Psychometric Characteristics of a Quality of Communication Questionnaire Assessing Communication about End-of-Life Care

Abstract

The importance of good clinician–patient communication to quality end-of-life care has been well documented yet there are no validated measures that allow patients to assess the quality of this communication. Using a sample of hospice patients (n = 83) and patients with chronic obstructive pulmonary disease (COPD) (n = 113), we evaluated the psychometric characteristics of a 13-item patient-centered, patient-report questionnaire about the quality of end-of-life communication (QOC). Our purpose was to explore the measurement structure of the QOC items to ascertain if the items represent unitary or multidimensional constructs and to describe the construct validity of the QOC score(s). Analyses included: principal component analyses to identify scales, internal consistency analyses to demonstrate reliability, and correlational and group comparisons to support construct validity. Findings support the construction of two scales: a six-item "general communication skills" scale and a seven-item, "communication about end-of-life care" scale. The two scales meet standards of scale measurement, including good factor convergence (values ≥ 0.63) and discrimination (values different ≥ 0.25), percent of variance explained (69.3%), and good internal consistency (α ≥ 0.79). The scales' construct validity is supported by significant associations (p ≤ 0.01) with items assessing overall quality of doctor communication and quality of care, number and type of end-of-life discussions, and doctor's awareness of patient's treatment preferences. The general communication skills scale correlates more strongly with the general communication items while the communication about end-of-life care scale correlates more strongly with items addressing end-of-life topics. While further validation studies are needed, this assessment of the QOC represents an important step toward providing a measure of the quality of end-of-life communication.