network Research Ethics Board (21-5143) and the University of North Carolina Institutional Review Board (21-1172). Ethics approval for the Malawi arm is being obtained from the University of North Carolina Institutional Review Board and the Malawian National Health Science Research Committee. Study findings will be disseminated through publication in peer-reviewed journals and conference presentations.
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Affiliation(s)
- Ekaterina An
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Alyssa Tilly
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Palliative Care Program, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kenneth Mah
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Warren Lewin
- Kensington Hospice, Toronto, Ontario, Canada
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
| | | | - Arnell Baguio
- Palliative Care Program, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario, Canada
- Margaret Bahen Hospice, Newmarket, Ontario, Canada
| | - Nazira Jaffer
- Global Institute of Psychosocial, Palliative and End-of-Life Care, University Health Network, Toronto, Ontario, Canada
- Yee Hong Peter K. Kwok Hospice, Scarborough, Ontario, Canada
- Hospice Palliative Care Ontario, Toronto, Ontario, Canada
| | | | | | | | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
- Cicely Saunders Institute of Palliative Care and Rehabilitation, London, UK
| | - Sarah Hales
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kayla Wolofsky
- Division of Palliative Care, University Health Network, Toronto, Ontario, Canada
- Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary Goombs
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Translation and Cultural Adaptation into Portuguese of the Quality of Dying and Death Scale for Family Members of Patients in Intensive Care Units. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063614. [PMID: 35329301 PMCID: PMC8950919 DOI: 10.3390/ijerph19063614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022]
Abstract
The translation and cultural adaptation of the Quality of Dying and Death in Brazil may provide a reliable and reproducible scale for collecting and analyzing data on the process of dying and death, given the absence of Brazilian studies that have produced or used scales in this topic. The purpose of this study was to perform the translation and cultural adaptation of the Quality of Dying and Death (QODD 3.2a) scale for intensive care patients' relatives into Portuguese (Brazil). This methodological study was carried out in a public university of the São Paulo State University (UNESP) medical school, São Paulo, Brazil, in three stages: translation and back-translation by two native-speaking independent professionals, analysis by a committee of specialists, and a pre-test phase. The final version was created by seven experts after making semantic, idiomatic, and cultural changes to 16 items. The results indicated a satisfactory content validation index (CVI ≥ 0.80). This version was applied on 32 relatives of patients who were hospitalized in a public hospital in the interior of São Paulo. No item was excluded from the instrument. The content and face validity were achieved to a satisfactory standard, in addition to reaching the minimum parameters recommended in the literature. The Portuguese version of QODD 3.2a for relatives of deceased patients in intensive care is appropriate and culturally adapted for use in Brazil.
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Paiva BSR, Valentino TCDO, Mingardi M, de Oliveira MA, Franco JO, Salerno MC, Palocci H, de Melo TC, Paiva CE. Translation, Validity and Internal Consistency of the Quality of Dying and Death Questionnaire for Brazilian families of patients that died from cancer: a cross-sectional and methodological study. SAO PAULO MED J 2022; 141:e202285. [PMID: 36417658 PMCID: PMC10065093 DOI: 10.1590/1516-3180.2022.0085.r2.09082022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Quality of Dying and Death Questionnaire (QoDD) may prove to be an important evaluation tool in the Brazilian context, and, therefore, can contribute to a more precise evaluation of the dying and death process, improving and guiding the end-of-life patient care. OBJECTIVE To translate and cross-culturally adapt the QoDD into Brazilian Portuguese and measure its validity (convergent and known-groups) and internal consistency. DESIGN AND SETTING A cross-sectional, methodological study was conducted at the Hospital de Câncer de Barretos, Brazil. METHODS A total of 78 family caregivers participated in this study. Semantic, cultural, and conceptual equivalences were evaluated using the content validity index. The construct validity was assessed through convergent validation and known groups analysis [presence of family members at the place of death; feel at peace with dying; and place of death (hospital versus home; hospital versus Palliative Care)]. Internal consistency was evaluated using Cronbach's alpha. RESULTS The questionnaire was translated into Brazilian Portuguese and presented evidence of a clear understanding of its content. Cronbach's alpha values were ≥ 0.70, except for the domains of treatment preference (α = 0.686) and general concerns (α = 0.599). The convergent validity confirmed a part of the previously hypothesized correlations between the Palliative Care Outcome Scale-Brazil (POS-Br) total scores and the QoDD domain scores. The QoDD-Br domains could distinguish the patients who died in palliative care and general wards. CONCLUSION The QoDD-Br is a culturally adapted valid instrument, and may be used to assess the quality of death of cancer patients.
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Affiliation(s)
- Bianca Sakamoto Ribeiro Paiva
- PhD. Researcher and Professor, Palliative Care and Quality of
Life Research Group (GPQual), Postgraduate Program, Hospital de Câncer de
Barretos, Barretos (SP), Brazil
| | - Talita Caroline de Oliveira Valentino
- MSc. Nurse and Doctoral Student, Palliative Care and Quality of
Life Research Group (GPQual), Postgraduate Program, Hospital de Câncer de
Barretos, Barretos (SP), Brazil
| | - Mirella Mingardi
- RN. Nurse and Master's Student, Palliative Care and Quality of
Life Research Group (GPQual), Postgraduate Program, Hospital de Câncer de
Barretos, Barretos (SP), Brazil
| | - Marco Antonio de Oliveira
- MSc. Biostatistics, Palliative Care and Quality of Life
Research Group (GPQual), Postgraduate Program, Hospital de Câncer de Barretos,
Barretos (SP), Brazil
| | - Julia Onishi Franco
- MD. Physician, Dr. Paulo Prata, School of Health Sciences of
Barretos and Palliative Care and Quality of Life Research Group (GPQual),
Postgraduate Program, Hospital de Câncer de Barretos, Barretos (SP),
Brazil
| | - Michelle Couto Salerno
- RN. Research Nurse, Palliative Care and Quality of Life
Research Group (GPQual), Postgraduate Program, Hospital de Câncer de Barretos,
Barretos (SP), Brazil
| | - Helena Palocci
- MD. Physician, Dr. Paulo Prata, School of Health Sciences of
Barretos and Palliative Care and Quality of Life Research Group (GPQual),
Postgraduate Program, Hospital de Câncer de Barretos, Barretos (SP),
Brazil
| | - Tais Cruz de Melo
- MD. Physician, Dr. Paulo Prata, School of Health Sciences of
Barretos and Palliative Care and Quality of Life Research Group (GPQual),
Postgraduate Program, Hospital de Câncer de Barretos, Barretos (SP),
Brazil
| | - Carlos Eduardo Paiva
- PhD. Physician and Professor, Palliative Care and Quality of
Life Research Group (GPQual), Postgraduate Program, Hospital de Câncer de
Barretos, Barretos (SP), Brazil
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Wang Y, Liu M, Chan WCH, Zhou J, Chi I. Validation of the Quality of Dying and Death Questionnaire among the Chinese populations. Palliat Support Care 2021; 19:694-701. [PMID: 36942576 DOI: 10.1017/s1478951521001413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study reports the evaluation of the original 31-item Quality of Dying and Death Questionnaire (QODD) using a sample of caregivers of recently deceased older adults in China, and the validation of a shortened version (QODD-C) derived from the original scale. METHODS The translation was performed using a forward and back method. The full scale was tested with 212 caregivers of decedents in four regions of China. Confirmatory factor analysis tested the model fit between the full Chinese version and the original conceptual model and generated the QODD-C. The psychometric analysis was performed to evaluate the QODD-C's internal consistency, content validity, construct validity, and discriminant validity. RESULTS A five-domain, 18-item QODD-C was identified with excellent internal consistency reliability (Cronbach's α = 0.933; split-half Pearson's value = 0.855). The QODD-C total score was significantly associated with constructs related to five domains. The caregiver's relationship with the decedent, the decedent's age at death, death reason, and death place was significantly associated with the QODD-C total score. SIGNIFICANCE OF RESULTS The QODD-C is a valid and reliable instrument for assessing the quality of dying and death among the Chinese populations.
