End-of-life practices in Danish ICUs: development and validation of a questionnaire

BMC Anesthesiology

Research Article

Helle Ørding¹  Hanne Irene Jensen¹  Mogens Erlandsen²  Jette Ammentorp³ 

[1] Department of Anaesthesiology, Vejle Hospital, Vejle, Denmark;Department of Biostatistics, Aarhus University, Aarhus, Denmark;Health Services Research Unit, Lillebaelt Hospital/IRS University of Southern, Kolding, Denmark;

关键词: Ceiling Effect;    Content Validity;    Focus Group Interview;    Weighted Kappa;    Primary Physician;   

DOI  :  10.1186/1471-2253-12-16

 received in 2011-09-28, accepted in 2012-07-16,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundPractices for withholding or withdrawing therapy vary according to professional, cultural and religious differences. No Danish-validated questionnaire examining withholding and withdrawing practices exists, thus the aim of this study was to develop and validate a questionnaire for surveying the views of intensive care nurses, intensivists, and primary physicians regarding collaboration and other aspects of withholding and withdrawing therapy in the ICU.MethodsA questionnaire was developed on the basis of literature, focus group interviews with intensive care nurses and intensivists, and individual interviews with primary physicians. The questionnaire was validated in the following 3 phases: a qualitative test with 17 participants; a quantitative pilot test with 60 participants; and a survey with 776 participants. The validation process included tests for face and content validity (by interviewing participants in the qualitative part of the pilot study), reliability (by assessing the distribution of responses within the individual response categories), agreement (by conducting a test-retest, evaluated by paired analyses), known groups’ validity (as a surrogate test for responsiveness, by comparing two ICUs with a known difference in end-of-life practices), floor and ceiling effect, and missing data.ResultsFace and content validity were assessed as good by the participants in the qualitative pilot test; all considered the questions relevant and none of the participants found areas lacking. Almost all response categories were used by the participants, thus demonstrating the questionnaires ability to distinguish between different respondents, agreement was fair (the average test-retest agreement for the Likert scale responses was 0.54 (weighted kappa; range, 0.25-0.73), and known groups’ validity was proved by finding significant differences in level of satisfaction with interdisciplinary collaboration and in experiences of withdrawal decisions being unnecessarily postponed. Floor and ceiling effect was in accordance with other questionnaires, and missing data was limited to a range of 0-7% for all questions.ConclusionsThe validation showed good and fair areas of validity of the questionnaire. The questionnaire is considered a useful tool to assess the perceptions of collaboration and other aspects of withholding and withdrawing therapy practices in Danish ICUs amongst nurses, intensivists, and primary physicians.

【 授权许可】

CC BY   
© Jensen et al.; licensee BioMed Central Ltd. 2012