title: A novel questionnaire to measure staff perception of end-of-life decision making in the intensive care unit--development and psychometric testing.
abstract: OBJECTIVE
  The aim of this study was to create a questionnaire that measures barriers and facilitators of effective end-of-life (EOL) decision making and communication and associated stress as perceived by intensive care unit (ICU) staff.
  
  
  METHODS
  The questionnaire was developed on the basis of a theoretical framework and discussion with ICU staff. It was pretested among 15 ICU nurses and physicians. A field test was conducted in 4 interdisciplinary ICUs of one university hospital Descriptive item analysis, exploratory factor analysis, and reliability and validity analysis were performed.
  
  
  RESULTS
  Overall, 174 of 284 ICU staff participated in the field test (61% response). Factor analysis indicated a 7-factor solution: (1) collaboration in the EOL context, (2) role clarity in the EOL context, (3) work-related interruptions of communication with families, (4) emotional support, (5) stress by involvement in EOL decision making and communication with families, (6) stress by work overload, and (7) taking initiative toward EOL decision making. Internal consistency of the scales was acceptable (range, 0.69-0.85). Construct validity was shown by relationships of the scales to several constructs, for example, satisfaction with EOL decision making and emotional exhaustion. Overall, 26 of 31 expected relationships achieved significance.
  
  
  CONCLUSIONS
  The new questionnaire meets psychometric criteria of reliability and validity and promises to be a useful quality measure of EOL decision making in the ICU.
authors.affiliation: Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital (JUH), Erlanger Allee 101, 07747 Jena, Germany. Electronic address: Daniel.Schwarzkopf@med.uni-jena.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schwarzkopf
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, JUH, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: Isabella.Westermann@med.uni-jena.de.
authors.forename: Isabella
authors.initials: I
authors.lastname: Westermann
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, JUH, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: Helga.Skupin@med.uni-jena.de.
authors.forename: Helga
authors.initials: H
authors.lastname: Skupin
authors.affiliation: Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital (JUH), Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, JUH, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: Niels.Riedemann@med.uni-jena.de.
authors.forename: Niels C
authors.initials: NC
authors.lastname: Riedemann
authors.affiliation: Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital (JUH), Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, JUH, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: Konrad.Reinhart@med.uni-jena.de.
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.affiliation: Department of Internal Medicine I, JUH, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: Ruediger.Pfeifer@med.uni-jena.de.
authors.forename: Ruediger
authors.initials: R
authors.lastname: Pfeifer
authors.affiliation: Department of Internal Medicine I, JUH, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: Michael.Fritzenwanger@med.uni-jena.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Fritzenwanger
authors.affiliation: Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital (JUH), Erlanger Allee 101, 07747 Jena, Germany; Department of Neurology, JUH, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: Albrecht.Guenther@med.uni-jena.de.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Günther
authors.affiliation: Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital (JUH), Erlanger Allee 101, 07747 Jena, Germany; Department of Neurology, JUH, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: Otto.Witte@med.uni-jena.de.
authors.forename: Otto W
authors.initials: OW
authors.lastname: Witte
authors.affiliation: Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital (JUH), Erlanger Allee 101, 07747 Jena, Germany; Department of Anesthesiology and Intensive Care Medicine, JUH, Erlanger Allee 101, 07747 Jena, Germany. Electronic address: Christiane.Hartog@med.uni-jena.de.
authors.forename: Christiane S
authors.initials: CS
authors.lastname: Hartog
mesh_terms: D000328:Adult; D003142:Communication; D003422:Critical Care / Q000523:psychology*; D064648:Critical Care Nursing; D003657:Decision Making; D005163:Factor Analysis, Statistical; D005260:Female; D005858:Germany; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D009784:Occupational Diseases / Q000523:psychology; D010358:Patient Participation; D011594:Psychometrics; D015203:Reproducibility of Results; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*; D055815:Young Adult
keywords: Decision making; Intensive care; Interdisciplinary health team; Palliative care; Professional Burnout; Questionnaires