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Affiliation(s)
- Ying Wang
- School of Philosophy and Sociology, Lanzhou University, Lanzhou, China
| | - Mandong Liu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA
| | - Wallace Chi Ho Chan
- Department of Social Work, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Jing Zhou
- School of Law, Shanghai Lixin University of Accounting and Finance, Shanghai, China
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA
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Caregiver bereavement outcomes in advanced cancer: associations with quality of death and patient age. Support Care Cancer 2021; 30:1343-1353. [PMID: 34499215 PMCID: PMC8426162 DOI: 10.1007/s00520-021-06536-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/31/2021] [Indexed: 12/02/2022]
Abstract
Purpose We investigated relationships between domains of quality of dying and death in patients with advanced cancer and their caregivers’ bereavement outcomes and the moderating effect of patient age at death. Methods Bereaved caregivers of deceased patients with advanced cancer who had participated in an early palliative care trial completed measures of grief (Texas Revised Inventory of Grief [TRIG]), complicated grief (Prolonged Grief Inventory [PG-13]), and depression (Center for Epidemiologic Studies-Depression [CESD-10]). They also completed the Quality of Dying and Death measure (QODD), which assesses patients’ symptom control, preparation for death, connectedness with loved ones, and sense of peace with death. Results A total of 157 bereaved caregivers completed the study. When patient age × QODD subscale interactions were included, greater death preparation was related to less grief at patient death (past TRIG: β = − .25, p = .04), less current grief (present TRIG: β = − .26, p = .03), less complicated grief (PG-13: β = − .37, p = .001), and less depression (CESD-10: β = − .35, p = .005). Greater symptom control was related to less current grief (present TRIG: β = − .27, p = .02), less complicated grief (PG-13: β = − .24, p = .03), and less depression (CESD-10: β = − .29, p = .01). Significant patient age × connectedness interaction effects for current grief (present TRIG: β = .30, p = .02) and complicated grief (PG-13: β = .29, p = .007) indicated that, with less connectedness, younger patient age at death was associated with greater caregiver grief. Conclusion Better end-of-life death preparation and symptom control for patients with cancer may attenuate later caregiver grief and depression. Less connectedness between younger patients and their families may adversely affect caregiver grief.
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Han XP, Mei X, Zhang J, Zhang TT, Yin AN, Qiu F, Liu MJ. Validation of the Chinese Version of the Quality of Dying and Death Questionnaire for Family Members of ICU Patients. J Pain Symptom Manage 2021; 62:599-608. [PMID: 33388383 DOI: 10.1016/j.jpainsymman.2020.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/10/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
CONTEXT The quality of end-of-life care services directly affects the end-of-life quality of life of patients and their families. At present, there are no standard tools in China for assessing the quality of dying and death (QODD) of critical intensive care unit (ICU) patients. OBJECTIVES This study aimed to introduce the Chinese version of the QODD questionnaire for family members of ICU patients, after transcultural adaptation and validation, to provide an effective instrument for assessing the quality of end-of-life care of ICU patients in China, fill the gap in the evaluation of the quality of end-of-life care of critical ICU patients in China, and offer a theoretical basis and practical guidance during purposeful intervention. METHODS This study involved the main adult caregivers or principal family members of 149 dying critically ill patients. The original QODD scale was translated using the double forward and backward method. Nine cultural adaptation experts adapted the Chinese version of the QODD scale for completion by family members of ICU patients. Then, we carried out content validity, structural validity, internal consistency, confirmatory factors, and item correlation analysis of the modified scale. RESULTS The Chinese version of the QODD for family members of ICU patients was developed after some items were deleted or modified. The content validity index was 0.93, indicating that all items were correlated with the measurement of death quality. The Kaiser-Meyer-Olkin value was 0.797, suggesting that the correlations between items were high. The Cronbach's α was 0.865, indicating good internal consistency. In confirmatory factor analysis, the fit indices were χ2 = 207.327, non-normed fit index = 0.916, root mean square error of approximation = 0.033, and comparative fit index = 0.93, indicating a good fit of the five-factor model of the Chinese version of the QODD questionnaire for family members of ICU patients. CONCLUSION The Chinese version of the QODD questionnaire for family members of ICU patients is a reliable and effective instrument for evaluating the quality of death among patients who die in the ICU and can be applied to clinical practice and research.
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Affiliation(s)
- Xing-Ping Han
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xu Mei
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Jing Zhang
- Department of Thoracic Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Ting-Ting Zhang
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Ai-Ni Yin
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Fang Qiu
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Meng-Jie Liu
- Department of Nursing, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
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Gutiérrez-Sánchez D, Gómez-García R, López-Medina IM, Cuesta-Vargas AI. Psychometric Testing of the Spanish Modified Version of the Mini-Suffering State Examination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157821. [PMID: 34360115 PMCID: PMC8345708 DOI: 10.3390/ijerph18157821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023]
Abstract
Background: The mini-suffering state examination is a valid and reliable measure that have been used to assess suffering in patients with advanced cancer. The aim of this study was to carry out a psychometric analysis of the Spanish version of the mini-suffering state examination. Method: A validation study was conducted. Seventy-two informal caregivers of deceased patients in palliative care were included in this study. A psychometric testing of content validity, internal consistency, and convergent validity with the Spanish version of the quality of dying and death questionnaire was performed. Results: The original instrument was modified to be used by informal caregivers. The content validity was acceptable (0.96), and the internal consistency was moderate (α = 0.67). Convergent validity was demonstrated (r = −0.64). Conclusion: The Spanish modified version of the MSSE showed satisfactory measurement properties. The Spanish modified version of MSSE can be useful to facilitate screening, monitor progress, and guide treatment decisions in end-of-life cancer patients.
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Affiliation(s)
- Daniel Gutiérrez-Sánchez
- Department of Nursing, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain
- Biomedical Research Institute of Málaga (IBIMA), 29071 Málaga, Spain; (R.G.-G.); (A.I.C.-V.)
- Correspondence:
| | - Rafael Gómez-García
- Biomedical Research Institute of Málaga (IBIMA), 29071 Málaga, Spain; (R.G.-G.); (A.I.C.-V.)
- Fundación Cudeca, 29631 Málaga, Spain
| | - Isabel María López-Medina
- Research Group Nursing and Innovation in Healthcare (CuiDsalud), Department of Nursing, Faculty of Health Sciences, University of Jaén, 23071 Jaén, Spain;
| | - Antonio I. Cuesta-Vargas
- Biomedical Research Institute of Málaga (IBIMA), 29071 Málaga, Spain; (R.G.-G.); (A.I.C.-V.)
