Yorkshire Cancer Research Senior Clinical Research Fellow and Honorary Consultant in Palliative Medicine (C.R.M.), University of Sheffield, Honorary Clinical Fellow, University of Liverpool, Liverpool, UK.
School of Health and Related Research (A.D.K., C.M.), University of Sheffield, Sheffield, UK.
J Pain Symptom Manage. 2022 Jul;64(1):e23-e33. doi: 10.1016/j.jpainsymman.2022.02.340. Epub 2022 Mar 5.
Assessing quality of care provided during the dying phase using validated tools aids quality assurance and recognizes unmet need.
To assess construct validity and internal consistency of 'Care Of the Dying Evaluation' (CODE) within an international context.
Post-bereavement survey (August 2017 to September 2018) using CODE. Respondents were next-of-kin to adult patients (≥ 18 years old) with cancer who had an 'expected' death within 22 study site hospitals in 7 countries: Argentina, Brazil, Germany, Norway, Poland, United Kingdom, Uruguay. Exploratory and Confirmatory Factor Analysis (EFA and CFA) were conducted, and internal reliability was assessed using Cronbach alpha (α). Known group validity was assessed by ability to discriminate quality of care based in place (Palliative Care Units (PCUs)) and country (Poland, where most deaths were in PCUs) of care. Differences were quantified using effect sizes (ES).
A 914 CODE questionnaires completed (54% response rate). 527 (58%) male deceased patients; 610 (67%) next-of-kin female who were most commonly the 'spouse/partner' (411, 45%). EFA identified 4 factors: 'Overall care,' 'Communication and support,' 'Trust, respect and dignity,' and 'Symptom management' with good reliability scores (α = 0.628 - 0.862). CFA confirmed the 4-factor model; these were highly correlated and a bifactor model showed acceptable fit. The ES for quality of care in PCU's was 0.727; ES for Poland was 0.657, supporting the sensitivity of CODE to detect differences.
Within an international context, good evidence supports the validity and reliability of CODE for assessing the quality of care provided in the last days of life.
使用经过验证的工具评估临终阶段的护理质量有助于保证护理质量并发现未满足的需求。
在国际背景下评估“临终关怀评估”（CODE）的结构效度和内部一致性。
采用 CODE 进行事后调查（2017 年 8 月至 2018 年 9 月）。调查对象为在 7 个国家的 22 家研究地点医院中患有癌症且预计在 2 年内死亡的成年患者（≥18 岁）的家属：阿根廷、巴西、德国、挪威、波兰、英国、乌拉圭。进行探索性和验证性因素分析（EFA 和 CFA），并使用 Cronbach alpha（α）评估内部可靠性。采用基于地点（姑息治疗病房（PCU））和国家（波兰，大多数死亡发生在 PCU）的护理质量来区分护理质量的能力来评估已知组的有效性。使用效应大小（ES）来量化差异。
共完成 914 份 CODE 问卷（54%的回应率）。527 名（58%）男性已故患者；610 名（67%）女性家属，她们最常见的是“配偶/伴侣”（411 名，45%）。EFA 确定了 4 个因素：“整体护理”、“沟通与支持”、“信任、尊重和尊严”和“症状管理”，具有良好的可靠性评分（α=0.628-0.862）。CFA 证实了 4 因素模型；这些因素高度相关，双因素模型显示出可接受的拟合度。PCU 护理质量的 ES 为 0.727；波兰的 ES 为 0.657，支持 CODE 检测差异的敏感性。
在国际背景下，有充分证据支持 CODE 评估生命最后几天提供的护理质量的有效性和可靠性。
