Yuen Jacqueline K, Chan Helen Y L, Chen Tracy W T, Chu Steven T, Kwok Annie O L, Leung Doris Y P, Gill Harinder S, Tsang Kwok-Wai, Tse Doris M W, Yap Desmond Y H, Yip Terence, Arnold Robert M
Division of Geriatrics, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China.
School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
BMC Palliat Care. 2025 May 19;24(1):140. doi: 10.1186/s12904-025-01786-3.
Effective clinician-patient communication is essential for delivering quality end-of-life care. However, there are no validated measures to assess the quality of end-of-life communication for Chinese patients.
This study aims to cross-culturally adapt and validate the patient-reported Quality of Communication Questionnaire (QOC) for Chinese speaking patients. The QOC was translated and adapted using a standardized methodology consisting of forward translations, backward translations, expert panel review, and testing with patients. We conducted a cross-sectional study to perform principal component, content validity, internal consistency, convergent and discriminant validity analyses of the 16-item Chinese QOC (C-QOC). Subjects were Chinese-speaking advanced cancer (n = 82) and advanced chronic kidney disease (n = 68) patients attending outpatient clinics in five hospitals or receiving home-based palliative care in Hong Kong.
The content validity of the C-QOC was established by an expert panel. The C-QOC has a 3-component structure (general communication skills, communication about illness trajectory, and end-of-life care planning subscales) and demonstrated good internal consistency (Cronbach's α = 0.88; subscales 0.84-0.90). Convergent validity was supported by positive association between C-QOC score and overall clinician communication quality (r = 0.47, p < 0.001) and clinician comfort in discussing dying (r = 0.63, p < 0.001). Discriminant validity was demonstrated by the stronger association between overall clinician communication quality and general communication skills, compared to the other two subscales.
The C-QOC is a valid, reliable, and culturally relevant instrument for evaluating the quality of clinician end-of-life care communication by Chinese patients with advanced cancer and chronic kidney disease.
有效的医患沟通对于提供高质量的临终关怀至关重要。然而，目前尚无经过验证的措施来评估中国患者临终沟通的质量。
本研究旨在对患者报告的沟通质量问卷（QOC）进行跨文化改编和验证，以适用于讲中文的患者。采用包括正向翻译、反向翻译、专家小组评审和患者测试的标准化方法对QOC进行翻译和改编。我们进行了一项横断面研究，对16项中文QOC（C-QOC）进行主成分、内容效度、内部一致性、收敛效度和区分效度分析。研究对象为香港五家医院门诊就诊或接受居家姑息治疗的晚期癌症患者（n = 82）和晚期慢性肾病患者（n = 68）。
专家小组确定了C-QOC的内容效度。C-QOC具有三成分结构（一般沟通技巧、疾病轨迹沟通和临终关怀计划子量表），并显示出良好的内部一致性（Cronbach's α = 0.88；子量表为0.84 - 0.90）。C-QOC得分与临床医生总体沟通质量呈正相关（r = 0.47，p < 0.001）以及与临床医生讨论死亡时的舒适度呈正相关（r = 0.63，p < 0.001），支持了收敛效度。与其他两个子量表相比，临床医生总体沟通质量与一般沟通技巧之间的关联更强，证明了区分效度。
C-QOC是一种有效、可靠且具有文化相关性的工具，可用于评估晚期癌症和慢性肾病中国患者对临床医生临终关怀沟通的质量。