- Department of Physiotherapy, University of Málaga, 29071 Málaga, Spain
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia
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Philipp R, Kalender A, Härter M, Bokemeyer C, Oechsle K, Koch U, Vehling S. Existential distress in patients with advanced cancer and their caregivers: study protocol of a longitudinal cohort study. BMJ Open 2021; 11:e046351. [PMID: 33895716 PMCID: PMC8074557 DOI: 10.1136/bmjopen-2020-046351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION At the end of life, patients with advanced cancer and their informal caregivers may confront multiple existential concerns. Despite the strong potential to alleviate existential distress through psychosocial interventions, existential distress and its impact on healthcare outcomes have not yet been studied systematically. We aim to investigate the frequency, longitudinal trajectory and predictive impact of existential distress on end-of-life outcomes. We further aim to determine patients' and caregivers' specific need for and utilisation of psychosocial support for existential distress. METHODS This longitudinal cohort study will consecutively recruit 500 patients with advanced cancer and 500 caregivers from oncological outpatient and inpatient clinics. Participants will complete self-report questionnaires (sociodemographic and disease-related characteristics, existential distress, end-of-life outcomes, resources and support needs) at five points of assessment (at baseline and after 3, 6, 9 and 12 months). At baseline and 6-month follow-up, we will conduct structured diagnostic interviews to assess mental disorders. Statistical analyses will include descriptive statistics to determine the prevalence of existential distress, mental disorders and end-of-life outcomes; multiple linear and logistic regression analyses to calculate the predictive impact of existential distress on end-of-life outcomes; and growth mixture models to analyse longitudinal trajectories of existential distress. DISCUSSION This study will provide comprehensive knowledge about patients' and caregivers' existential concerns. The longitudinal empirical data will allow for conclusions concerning the frequency and course of existential distress throughout 1 year. This important extension of existing cross-sectional research will contribute to further develop targeted psychosocial interventions. Profiles of existential distress may be applied by clinicians from multiple professions and help to address existential concerns effectively. ETHICS AND DISSEMINATION The study was approved by the institutional research ethics committee (reference number LPEK-0177). Results will be presented at scientific conferences and published in peer-reviewed journals. Other forms of dissemination will include sharing results on the psychometric properties of the structured demoralisation interview with international research groups and communication with healthcare professionals providing psychosocial treatment for patients and caregivers. Following scientific standards, our progress will be regularly updated on ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT04600206.
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Affiliation(s)
- Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Kalender
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Koch
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Vogt A, Stiel S, Heckel M, Goebel S, Mai SS, Seifert A, Gerlach C, Ostgathe C, Weber M. Assessment of the quality of end-of-life care: translation and validation of the German version of the "Care of the Dying Evaluation" (CODE-GER) - a questionnaire for bereaved relatives. Health Qual Life Outcomes 2020; 18:311. [PMID: 32962706 PMCID: PMC7507719 DOI: 10.1186/s12955-020-01473-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background International studies indicate deficits in end-of-life care that can lead to distress for patients and their next-of-kin. The aim of the study was to translate and validate the “Care of the Dying Evaluation” (CODE) into German (CODE-GER). Methods Translation according to EORTC (European Organisation for Research and Treatment of Cancer) guidelines was followed by data collection to evaluate psychometric properties of CODE-GER. Participants were next-of-kin of patients who had died an expected death in two hospitals. They were invited to participate at least eight, but not later than 16 weeks after the patient’s death. To calculate construct validity, the Palliative care Outcome Scale (POS) was assessed. Difficulty and perceived strain of answering the questionnaire were assessed by a numeric scale (0–10). Results Out of 1137 next-of-kin eligible, 317 completed the questionnaire (response rate: 27.9%). Data from 237 main sample participants, 38 interraters and 55 next-of-kin who participated for repeated measurement were analysed. Overall internal consistency, α = 0.86, interrater reliability, ICC (1) = 0.79, and retest-reliability, ICC (1, 2) = 0.85, were good. Convergent validity between POS and CODE-GER, r = −.46, was satisfactory. A principal component analysis with varimax rotation showed a 7-factor solution. Difficulty, M = 2.2; SD ± 2.4, and perceived strain, M = 4.1; SD ± 3.0, of completing the questionnaire were rather low. Conclusion The results from the present study confirm CODE-GER as a reliable and valid instrument to assess the quality of care of the dying person. More over our study adds value to the original questionnaire by proposing a deepened analysis of obtained data. The development of seven subscales increases its potential for further surveys and research. Trial registration This study was registered retrospectively on the 25th of January 2018 at the German Clinical Trials Register (DRKS00013916).
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Affiliation(s)
- Annika Vogt
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstr.1, 55131, Mainz, Germany
| | - Stephanie Stiel
- Hannover Medical School, Institute for General Practice, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Maria Heckel
- Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Department of Palliative Medicine, CCC Erlangen -EMN, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Swantje Goebel
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstr.1, 55131, Mainz, Germany
| | - Sandra Stephanie Mai
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstr.1, 55131, Mainz, Germany
| | - Andreas Seifert
- Centre for Educational Research and Teacher Training (PLAZ), Paderborn University, Warburger Straße 100, 33098, Paderborn, Germany
| | - Christina Gerlach
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstr.1, 55131, Mainz, Germany
| | - Christoph Ostgathe
- Friedrich-Alexander-Universität Erlangen- Nürnberg (FAU), Department of Palliative Medicine, CCC Erlangen -EMN, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Martin Weber
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Langenbeckstr.1, 55131, Mainz, Germany.
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Seifart C, Koch M, Leppin N, Nagelschmidt K, Knorrenschild JR, Timmesfeld N, Rief W, von Blanckenburg P. Collaborative advance care planning in advanced cancer patients: col-ACP -study - study protocol of a randomised controlled trial. BMC Palliat Care 2020; 19:134. [PMID: 32838763 PMCID: PMC7445911 DOI: 10.1186/s12904-020-00629-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To assure patient-centred end-of-life care, palliative interventions need to account for patients' preferences. Advance care planning (ACP) is a structured approach that allows patients, relatives and physicians to discuss end-of-life decisions. Although ACP can improve several patient related outcomes, the implementation of ACP remains difficult. The col-ACP-study (collaborative advance care planning) will investigate a new ACP procedure (col-ACP-intervention (German: Hand-in-Hand Intervention)) in palliative cancer patients and their relatives that addresses individual values and targets barriers of communication before an ACP process. METHODS In a randomised controlled trial, 270 cancer patients without curative treatment options and their relatives will receive either 1) col-ACP 2) a supportive intervention (active control group) or 3) standard medical care (TAU). col-ACP comprises two steps: a) addressing various barriers of patients and relatives that discourage them from discussing end-of-life issues followed by b) a regular, structured ACP procedure. The col-ACP-intervention consists of 6 sessions. Primary endpoint is the patients' quality of life 16 weeks after randomisation. Secondary endpoints include measurements of distress; depression; communication barriers; caregivers' quality of life; existence of ACP or advance directives; the consistence of end of life care; and others. Patients will be followed up for 13 months. Multivariate analyses will be carried out. Qualitative evaluation of the intervention will be conducted. DISCUSSION Augmentation of a regular ACP program by a structured psycho-oncological intervention is an innovative approach to target barriers of communication about end-of-life issues. Study findings will help to understand the value of such a combined intervention in palliative care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03387436 (Date of registration: 01/02/2018, retrospectively registered.
