Adaptation and validation of an instrument to measure quality of end-of-life care in emergency departments

Abstract

Introduction: One way of successfully measuring the quality of end-of-life care is by means of practical, applicable and valid questionnaires that focus on quality end-of-life care and can be used to help healthcare professionals to identify what interventions are needed to improve the quality of end-of-life care they deliver. Background: Dying and end-of-life care is a world-wide concern and healthcare professionals are expected to deliver, evaluate and improve the quality of care delivered. End-of-life care affects the patients’ families and healthcare professionals. However the reality is that patients die in the emergency department whether expected or unexpected. Healthcare professionals in the EDs render care to patients of all ages ranging from newborns to elderly patients on a 24-hour basis, including adult patients with end-of-life care needs. Aim: The aim of the study was to adapt and validate the ‘ICU Palliative Care Quality Assessment Tool’ used to measure quality end-of-life in an ICU context for the ED. Research design and methods: A quantitative and descriptive study was conducted with healthcare professionals working in EDs in private and public hospitals in South Africa. The study was conducted in four stages and data was collected over six months by means of an on-line survey to adapt and validate the instrument. The respondents were asked to give feedback on the instructions to respondents, the layout of the instrument, the 10-point Likert scale, and each item. In terms of the items, the respondents were asked to comment on the relevance, content, and clarity of each of the 61 items. The respondents were given an opportunity to add additional items to the instrument that they considered relevant to the provision of quality end-of-life in the ED (Ranse et al 2014:699). Text boxes were provided for comments or rephrasing of the items. Stage 4 was a pilot study with three hundred and fifteen respondents to validate the instrument. Results: The results showed a Cronbach’s alpha above 80%. Conclusion: The results therefore validated the ‘Quality End-of-life Care Assessment in Emergency Departments’ instrument to measure quality end-of-life care in the ED.