Acute Crit Care.  2018 May;33(2):95-101. 10.4266/acc.2017.00612.

Transcultural Adaptation and Validation of Quality of Dying and Death Questionnaire in Medical Intensive Care Units in South Korea

• Cho JY
• Lee J
• Lee SM
• Park JH
• Kim J
• Kim Y
• Lee SH
• Park JS
• Cho YJ
• Yoon HI
• Lee JH
• Lee CT
• Lee YJ

• KMID: 2436317
• DOI: http://doi.org/10.4266/acc.2017.00612

Abstract

BACKGROUND
Providing palliative care to dying patients in the intensive care unit (ICU) has recently received much attention. Evaluating the quality of dying and death (QODD) is important for appropriate comfort care in the ICU. This study aimed to validate the Korean version of the QODD questionnaire.
METHODS
This study included decedents in the ICUs of three tertiary teaching hospitals and one secondary hospital from June 2016 to May 2017. ICU staff members were asked to complete the translated QODD questionnaire and the visual analogue scale (VAS) questionnaire within 48 hours of patient death. The validation process consisted of evaluating construct validity, internal consistency, and interrater reliability.
RESULTS
We obtained 416 completed questionnaires describing 255 decedents. The QODD score was positively correlated with the 100-VAS score (Pearson correlation coefficient, 0.348; P < 0.001). An evaluation of the internal consistency presented favorable results (calculated Cronbach's alpha if a given item exceeded 0.8 in all items). The interrater reliability revealed no concordance between doctors and nurses.
CONCLUSIONS
The QODD questionnaire was successfully translated and validated in Korean medical ICUs. We hope further studies that use this valuable instrument will be conducted in Korea.

Keyword

attitude to death; intensive care units; medical staff; questionnaires and surveys; validation studies

MeSH Terms

Attitude to Death
Critical Care*
Hope
Hospitals, Teaching
Humans
Intensive Care Units*
Korea*
Medical Staff
Palliative Care
Surveys and Questionnaires

Reference

1. Adhikari NK, Fowler RA, Bhagwanjee S, Rubenfeld GD. Critical care and the global burden of critical illness in adults. Lancet. 2010; 376:1339–46.

2. Vincent JL, Marshall JC, Namendys-Silva SA, Francois B, Martin-Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med. 2014; 2:380–6.

3. Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000; 284:2476–82.

4. Hofmann JC, Wenger NS, Davis RB, Teno J, Connors AF Jr, Desbiens N, et al. Patient preferences for communication with physicians about end-of-life decisions. Ann Intern Med. 1997; 127:1–12.

5. Connors AF, Dawson NV, Desbiens NA, Fulkerson WJ, Goldman L, Knaus WA, et al. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA. 1995; 274:1591–8.

6. Beckstrand RL, Callister LC, Kirchhoff KT. Providing a “good death”: critical care nurses’ suggestions for improving end-of-life care. Am J Crit Care. 2006; 15:38–45.

7. Patrick DL, Engelberg RA, Curtis JR. Evaluating the quality of dying and death. J Pain Symptom Manage. 2001; 22:717–26.

8. Glavan BJ, Engelberg RA, Downey L, Curtis JR. Using the medical record to evaluate the quality of end-of-life care in the intensive care unit. Crit Care Med. 2008; 36:1138–46.

9. Treece PD, Engelberg RA, Crowley L, Chan JD, Rubenfeld GD, Steinberg KP, et al. Evaluation of a standardized order form for the withdrawal of life support in the intensive care unit. Crit Care Med. 2004; 32:1141–8.

10. Curtis JR, Patrick DL, Engelberg RA, Norris K, Asp C, Byock I. A measure of the quality of dying and death: initial validation using after-death interviews with family members. J Pain Symptom Manage. 2002; 24:17–31.

11. University of Washington School of Medicine. Quality of dying and death questionnaire for nurses: version 3.2. Healthcare professional after-death self-administered questionnaire [Internet]. Seattle (WA): University of Washington School of Medicine;[cited 2018 May 11]. Available from: http://depts.washington.edu/eolcare/pubs/wp-content/uploads/2011/08/nurseqodd3_2.pdf.

12. Bagozzi RP, Yi Y, Phillips LW. Assessing construct validity in organizational research. Adm Sci Q. 1991; 36:421–58.

13. Henson RK. Understanding internal consistency reliability estimates: a conceptual primer on coefficient alpha. Meas Eval Couns Dev. 2001; 34:177–89.

14. Ferrand E, Robert R, Ingrand P, Lemaire F; French LATAREA Group. Withholding and withdrawal of life support in intensive-care units in France: a prospective survey. French LATAREA Group. Lancet. 2001; 357:9–14.

15. Prendergast TJ, Puntillo KA. Withdrawal of life support: intensive caring at the end of life. JAMA. 2002; 288:2732–40.

16. Billings ME, Engelberg R, Curtis JR, Block S, Sullivan AM. Determinants of medical students’ perceived preparation to perform end-of-life care, quality of end-of-life care education, and attitudes toward end-of-life care. J Palliat Med. 2010; 13:319–26.

17. Levy CR, Ely EW, Payne K, Engelberg RA, Patrick DL, Curtis JR. Quality of dying and death in two medical ICUs: perceptions of family and clinicians. Chest. 2005; 127:1775–83.

18. Breen CM, Abernethy AP, Abbott KH, Tulsky JA. Conflict associated with decisions to limit life-sustaining treatment in intensive care units. J Gen Intern Med. 2001; 16:283–9.

19. Bae JM, Gong JY, Lee JR, Heo DS, Koh Y. A survey of patients who were admitted for life-sustaining therapy in nationwide medical institutions. Korean J Crit Care Med. 2010; 25:16–20.

20. Shin K, Mok JH, Lee SH, Kim EJ, Seok NR, Ryu SS, et al. The current status of medical decision-making for dying patients in a medical intensive care unit: a single-center study. Korean J Crit Care Med. 2014; 29:160–5.