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Affiliation(s)
- Carola Seifart
- Institutional Review Board, Clinical Ethics, Philipps-University Marburg, Marburg, Germany
| | - Martin Koch
- Institutional Review Board, Clinical Ethics, Philipps-University Marburg, Marburg, Germany
| | - Nico Leppin
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Katharina Nagelschmidt
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Jorge Riera Knorrenschild
- Department of Internal Medicine, Division Hematology and Oncology, University Clinic of Gießen and Marburg, Marburg, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
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14
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Mai SS, Vogt AR, Schmidtmann I, Maier BO, Wagner B, Dvir M, Weber M. Sequential use of the Demoralization Scale in palliative care: feasibility, strain, and personal benefits of participation for patients at the end of life. Support Care Cancer 2020; 29:965-973. [PMID: 32556715 DOI: 10.1007/s00520-020-05555-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the efficacy of specifically targeted interventions in palliative care, sequential use of the Demoralization Scale (DS) could be a useful approach. This study's main objective was to evaluate the weekly use of the DS for palliative care inpatients. Secondary objectives were the analysis of the DS, self-perceived strain, and personal benefits of the assessment. METHODS Patients admitted to 3 palliative care units (PCUs) were tested for eligibility and asked to complete the DS weekly. Self-perceived strain was rated on a numeric scale (0-10). Open questions about strain and helpfulness of the survey were asked. RESULTS Over 10 months, 568 patients were admitted to the PCUs; 193 patients were eligible. A total of 120 patients participated once, of whom only 41 (34.1%) participated at least twice. The mean self-perceived strain caused by the assessment was 1.53 at T1 (N = 117, SD = 2.27, max = 8). CONCLUSIONS While the single use of the DS in PCUs seems justified in view of the possibility to detect severe demoralization with overall low to moderate strain and self-perceived helpfulness for patients, the feasibility of the sequential use of the DS has to be regarded critically. Our study undermines the complexity of assessing changes in self-reported psychological phenomena with end-of-life patients at a PCU. The most limiting factors for participating twice were that patients were either discharged from hospital or declined further participation.
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Affiliation(s)
- Sandra Stephanie Mai
- III. Department of Medicine, Interdisciplinary Department of Palliative Care, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Annika Renate Vogt
- III. Department of Medicine, Interdisciplinary Department of Palliative Care, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Irene Schmidtmann
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bernd Oliver Maier
- Department for Palliative Medicine and Interdisciplinary Oncology, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Bernd Wagner
- Department of Palliative Care, Katholisches Klinikum Mainz (kkm), Mainz, Germany
| | - Martina Dvir
- III. Department of Medicine, Interdisciplinary Department of Palliative Care, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Martin Weber
- III. Department of Medicine, Interdisciplinary Department of Palliative Care, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
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15
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The quality of care of the dying in hospital-next-of-kin perspectives. Support Care Cancer 2020; 28:4527-4537. [PMID: 32388617 PMCID: PMC7378108 DOI: 10.1007/s00520-020-05465-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/13/2020] [Indexed: 11/07/2022]
Abstract
Purpose Providing high-quality care for the dying is essential in palliative care. Quality of care can be checked, compared, and improved by assessing responses from bereaved next-of-kin. The objectives of this study are to examine quality of care in the last 2 days of life of hospitalized patients considering specific aspects of their place of care. Methods The “Care of the Dying Evaluation” (CODE™) questionnaire, validated in German in 2018 (CODE-GER), examines quality of care for the patient and support of next-of-kin, allocating values between 0 (low quality) and 4 (high quality). The total score (0–104) is divided into subscales which indicate support/time given by doctors/nurses, spiritual/emotional support, information/decision-making, environment, information about the dying process, symptoms, and support at the actual time of death/afterwards. Next-of-kin of patients with an expected death in specialized palliative care units and other wards in two university hospitals between April 2016 and March 2017 were included. Results Most of the 237 analyzed CODE-GER questionnaires were completed by the patient’s spouse (42.6%) or children (40.5%) and 64.1% were female. Patients stayed in hospital for an average of 13.7 days (3–276; SD 21.1). Half of the patients died in a specialized palliative care unit (50.6%). The CODE-GER total score was 85.7 (SD 14.17; 25–104). Subscales were rated significantly better for palliative care units than for other wards. Unsatisfying outcomes were reported in both groups in the subscales for information/decision-making and information about the dying process. Conclusion The overall quality of care for the dying was rated to be good. Improvements of information about the dying process and decision-making are needed. Trial registration DRKS00013916 Electronic supplementary material The online version of this article (10.1007/s00520-020-05465-2) contains supplementary material, which is available to authorized users.
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Leppin N, Nagelschmidt K, Koch M, Riera Knorrenschild J, Rief W, Seifart C, von Blanckenburg P. Gespräche über das Lebensende erleichtern: Erkenntnisse aus der “Hand-in-Hand” Intervention. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000506111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Tod und Sterben sind in Psychotherapien häufig relevante Themen, besonders, wenn Menschen mit lebensbedrohlichen Erkrankungen in Behandlung kommen. Die Kommunikation über das Lebensende in der Therapie und im Alltag ist häufig mit Angst und Überforderung verknüpft. Dabei kann eine gelungene Kommunikation bedeuten, dass die Lebensqualität von Betroffenen und Angehörigen steigt, genau wie ihre Verbundenheit. Bisher existieren keine wissenschaftlich evaluierten Programme zur Anbahnung von Gesprächen über das Lebensende. Ein solches wurde im Rahmen der “Hand-in-Hand” Studie als Zugang für eine medizinische Vorausplanung entwickelt. <b><i>Fallbericht:</i></b> Zwei Krebsbetroffene, die im Rahmen einer randomisierten kontrollierten Studie an der “Hand-in-Hand” Intervention teilnahmen, werden vorgestellt. Die Interventionsbausteine aus Würde-Therapie, Wissensvermittlung und kognitiver Therapie werden beschrieben und ihre Wirkung qualitativ und quantitativ bewertet. Dabei zeigt sich eine hohe Zufriedenheit bezüglich der Intervention. Die Intervention kann die Kommunikation zwischen Betroffenen und Angehörigen verbessern, wenn auch in unterschiedlich starkem Ausmaß. <b><i>Schlussfolgerung:</i></b> Es ist wichtig, Menschen im Rahmen der psychotherapeutischen Versorgung nach lebensbedrohlichen Erkrankungen in ihrem Umfeld zu befragen. PsychotherapeutInnen besitzen dabei bereits Kompetenzen, mit denen sie Gespräche über das Lebensende fördern können. Der gezielte Einsatz dieser Kompetenzen im Rahmen der “Hand-in-Hand” Intervention hat in den beschriebenen Einzelfällen zu einer Veränderung in der Kommunikation geführt.
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Moslemi M, Nikfarid L, Nourian M, Nasiri M, Rezayi F. Translation, Cultural, and Age-Related Adaptation and Psychometric Properties of Persian Version of "Quality of Dying and Death" in Nurses Working in Neonatal Intensive Care Units. Indian J Palliat Care 2020; 26:34-39. [PMID: 32132781 PMCID: PMC7017712 DOI: 10.4103/ijpc.ijpc_119_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/10/2019] [Accepted: 11/02/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Death and dying care is an area with less attention in nursing. This even is evidenced as more challenging in some populations such as neonates. Neonatal intensive care unit (NICU) nurses should be aware of the quality of care they provide for dying neonates and their families to find the areas which need attention. Objective: The aim of this study was to assess the psychometric features of the Quality of Dying and Death (QODD) questionnaire in NICU nurses in Tehran, the capital city of Iran. Methods: This methodological study was conducted in 2017. For this purpose, using census method, 130 NICU nurses working in selected hospitals participated. After the backward–forward translation, based on the method proposed by the International Test Commission, the psychometric properties of the Persian QODD were examined through the assessment of the face, content and construct validity, internal consistency, and stability. Results: Final Persian QODD's content and face validity were accepted through a qualitative method. In the confirmatory factor analysis, the original version of QODD was not confirmed. Subsequently, an exploratory factor analysis was carried out in which phrases were included in three dimensions (symptom control, preparation for death of neonate, and professional attention) that explained 75% of the variance. Cronbach's alpha values ranged from 0.82 to 0.88 for these three dimensions. The intraclass correlation coefficient (ICC) was ICC = 0.94 between two tests performed with a 2-week interval on twenty eligible nurses. Conclusions: The Persian version of QODD has acceptable psychometric properties in nurses working with the neonatal population and can be used to investigate the NICU nurses' opinion on the QODD provided in NICU patients.
