Selecting the Best Instrument to Measure Family Perceptions of End-of-Life Communication in Intensive Care Units

Abstract

Background: Good communication with the family is a clinical imperative for high quality end-of-life (EOL) care in intensive care unit (ICU). Many interventions aim to improve EOL communication, and the choice of an outcome instrument has important implications for evaluating interventions. The purpose of this project is to search and review available instruments’ psychometric properties and determine which best measures family–clinician communication in the ICU. Method: A stepwise method was used by searching 2 databases (PsycInfo and Web of Science) to identify instruments and articles that provide information about scale psychometric properties. Instruments: Three instruments were identified, including Family Inpatient Communication Survey, Family Perception of Physician–Family Caregiver Communication, and Quality of Communication (QOC). Results: Reliability estimates were high (≥ 0.79) in all 3 instruments. The QOC’s convergent validity estimates exceed its discriminant validity values, and the QOC is an intervention-sensitive measure used to examine families’ treatment response in randomized control trials. Conclusion: Quality of Communication is the most suitable instrument to measure family’s perceptions of EOL communication in the ICU. Quality of Communication scores provide a deeper understanding of family–clinician communication and data about how to improve EOL care in ICUs.

Adaptation of the Quality of Communication Questionnaire for Family Members and Its Validity Evidence for Use in Brazil

“…For Brazilian cultural appropriateness, it was 9.74 (SD = . 19), with no significant statistical difference between men and women, t (28) = À.050, p = .96, rendering it unnecessary to modify any component. Figure 2 displays the original version of the QoC (for patients), the QoC version for family members for use in Brazil, and its back-translation.…”

“…18 It has validity evidence, and it has been widely used in international contexts. 19 Moreover, it has a validated version in Brazil. 20,21 However, there was still a gap in studies that adapted the QoC version for family members and analyzed its validity evidence.…”

Assessing Family Caregiver Communication in Chronic Illness: Validation of the FCCT-CI

“…12 Most of the published instruments for family caregiver communication are related to end-of-life care, are diseasespecific with a predominant focus on cancer or cancer populations, are not theory-driven, and none of them address the context of chronic illness. 13,14 Overall, little is known about how and why caregivers communicate about illness which may influence intervention outcomes and intervention participation. 15 Factors such as communication between caregiver and patient, healthcare providers, and other family members are often unaccounted for, yet psychosocial and psychoeducational interventions often include communication.…”