Development and validation of a Care Of the Dying Evaluation ‐ Thai version (CODE-THAI)

Background Palliative care in Thailand has been integrated into the national healthcare system. Few instruments are available to assess outcomes relating to the quality of death and dying. However, no specific tool exists to evaluate the quality of care during the dying phase. This study aimed to translate into Thai and cross-culturally adapt the ‘Care Of the Dying Evaluation’ (CODE-THAI). Additionally, the study aimed to evaluate its reliability and validity. Methods A forward-backward translation approach was employed. Content validity and cognitive interviews were then conducted. The construct validity, concurrent validity, and reliability were assessed among bereaved relatives recruited from two hospitals in Thailand. Results Of the 966 questionnaires distributed, 229 were returned, and 185 (19.2%) were included in the analysis. The CODE-THAI demonstrated linguistic, semantic, and conceptual equivalence, with excellent content validity (CVI = 1.00). The instrument indicated good internal consistency (Cronbach's α = 0.89) and excellent test-retest reliability (ICC = 0.81, p < 0.001). The four-factor model demonstrated suboptimal fit, with several fit indices failing to reach recommended standards. The concurrent validity was supported by a moderate correlation with the Good Death Inventory-Short Version (r = 0.41, p < 0.001). Conclusions The CODE-THAI represents the first instrument developed to assess the quality of care during the dying phase in Thailand and has demonstrated acceptable psychometric properties. These findings suggest its potential use by healthcare providers for evaluating dying care quality in both clinical practice and research.