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Affiliation(s)
- Mahsa Moslemi
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Lida Nikfarid
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Manijeh Nourian
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maliheh Nasiri
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ferershteh Rezayi
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Choi Y, Park M, Kang DH, Lee J, Moon JY, Ahn H. The quality of dying and death for patients in intensive care units: a single center pilot study. Acute Crit Care 2019; 34:192-201. [PMID: 31723928 PMCID: PMC6849018 DOI: 10.4266/acc.2018.00374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/16/2019] [Accepted: 05/03/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To identify the necessary care for dying patients in intensive care units (ICUs), we designed a retrospective study to evaluate the quality of dying and death (QODD) experienced by the surrogates of patients with medical illness who died in the ICU of a tertiary referral hospital. METHODS To achieve our objective, the authors compared the QODD scores as appraised by the relatives of patients who died of cancer under hospice care with those who died in the ICU. For this study, a Korean version of the QODD questionnaire was developed, and individual interviews were also conducted. RESULTS Sixteen people from the intensive care group and 23 people from the hospice care group participated in the survey and completed the questionnaire. The family members of patients who died in the ICU declined participation at a high rate (50%), with the primary reason being to avoid bringing back painful memories (14 people, 87.5%). The relatives of the intensive care group obtained an average total score on the 17-item QODD questionnaire, which was significantly lower than that of the relatives of the hospice group (48.7±15.5 vs. 60.3±14.8, P=0.03). CONCLUSIONS This work implies that there are unmet needs for the care of dying patients and for the QODD in tertiary hospital ICUs. This result suggests that shared decision making for advance care planning should be encouraged and that education on caring for dying patients should be provided to healthcare professionals to improve the QODD in Korean ICUs.
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Affiliation(s)
- Yanghwan Choi
- Department of Burn and Critical Care, Bestian Hospital, Osong, Korea
| | - Myoungrin Park
- Department of Internal Medicine, Daejeon Veterans Hospital, Daejeon, Korea
| | - Da Hyun Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jooseon Lee
- Hospital Ethics Committee, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Young Moon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Heejoon Ahn
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Tools Measuring Quality of Death, Dying, and Care, Completed after Death: Systematic Review of Psychometric Properties. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:183-197. [PMID: 30141020 PMCID: PMC6397142 DOI: 10.1007/s40271-018-0328-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Measuring the quality of care at the end of life and/or the quality of dying and death can be challenging. Some measurement tools seek to assess the quality of care immediately prior to death; others retrospectively assess, following death, the quality of end-of-life care. The comparative evaluation of the properties and application of the various instruments has been limited. Objective This systematic review identified and critically appraised the psychometric properties and applicability of tools used after death. Method We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by systematically searching MEDLINE, Embase, CINAHL, and PsycINFO for relevant studies. We then appraised the psychometric properties and the quality of reporting of the psychometric properties of the identified tools using the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) checklist. The protocol of this systematic review has been registered on PROSPERO (CRD42016047296). Results The search identified 4751 studies. Of these, 33 met the inclusion criteria, reporting on the psychometric properties of 67 tools. These tools measured quality of care at the end of life (n = 35), quality of dying and death (n = 22), or both quality of care at the end of life and dying and death (n = 10). Most tools were completed by family carers (n = 57), with some also completed by healthcare professionals (HCPs) (n = 2) or just HCPs (n = 8). No single tool was found to be adequate across all the psychometric properties assessed. Two quality of care at the end of life tools—Care of the Dying Evaluation and Satisfaction with Care at the End of Life in Dementia—had strong psychometric properties in most respects. Two tools assessing quality of dying and death—the Quality of Dying and Death and the newly developed Staff Perception of End of Life Experience—had limited to moderate evidence of good psychometric properties. Two tools assessing both quality of care and quality of dying and death—the Quality Of Dying in Long-Term Care for cognitively intact populations and Good Death Inventory (Korean version)—had the best psychometric properties. Conclusion Four tools demonstrated some promise, but no single tool was consistent across all psychometric properties assessed. All tools identified would benefit from further psychometric testing. Electronic supplementary material The online version of this article (10.1007/s40271-018-0328-2) contains supplementary material, which is available to authorized users.
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Mah K, Powell RA, Malfitano C, Gikaara N, Chalklin L, Hales S, Rydall A, Zimmermann C, Mwangi-Powell FN, Rodin G. Evaluation of the Quality of Dying and Death Questionnaire in Kenya. J Glob Oncol 2019; 5:1-16. [PMID: 31162985 PMCID: PMC6613712 DOI: 10.1200/jgo.18.00257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2019] [Indexed: 12/01/2022] Open
Abstract
PURPOSE A culturally appropriate, patient-centered measure of the quality of dying and death is needed to advance palliative care in Africa. We therefore evaluated the Quality of Dying and Death Questionnaire (QODD) in a Kenyan hospice sample and compared item ratings with those from a Canadian advanced-cancer sample. METHODS Caregivers of deceased patients from three Kenyan hospices completed the QODD. Their QODD item ratings were compared with those from 602 caregivers of deceased patients with advanced cancer in Ontario, Canada, and were correlated with overall quality of dying and death ratings. RESULTS Compared with the Ontario sample, outcomes in the Kenyan sample (N = 127; mean age, 48.21 years; standard deviation, 13.57 years) were worse on 14 QODD concerns and on overall quality of dying and death (P values ≤ .001) but better on five concerns, including interpersonal and religious/spiritual concerns (P values ≤ .005). Overall quality of dying was associated with better patient experiences with Symptoms and Personal Care, interpersonal, and religious/spiritual concerns (P values < .01). Preparation for Death, Treatment Preferences, and Moment of Death items showed the most omitted ratings. CONCLUSION The quality of dying and death in Kenya is worse than in a setting with greater PC access, except in interpersonal and religious/spiritual domains. Cultural differences in perceptions of a good death and the acceptability of death-related discussions may affect ratings on the QODD. This measure requires revision and validation for use in African settings, but evidence from such patient-centered assessment tools can advance palliative care in this region.
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Affiliation(s)
- Kenneth Mah
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Carmine Malfitano
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- University of Ferrara, Ferrara, Italy
| | | | - Lesley Chalklin
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care, Toronto, Ontario, Canada
| | - Sarah Hales
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Anne Rydall
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Gary Rodin
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Global Institute of Psychosocial, Palliative and End-of-Life Care, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Mah K, Hales S, Weerakkody I, Liu L, Fernandes S, Rydall A, Vehling S, Zimmermann C, Rodin G. Measuring the quality of dying and death in advanced cancer: Item characteristics and factor structure of the Quality of Dying and Death Questionnaire. Palliat Med 2019; 33:369-380. [PMID: 30561236 DOI: 10.1177/0269216318819607] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Ensuring a good death in individuals with advanced disease is a fundamental goal of palliative care. However, the lack of a validated patient-centered measure of quality of dying and death in advanced cancer has limited quality assessments of palliative-care interventions and outcomes. Aim: To examine item characteristics and the factor structure of the Quality of Dying and Death Questionnaire in advanced cancer. Design: Cross-sectional study with pooled samples. Setting/participants: Caregivers of deceased advanced-cancer patients ( N = 602; mean ages = 56.39–62.23 years), pooled from three studies involving urban hospitals, a hospice, and a community care access center in Ontario, Canada, completed the Quality of Dying and Death Questionnaire 8–10 months after patient death. Results: Psychosocial and practical item ratings demonstrated negative skewness, suggesting positive perceptions; ratings of symptoms and function were poorer. Of four models evaluated using confirmatory factor analyses, a 20-item, four-factor model, derived through exploratory factor analysis and comprising Symptoms and Functioning, Preparation for Death, Spiritual Activities, and Acceptance of Dying, demonstrated good fit and internally consistent factors (Cronbach’s α = 0.70–0.83). Multiple regression analyses indicated that quality of dying was most strongly associated with Symptoms and Functioning and that quality of death was most strongly associated with Preparation for Death ( p < 0.001). Conclusion: A new four-factor model best characterized quality of dying and death in advanced cancer as measured by the Quality of Dying and Death Questionnaire. Future research should examine the value of adding a connectedness factor and evaluate the sensitivity of the scale to detect intervention effects across factors.
