Development of an Audit Tool to Evaluate End of Life Care in the Emergency Department: A Face and Content Validity Study

Abstract

Objectives:Emergency Departments (ED) are increasingly caring for patients with acute, chronic and terminal conditions requiring End of Life Care (EOLC). There is no published and validated tool available to evaluate EOLC delivery of patients dying in the ED. This study describes the face and content validity testing process to develop, refine and test a new and unique audit tool to evaluate EOLC in the ED.Methods: The face and content validation process used a three-round modified-Delphi technique. We consulted 11 experts to assess the proposed 89 items. Face validity explored the overall question of appropriateness and relevance; and content validity examined relevance ratings using the Content Validity Index (CVI) 4-point Likert scale in two rounds. Iterative assessment of ratings led to inclusion (CVI > 0.78), revision (CVI 0.65 to < 0.78) or exclusion (CVI < 0.65) of items from the tool.Results: Of the initial 89 items, 66 were included (CVI > 0.78), 16 items revised (scores 0.65 to < 0.78), seven were removed (scores < 0.65) and two new items suggested. Items covered the constructs patient characteristics, circumstances of death, ED performance, communication and care planning, recognition of dying, care delivery, and needs of families and carers. Scale CVI achieved 0.90. The consolidated list of 81 items achieved acceptable face validity and excellent content validity.Conclusion:Face and content validity of the ED EOLC audit tool achieved acceptable item-CVI scores and an excellent scale-CVI score. We recommend external validation of its components in real-life settings to monitor and set locally relevant clinical practice benchmarks.