A measure of the quality of dying and death: Initial validation using after-death interviews with family members
A measure of the quality of dying and death: Initial validation using after-death interviews with family members
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DOI：
10.1016/s0885-3924(02)00419-0
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发表时间：
2002-07-01
影响因子：
4.7
通讯作者：
Byock, I
中科院分区：
文献类型：
--
作者：
Curtis, JR;Patrick, DL;Byock, I
对临终体验质量进行可靠且有效的衡量将有助于临床医生和研究人员改善对临终患者的护理。为了描述从死后家庭成员的角度评估临终和死亡质量的工具的有效性，并确定高质量死亡的临床相关性，一项回顾性队列研究评估了 31 项临终和死亡质量 (QODD) 问卷。该问卷调查对象为 1996 年和 1997 年在蒙大拿州米苏拉县死亡的患者家属。访谈包括评估症状、患者偏好和护理满意度的问题。检查项目和总分的测量有效性，并评估 QODD 总分的可靠性分析。使用假设与临终和死亡质量相关的概念测量来评估构建效度。死亡人数为 935 人，其中有 252 人（27.0%）进行了家庭访谈。未登记的死者与登记的死者在年龄、性别、死因或死亡地点方面没有显着差异。我们排除了猝死 (n = 45) 和 18 岁以下死者 (n = 2)，留下 205 份死后访谈。 QODD 总分，按比例计算。 0 至 100 分，分数越高表示质量越好，范围为 26.0 至 99.6，平均值为 67.4，Cronbach's alpha 为 0.89。 QODD 总分与患者年龄、性别、教育程度、婚姻状况或收入无关。正如假设的那样，较高的 QODD 评分与在家中死亡 (P < 0.01)、在患者希望的地点死亡 (P < 0.01)、较低的症状负担 (P < 0.001) 以及更好的症状治疗评级 (P < 0.01) 显着相关。尽管总分与是否存在预先指示无关，但较高的分数与治疗偏好的沟通（P < 0.01）、治疗偏好的依从性（P < 0.001）以及家庭对与医疗团队沟通的满意度（P < 0.01）相关。医疗保健团队成员在夜间或周末的可用性也与较高的 QODD 评分相关 (P < 0.001)。 QODD 总分显示出良好的横截面效度。照顾临终患者的临床医生应重点改善与患者和家属的沟通，并改进症状评估和治疗。医疗团队应注重护理的连续性，包括安排一名熟悉患者的团队成员在晚上和周末接听电话。未来的工作将评估 QODD 在提高临终体验质量方面的潜在作用。
A reliable and valid measure of the quality of the dying experience would, help clinicians and researchers improve care for dying patients. To describe the validity of an instrument assessing the quality of dying and death using the perspective of family members after death and to identify clinical correlates of a high quality death, a retrospective cohort study evaluated the 31-item Quality of Dying and Death (QODD) questionnaire. The questionnaire was administered to family members of patients who died in Missoula county Montana in 1996 and 1997. The interview included questions assessing symptoms, patient Preferences, and satisfaction with care. Measurement validity was examined for item and total scores and reliability analyses for the QODD total score were assessed. Construct validity was assessed using measures of concepts hypothesized to be associated with the quality of dying and death. There were 935 deaths, of which 252 (27.0%) family interviews were represented. Non-enrolled decedents were not significantly different from enrolled decedents on age, sex, cause of death, or location of death. We excluded, sudden deaths (n = 45) and, decedents under age 18 (n = 2), leaving 205 after-death interviews. A total QODD score, on a scale from. 0 to 100 with higher scores indicating better quality, ranged from 26.0 to 99.6, with a mean of 67.4 and Cronbach's alpha of 0.89. The total QODD score was not associated with patient age, sex, education, marital status, or income. As hypothesized, higher QODD scores were significantly associated with death at home (P < 0.01), death in the location the patient desired (P < 0.01), lower symptom burden (P < 0.001), and better ratings of symptom treatment (P < 0.01). Although the total score was not associated with the presence of an advance directive, higher scores were associated with communication about treatment Preferences (P < 0.01), compliance with treatment preferences (P < 0.001), and family satisfaction regarding communication with the health care team (P < 0.01). Availability of a health care team member at night or on weekends was also associated with a higher QODD score (P < 0.001). The QODD total score demonstrated good cross-sectional validity. Clinicians caring for dying patients should focus on improving communication with the patient and family and improving symptom assessment and treatment. Health care teams should focus on continuity of care, including having a team member familiar with the patient available for calls at nights and on weekends. Future work will assess the potential role, of the QODD in improving the quality of the dying experience.