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Affiliation(s)
- Kenneth Mah
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sarah Hales
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Isuri Weerakkody
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lucy Liu
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Samantha Fernandes
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Anne Rydall
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sigrun Vehling
- 3 Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,4 Palliative Care Unit, Department of Oncology, Hematology and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Camilla Zimmermann
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,5 Department of Medicine, University of Toronto, Toronto, ON, Canada.,6 Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,7 Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Gary Rodin
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,6 Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,7 Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto and Princess Margaret Cancer Centre, Toronto, ON, Canada
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22
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Heckel M, Bussmann S, Weber M, Ostgathe C, Stiel S. Interference Between Family Caregivers' Mental Disorders and Their Estimates of Quality of Dying and Death (QODD) of Their Loved Ones. J Palliat Care 2018; 32:34-39. [PMID: 28662624 DOI: 10.1177/0825859717711319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In studies enrolling informal caregivers of patients in palliative care, it is necessary to ensure that findings are not influenced by factors such as mental disorders. AIM This study aims to describe the influence of anxiety and depression on bereaved informal caregivers' retrospective ratings of the quality of dying and death (QoDD) of their loved ones. DESIGN Informal caregivers of deceased patients from 2 German palliative care (PC) units took part in a validation study of the German version of the original QoDD-Deutsch-Angehörige (QoDD-D-Ang) during the fourth week following the patient's death at the earliest. Depressive and panic disorders were assessed via the Patient Health Questionnaire (PHQ). Group comparisons (χ2, t test; significance level P < .05) analyzed whether informal caregivers with depression or panic disorders and those without such disorders differ in their estimates. RESULTS A total of 226 informal caregivers participated between August 2012 and December 2013. The mean age of participants was 55.5 years; 61.1% were female. The PHQ of 221 participants resulted in 8.6% with major disorders, 13.6% with other depressive syndromes, and 77.8% without depressive disorders. In this secondary data analysis here, there was no difference between female and male participants concerning the incidence of depression ( P = .519, χ2). Two participants screened positive for both panic and major depressive disorders. Both groups presented no significant differences in the mean total QoDD-D-Ang scores ( P = .343). CONCLUSION Informal caregivers' estimates on the QoDD-D-Ang of their significant others do not interfere with mental disorders. Therefore, bereaved informal caregivers are able to participate in the PC research after a few weeks following the loss of a loved one.
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Affiliation(s)
- Maria Heckel
- 1 Institue for General Practice, Hannover Medical School, Germany
| | - Sonja Bussmann
- 1 Institue for General Practice, Hannover Medical School, Germany
| | - Martin Weber
- 1 Institue for General Practice, Hannover Medical School, Germany
| | | | - Stephanie Stiel
- 1 Institue for General Practice, Hannover Medical School, Germany.,2 Department of Palliative Medicine, Universitätsklinikum Erlangen, Krankenhausstraße, Erlangen, Germany
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Stiel S, Stelzer EM, Schneider N, Herbst FA. Exploring end-of-life interaction in dyads of parents and adult children: a protocol for a mixed-methods study. BMC Palliat Care 2018; 17:68. [PMID: 29703204 PMCID: PMC5921393 DOI: 10.1186/s12904-018-0322-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/20/2018] [Indexed: 11/26/2022] Open
Abstract
Background A considerable number of terminally-ill adult children are outlived by at least one parent and receive palliative care prior to their death. At the same time, adult children continue to be confronted with their parents’ terminal illnesses and end-of-life situations. The current study explores the specifics of dyadic interaction at the end of life between a) adult children suffering from a life-threatening disease and their parents, and b) terminally ill parents and their adult children. Methods This prospective observational study aims at filling the existing gap on adult child-parent interaction specifics at the end of life using an exploratory mixed-methods framework. The mixed-methods framework combines a qualitative face-to face interview and quantitative self-report questionnaires to study the topic at hand. The qualitative interview will focus on experiences, expectations, and wishes with regard to dyadic communication, information about illness and prognosis, expressed and perceived burden and support as well as caregiving role at the end of life. The questionnaires will cover socio-demographics, loneliness, attachment style, social support, and emotional closeness. Discussion The research group is currently adjusting a semi-structured interview guide and questionnaire instructions based on the results of a multiprofessional scientific advisory board meeting (Jan. 2018). In a next step, and prior to qualitative and quantitative data collection, the questionnaires will be piloted on patients and their family members in a palliative care setting. The main expected results are i) a description of the specifics of the interaction within and between both dyads, ii) the development of hypotheses and a theoretical framework on the specifics, similarities, and differences for both study groups, and iii) clinical conclusions on specific psychosocial care needs of both groups. Trial registration The study was registered prospectively in the Health Services Research Germany register (Versorgungsforschung Deutschland – Datenbank) (Registration N° VfD_Dy@EoL_17_003897; date of registration: November 22, 2017) and in the German Clinical Trials Register (Deutsches Register Klinischer Studien) (Registration N° DRKS00013206; date of registration: October 27, 2017). The study is visible in the International Clinical Trials Registry Platform Search Portal of the World Health Organization under the German Clinical Trials Register number.
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Affiliation(s)
- Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Eva-Maria Stelzer
- Department of Psychology, The University of Arizona, 1503 E University Blvd, Tucson, AZ, 85721, USA
| | - Nils Schneider
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Franziska A Herbst
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany.
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Gutiérrez Sánchez D, Pérez Cruzado D, Cuesta-Vargas AI. The quality of dying and death measurement instruments: A systematic psychometric review. J Adv Nurs 2018; 74:1803-1818. [PMID: 29672911 DOI: 10.1111/jan.13687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
Abstract
AIMS To identify instruments that could assess the quality of dying and death and their psychometric properties. To assess the methodological quality of studies on measurement properties. BACKGROUND A high quality of death is regarded as a goal at the end of life and, therefore, an assessment of the end of life experience is essential. Many instruments have been developed to evaluate the quality of dying and death. The selection of the most appropriate measure to be used in clinical and research settings is crucial. DESIGN Psychometric systematic review. DATA SOURCES We systematically searched ProQuest Medline, SciELO and ProQuest PsycINFO from 1970 - May 2016. REVIEW METHODS Identification and evaluation of instruments that assessed quality of dying and death. Papers were evaluated by two independent reviewers according to the COSMIN checklist with a 4-point scale. RESULTS A total of 19 studies were included in this review. Seven instruments were found that were specifically designed for assessing quality of dying and death. A retrospective carer proxy report to evaluate this construct was used in most of the papers. The methodological quality of the studies was fair for most of the psychometric characteristics analyzed. CONCLUSION Many instruments have been developed to assess the quality of dying and death. The Quality of Dying and Death Questionnaire is the best available measure of the quality of dying and death. It is the only questionnaire identified in this review where all psychometric properties according to the COSMIN checklist have been evaluated.
