Evaluating quality of care for dying patients from the perspective of bereaved relatives: validation of the Chinese version of the international care of the dying evaluation

Background

Few recognized, valid and reliable tools are used to assess the current quality of care at the very end-of-life from the bereaved relative’s perspective in Mainland China. The purpose of this study was to validate the Chinese version of the international Care Of the Dying Evaluation (i-CODE) questionnaire by assessing its reliability and validity.

Methods

From June 2023 to January 2024, participants were 216 bereaved relatives who were the primary caregivers of the deceased patients. Confirmatory Factor Analyses (CFA) were conducted, concurrent and discriminant validity was examined by correlating scores from the Chinese version of the i-CODE with Good Death Inventory (GDI), Care Evaluation Scale (CES), and Patient Health Questionnaire (PHQ-9). Internal reliability was assessed with Cronbach alpha (α) and test-retest reliability was assessed using Intraclass Correlation Coefficients (ICC).

Results

The Chinese version of the i-CODE had four dimensions and 27 items were confirmed based on confirmatory factor analysis of the factor structure proposed by the authors of the original version. The fit indices were acceptable: Root Mean Square Error of Approximation (RMSEA) was 0.069, Standardised Root Mean Square Residual (SRMR) was 0.063, Comparative Fit Index (CFI) was 0.879, and Tucker-Lewis Index (TLI) was 0.864. The i-CODE was moderately correlated with the GDI (r = 0.50, p < 0.001) and CES (r = 0.31, p < 0.001) and not correlated with PHQ-9 (r = 0.02, p = 0.765). The internal consistency was excellent (Cronbach’s α = 0.91) and the test-retest reliability was good (ICC = 0.73).

Conclusions

The Chinese version of the i-CODE demonstrated acceptable preliminary psychometric properties and broadly supported the original four-factor structure, indicating suitability for assessing the quality of care in the last days of life from the perspective of bereaved relatives in Mainland China. Further validation in larger and more diverse samples is needed, and the scale may be useful for clinical evaluation, quality improvement and cross-cultural research in end-of-life care.