Validation of the Family Inpatient Communication Survey

Abstract

Context Although many family members who make surrogate decisions report problems with communication, there is no validated instrument to accurately measure surrogate/clinician communication for older adults in the acute hospital setting. Objectives To validate a survey of surrogate-rated communication quality in the hospital that would be useful to clinicians, researchers and health systems. Methods After expert review and cognitive interviewing (n=10 surrogates), we enrolled 350 surrogates (250 development sample and 100 validation sample) of hospitalized adults aged 65 and older from three hospitals in one metropolitan area. The communication survey and a measure of decision quality were administered within hospital days 3 and 10. Mental health and satisfaction measures were administered 6–8 weeks later. Results Factor analysis showed support for both one-factor (Total Communication) and two-factor models (Information and Emotional Support.) Item reduction led to a final 30 item scale. For the validation sample, internal reliability (Cronbach’s alpha) was 0.96 (total), 0.94 (Information) and 0.90 (Emotional Support). Confirmatory Factor Analysis fit statistics were adequate (one factor model, CFI=0.981, RMSEA=0.62, WRMR=1.011; two factor model CFI=0.984, RMSEA=0.055, WRMR=0.930) Total score and subscales showed significant associations with the Decision Conflict Scale (Pearson correlation −0.43, p<.001 for total score). Emotional support was associated with improved mental health outcomes at 6–8 weeks such as anxiety (−0.19 p<0.001) and Information was associated with satisfaction with the hospital stay (0.49, p<0.001). Conclusion The survey show high reliability and validity in measuring communication experiences for hospital surrogates. The scale has promise for measurement of communication quality and is predictive of important outcomes such as surrogate satisfaction and well-being.

How Surrogates Decide: A Secondary Data Analysis of Decision-Making Principles Used by the Surrogates of Hospitalized Older Adults

“…We performed a secondary data analysis of a multi-hospital study of surrogate-decision makers for incapacitated hospitalized elderly patients. 16 The study was conducted between April 2012 and July 2015 on the inpatient general medicine and medical ICUs of a county hospital, a tertiary referral center, and a community hospital, all affiliated with Indiana University. Research assistants screened patients for enrollment by real-time monitoring of the electronic medical record for general medicine and ICU admissions.…”

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

“…Abstracts of 252 articles were reviewed and 2 family-clinician communication instruments were identified: Family Inpatient Communication Survey (FICS) and Family Perception of Physician-Family caregiver Communication (FPPFC). 14,15 Second, each instrument was entered in the Web of Science database to search for sources with information about psychometric properties. The second search resulted in 3 articles for FICS and 61 articles for FPPFC.…”

“…Family Inpatient Communication Survey is a measurement intended to assess hospital communication from the family surrogate's perspective. 15 information disclosure, (c) emotional/spiritual support, (d) treated with respect, (e) surrogate engagement/advocacy, and (f) strength of relationships. 15 In the development stage, 4 criteria were employed to reduce the number of test items: (a) item response rate, (b) intertotal/interitem correlations, (c) ceiling/floor effects, and (d) confirmatory factor analysis.…”

“…15 information disclosure, (c) emotional/spiritual support, (d) treated with respect, (e) surrogate engagement/advocacy, and (f) strength of relationships. 15 In the development stage, 4 criteria were employed to reduce the number of test items: (a) item response rate, (b) intertotal/interitem correlations, (c) ceiling/floor effects, and (d) confirmatory factor analysis. Example items include "The hospital staff communicated with me as often as I would have liked" and "The hospital staff really listened to me when we talked."…”

Nontraditional Surrogate Decision Makers for Hospitalized Older Adults

“…This is a secondary analysis of a baseline cross-sectional survey of a larger prospective observational study which validated a survey of surrogate-clinician communication in hospitals (18). All data in this analysis are from the baseline interview .…”