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Affiliation(s)
- Daniel Gutiérrez Sánchez
- Fundación Cudeca. Av. del Cosmos, s/n, 29631 Arroyo de la Miel, Málaga, Spain
- Departamento de Fisioterapia, Instituto de Investigación Biomédico de Málaga (IBIMA), Universidad de Málaga, C/ Arquitecto Francisco Peñalosa, Ampliación Campus Teatinos, 29071 Malaga, Spain
| | - David Pérez Cruzado
- Departamento de Fisioterapia, Instituto de Investigación Biomédico de Málaga (IBIMA), Universidad de Málaga, C/ Arquitecto Francisco Peñalosa, Ampliación Campus Teatinos, 29071 Malaga, Spain
| | - Antonio I Cuesta-Vargas
- Departamento de Fisioterapia, Instituto de Investigación Biomédico de Málaga (IBIMA), Universidad de Málaga, C/ Arquitecto Francisco Peñalosa, Ampliación Campus Teatinos, 29071 Malaga, Spain
- School of Clinical Sciences, Faculty of Health at the Queensland University of Technology, Queensland, Australia
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25
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Gutiérrez Sánchez D, Cuesta-Vargas AI. Cross-cultural adaptation and psychometric testing of the Quality of Dying and Death Questionnaire for the Spanish population. Eur J Oncol Nurs 2018; 33:8-13. [DOI: 10.1016/j.ejon.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/08/2017] [Accepted: 01/04/2018] [Indexed: 11/29/2022]
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26
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Stiel S, Heckel M, Wendt KN, Weber M, Ostgathe C. Palliative Care Patients’ Quality of Dying and Circumstances of Death—Comparison of Informal Caregivers’ and Health-Care Professionals’ Estimates. Am J Hosp Palliat Care 2018. [DOI: 10.1177/1049909118756616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Patient-reported outcomes are usually considered to be the gold standard assessment. However, for the assessment of quality of dying and death, ratings of informal caregivers (ICGs) or health-care professionals (HCPs) must be considered for ethical and methodological reasons. This article aims to present results of ICGs’ and HCPs’ estimates of the questionnaire, quality of dying and death (QoDD) on patients who died in PCUs and to compare the level of agreement of both ratings/raters. Methods: The parent validation study to this analysis assessed the ICG and HCP versions of the QoDD. Descriptive statistics are presented for each item in both versions. T tests for the estimation of differences between ICG and HCP were performed. Case-related absolute differences between estimates were analyzed regarding the extent of agreement and deviation. Results: Two hundred fifteen matched ICG and HCP ratings were analyzed. The ratings in all 6 QoDD dimensions were high; single items scored low. Mean absolute difference between both ratings was 0.33 (standard deviation [SD]: 3.08; median 0.05) on a 0 to 10 numerical rating scale and ranges between −8.24 (higher rating of ICGs compared to HCPs) and 9.33 (higher rating of HCPs compared to ICGs). Conclusions: The findings appear to show a high satisfaction with quality of dying and death as rated by ICGs and HCPs, but we suspect this might be indicative of a methodological challenge, that is, a ceiling effect in both assessments. Single low scoring items may provide important clues for improvement in end-of-life care. Although descriptive data show comparable mean values and standard deviations, the actual congruence of ratings is low. In summary, replacing one rating by another cannot be recommended.
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Affiliation(s)
- Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Hanover, Germany
| | - Maria Heckel
- Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), CCC Erlangen—EMN, Universitätsklinikum Erlangen, Germany
| | - Kim Nikola Wendt
- Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), CCC Erlangen—EMN, Universitätsklinikum Erlangen, Germany
| | - Martin Weber
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), CCC Erlangen—EMN, Universitätsklinikum Erlangen, Germany
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Yun YH, Kang EK, Lee J, Choo J, Ryu H, Yun HM, Kang JH, Kim TY, Sim JA, Kim Y. Development and validation of the quality care questionnaire -palliative care (QCQ-PC): patient-reported assessment of quality of palliative care. BMC Palliat Care 2018; 17:40. [PMID: 29506514 PMCID: PMC5836356 DOI: 10.1186/s12904-018-0296-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 02/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study, we aimed to develop and validate an instrument that could be used by patients with cancer to evaluate their quality of palliative care. METHODS Development of the questionnaire followed the four-phase process: item generation and reduction, construction, pilot testing, and field testing. Based on the literature, we constructed a list of items for the quality of palliative care from 104 quality care issues divided into 14 subscales. We constructed scales of 43 items that only the cancer patients were asked to answer. Using relevance and feasibility criteria and pilot testing, we developed a 44-item questionnaire. To assess the sensitivity and validity of the questionnaire, we recruited 220 patients over 18 years of age from three Korean hospitals. RESULTS Factor analysis of the data and fit statistics process resulted in the 4-factor, 32-item Quality Care Questionnaire-Palliative Care (QCQ-PC), which covers appropriate communication with health care professionals (ten items), discussing value of life and goals of care (nine items), support and counseling for needs of holistic care (seven items), and accessibility and sustainability of care (six items). All subscales and total scores showed a high internal consistency (Cronbach alpha range, 0.89 to 0.97). Multi-trait scaling analysis showed good convergent (0.568-0.995) and discriminant (0.472-0.869) validity. The correlation between the total and subscale scores of QCQ-PC and those of EORTC QLQ-C15-PAL, MQOL, SAT-SF, and DCS was obtained. CONCLUSION This study demonstrates that the QCQ-PC can be adopted to assess the quality of care in patients with cancer.
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Affiliation(s)
- Young Ho Yun
- Department of Family Medicine, Seoul National University Hospital, 103 Daehak-ro, Jongno-GU, Seoul, 03080, Republic of Korea. .,Department of Biomedical Informatics, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Biomedical Science, Seoul National University College of Medicine, Seoul, South Korea.
| | - Eun Kyo Kang
- Department of Family Medicine, Seoul National University Hospital, 103 Daehak-ro, Jongno-GU, Seoul, 03080, Republic of Korea
| | - Jihye Lee
- Department of Biomedical Informatics, Seoul National University College of Medicine, Seoul, South Korea
| | - Jiyeon Choo
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyewon Ryu
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Hye-Min Yun
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Postgraduate Medical School, Gyeongsang National University, Jinju, South Korea
| | - Tae You Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jin-Ah Sim
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, South Korea
| | - Yaeji Kim
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, South Korea
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Mai SS, Gerlach C, Schmidtmann I, Vogt AR, Zeller V, Renner KH, Weber M. Are Repeated Self-Reports of Psychological Variables Feasible for Patients Near the End of Life at a Palliative Care Unit? J Palliat Med 2018; 21:1005-1010. [PMID: 29437545 DOI: 10.1089/jpm.2017.0537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measurement is crucial to assess the benefit of psychotherapeutic interventions. Is repeated assessment of psychometric self-report data possible, as inpatient palliative care patients suffer from physical and psychological symptoms? What is the self-perceived strain caused by the assessment? Objective The main objective of this study was to investigate the feasibility of a repeated comprehensive psychometric self-assessment of inpatient palliative care patients. Secondary objectives were the PROs of the psychometric assessment. DESIGN We conducted a prospective cohort study. Patients admitted to our palliative care unit (PCU) were reviewed for eligibility within 72 hours. They were asked for weekly self-reports regarding hope (HHI-D), well-being (FACIT-Sp), anxiety and depression (STADI), and quality of life (QoL; EORTC-QLQ-C-30 single item). The strain caused by the assessment was assessed by a numeric rating scale (0-10) and free comments. RESULTS Within 11 months, 219 patients were admitted to the PCU. In total, 92 patients were eligible. The most frequent exclusion criterion was "life expectancy <1 week." A total of 60 patients participated at the first point of measurement. The mean of self-perceived strain (Likert scale 0-10) due to the assessment was 1.44 (SD 1.99) at T1. Twenty-four patients participated twice. Here we found increased scores for physical well-being and QoL. CONCLUSION Repeated assessment of psychological conditions is feasible for 27.4% of inpatients at a German PCU. The most limiting factor is life expectancy of only days at admission to the PCU. However, the self-perceived strain is low.
