A novel questionnaire to measure staff perception of end-of-life decision making in the intensive care unit--development and psychometric testing

Abstract

Purpose: The aim of this study was to create a questionnaire that measures barriers and facilitators of effective end-of-life (EOL) decision making and communication and associated stress as perceived by intensive care unit (ICU) staff.

Methods: The questionnaire was developed on the basis of a theoretical framework and discussion with ICU staff. It was pretested among 15 ICU nurses and physicians. A field test was conducted in 4 interdisciplinary ICUs of one university hospital Descriptive item analysis, exploratory factor analysis, and reliability and validity analysis were performed.

Results: Overall, 174 of 284 ICU staff participated in the field test (61% response). Factor analysis indicated a 7-factor solution: (1) collaboration in the EOL context, (2) role clarity in the EOL context, (3) work-related interruptions of communication with families, (4) emotional support, (5) stress by involvement in EOL decision making and communication with families, (6) stress by work overload, and (7) taking initiative toward EOL decision making. Internal consistency of the scales was acceptable (range, 0.69-0.85). Construct validity was shown by relationships of the scales to several constructs, for example, satisfaction with EOL decision making and emotional exhaustion. Overall, 26 of 31 expected relationships achieved significance.

Conclusions: The new questionnaire meets psychometric criteria of reliability and validity and promises to be a useful quality measure of EOL decision making in the ICU.

Keywords: Decision making; Intensive care; Interdisciplinary health team; Palliative care; Professional Burnout; Questionnaires.