title: From Theory to Practice: Measuring end-of-life communication quality using multiple goals theory.
abstract: To describe how multiple goals theory can be used as a reliable and valid measure (i.e., coding scheme) of the quality of conversations about end-of-life issues.
  
  
  
  We analyzed conversations from 17 conversations in which 68 participants (mean age=51years) played a game that prompted discussion in response to open-ended questions about end-of-life issues. Conversations (mean duration=91min) were audio-recorded and transcribed. Communication quality was assessed by three coders who assigned numeric scores rating how well individuals accomplished task, relational, and identity goals in the conversation.
  
  
  
  The coding measure, which results in a quantifiable outcome, yielded strong reliability (intra-class correlation range=0.73-0.89 and Cronbach's alpha range=0.69-0.89 for each of the coded domains) and validity (using multilevel nonlinear modeling, we detected significant variability in scores between games for each of the coded domains, all p-values <0.02).
  
  
  
  Our coding scheme provides a theory-based measure of end-of-life conversation quality that is superior to other methods of measuring communication quality.
  
  
  
  Our description of the coding method enables researches to adapt and apply this measure to communication interventions in other clinical contexts.
authors.affiliation: Department of Medicine and Humanities, Penn State Milton S. Hershey Medical Center, United States. Electronic address: lvanscoy@hmc.psu.edu.
authors.forename: L J
authors.initials: LJ
authors.lastname: Van Scoy
authors.affiliation: Department of Communication, University of Kentucky, United States.
authors.forename: A M
authors.initials: AM
authors.lastname: Scott
authors.affiliation: Department of Medicine, Penn State Milton S. Hershey Medical Center, United States.
authors.forename: J M
authors.initials: JM
authors.lastname: Reading
authors.affiliation: Department of Medicine and Public Health Sciences, Penn State Milton S. Hershey Medical Center, United States.
authors.forename: C H
authors.initials: CH
authors.lastname: Chuang
authors.affiliation: Department of Public Health Sciences and Statistics, Penn State Milton S. Hershey Medical Center, United States.
authors.forename: V M
authors.initials: VM
authors.lastname: Chinchilli
authors.affiliation: Department of Humanities and Pediatrics, Penn State Milton S. Hershey Medical Center, United States.
authors.forename: B H
authors.initials: BH
authors.lastname: Levi
authors.affiliation: Department of Medicine and Humanities, Penn State Milton S. Hershey Medical Center, United States.
authors.forename: M J
authors.initials: MJ
authors.lastname: Green
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D010819:Physician's Role; D010817:Physician-Patient Relations; D011788:Quality of Life; D015203:Reproducibility of Results; D013727:Terminal Care / Q000379:methods
keywords: Advance care planning; Communication; End of life care; Measurement; Palliative care; Terminal care