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Affiliation(s)
- Sandra Stephanie Mai
- 1 Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz , Mainz, Germany
| | - Christina Gerlach
- 1 Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz , Mainz, Germany
| | - Irene Schmidtmann
- 2 Institute for Medical Biostatistics, Epidemiology and Informatics, Department of Biometry and Bioinformatics, University Medical Centre of the Johannes Gutenberg University , Mainz, Germany
| | - Annika Renate Vogt
- 1 Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz , Mainz, Germany
| | - Viola Zeller
- 1 Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz , Mainz, Germany
| | - Karl-Heinz Renner
- 3 Department of Psychology, Bundeswehr University Munich , Neubiberg, Germany
| | - Martin Weber
- 1 Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz , Mainz, Germany
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29
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Ewertowski H, Tetzlaff F, Stiel S, Schneider N, Jünger S. Primary palliative Care in General Practice - study protocol of a three-stage mixed-methods organizational health services research study. BMC Palliat Care 2018; 17:21. [PMID: 29378561 PMCID: PMC5789650 DOI: 10.1186/s12904-018-0276-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/22/2018] [Indexed: 12/02/2022] Open
Abstract
Background The focus of this project is on improving the provision of primary palliative care (PC) by general practitioners (GPs). While approximately 10–15% of the incurable, seriously ill or dying people will be in need of specialist PC, the vast majority can be adequately treated within generalist care. The strengthening of the GP’s role in PC, as well as ensuring close collaboration between specialist PC services and GPs have been identified as top priorities for the improvement of PC in Germany. Despite healthcare policy actions, diverse obstacles still exist to successful implementation of primary PC on a structural, process, and economic level. Therefore, this project aims at addressing barriers and facilitators to primary PC delivery in general practice in Germany. Methods The study follows a three-step approach; first, it aims at systematically analyzing barriers and facilitators to primary PC provision by GPs. Second, based on these outcomes, a tailored intervention package will be developed to enhance the provision of primary PC by GPs. Third, the intervention package will be implemented and evaluated in practice. The expected outcome will be an evidence-based model for successful implementation of primary PC delivery tailored to the German healthcare system, followed by a strategic action plan on how to improve current practice both on a local level and nationally. Discussion The first step of the project has been partly completed at the time of writing. The chosen methodologies of four sub-projects within this first step have opened up different advantages and disadvantages for the data collection. In sum of all sub-projects, the different methodologies and target groups contributed valuable information to the systematic analysis of barriers and facilitators to primary PC provision by GPs. Trial registration The study (BMBF-FK 01 GY 1610) was retrospectively registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien) (Registration N° DRKS00011821; date of registration: December 04th 2017) and at the German Register of health care research (Versorgungsforschung Deutschland - Datenbank) (Registration N° VfD_ALLPRAX_16_003817; date of registration: March 30th 2017).
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Affiliation(s)
- Helen Ewertowski
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany.
| | - Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Nils Schneider
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany
| | - Saskia Jünger
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany.,Cologne Center for Ethics, Rights, Economics and Social Sciences of Health, University of Cologne, Universitätsstraße 91, 50931, Cologne, Germany
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30
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Pérez-Cruz PE, Padilla Pérez O, Bonati P, Thomsen Parisi O, Tupper Satt L, Gonzalez Otaiza M, Ceballos Yáñez D, Maldonado Morgado A. Validation of the Spanish Version of the Quality of Dying and Death Questionnaire (QODD-ESP) in a Home-Based Cancer Palliative Care Program and Development of the QODD-ESP-12. J Pain Symptom Manage 2017; 53:1042-1049.e3. [PMID: 28323080 DOI: 10.1016/j.jpainsymman.2017.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 01/20/2017] [Accepted: 02/08/2017] [Indexed: 11/30/2022]
Abstract
CONTEXT Improving quality of death (QOD) is a key goal in palliative care (PC). To our knowledge, no instruments to measure QOD have been validated in Spanish. OBJECTIVES The goals of this study were to validate the Spanish version of the quality of dying and death (QODD) questionnaire and to develop and validate a shortened version of this instrument by phone interview. METHODS We enrolled caregivers (CGs) of consecutive deceased cancer patients who participated in a single PC clinic. CGs were contacted by phone between 4 and 12 weeks after patients' death and completed the Spanish QODD (QODD-ESP). A question assessing quality of life during last week of life was included. A 12-item QODD (QODD-ESP-12) was developed. Reliability, convergent validity, and construct validity were estimated for both versions. RESULTS About 150 (50%) of 302 CGs completed the QODD-ESP. Patient's mean age (SD) was 67 (14); 71 (47%) were females, and 131 (87%) died at home. CGs' mean age (SD) was 51 (13); 128 (85%) were females. Mean QODD-ESP score was 69 (range 35-96). Kaiser-Meyer-Olkin measure of sampling adequacy was 0.322, not supporting the use of factorial analysis to assess the existence of an underlying construct. Mean QODD-ESP-12 score was 69 (range 31-97). Correlation with last week quality of life was 0.306 (P < 0.01). Confirmatory factorial analysis of QODD-ESP-12 showed that data fitted well Downey's four factors; Chi-square test = 6.32 (degrees of freedom = 60), P = 0.394 comparative fit index = 0.988; Tucker-Lewis Index = 0.987, and root mean square error of approximation = 0.016 (95% CI 0-0.052). CONCLUSION QODD-ESP-12 is a reliable and valid instrument with good psychometric properties and can be used to assess QOD in a Spanish-speaking cancer PC population by phone interview.
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Affiliation(s)
- Pedro E Pérez-Cruz
- Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Oslando Padilla Pérez
- Departamento Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pilar Bonati
- Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Oliva Thomsen Parisi
- Departamento Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Laura Tupper Satt
- Unidad Cuidados Paliativos, Complejo Asistencial Dr. Sótero del Río, Servicio de Salud Metropolitano Sur Oriente, Puente Alto, Chile
| | - Marcela Gonzalez Otaiza
- Unidad Cuidados Paliativos, Complejo Asistencial Dr. Sótero del Río, Servicio de Salud Metropolitano Sur Oriente, Puente Alto, Chile
| | - Diego Ceballos Yáñez
- Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Armando Maldonado Morgado
- Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Programa Medicina Paliativa y Cuidados Continuos, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Heckel M, Bussmann S, Stiel S, Ostgathe C, Weber M. Validation of the German Version of the Quality of Dying and Death Questionnaire for Health Professionals. Am J Hosp Palliat Care 2016; 33:760-9. [DOI: 10.1177/1049909115606075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: To validate the Quality of Dying and Death (QoDD) instrument for health professionals (QoDD-D-MA) and to test its feasibility in 2 German palliative care units (PCUs). Methods: The QoDD was translated from English to German and then retranslated following European Organisation for Research and Treatment of Cancer (EORTC) guidelines. Data were collected in 2 German PCUs to calculate aspects of validity and reliability. Results: Mean total score was 83.05 (range 49-100; N = 232). The QoDD-D-MA showed satisfactory psychometric properties, Cronbach α = .830; interrater reliability r = .245 ( P < .01). The QoDD-D-MA was independent of patients’ demographic and clinical aspects. Some challenges occurred when applying the instrument. Conclusions: Feasibility could be improved by adapting the QoDD-D-MA to create a self-assessment version and finding a solution for items that result in many missing data. Future research should validate the QoDD-D-MA in other care settings.
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Affiliation(s)
- Maria Heckel
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Sonja Bussmann
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Stephanie Stiel
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Martin Weber
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
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