Validation of the Japanese Version of the Ethical Decision-making Climate Questionnaire

Purpose: This study aimed to verify the reliability and validity of the Japanese version of the Ethical Decision-making Climate Questionnaire (EDMCQ) for decision making in intensive care units (ICU). Methods: The Japanese version was created by translating the English version of EDMCQ. A survey was conducted by mailing the questionnaires, targeting ICU nurses. The test was retested 14 days later. Results: The test was distributed to 439 ICU nurses. Overall, 204 responses from nurses at 25 facilities were received and analyzed (effective response rate: 46.5%). Cronbach’s α coefficient for the entire scale was 0.91, and the intraclass correlation coefficient was 0.80 (n=101, valid response rate: 23.0%). The indices for model fit in the confirmatory factor analysis were CFI: 0.836, GFI: 0.783, AGFI: 0.741, and RMSEA: 0.071. Conclusion: The Japanese version of the EDMCQ can be considered to be a practical scale for evaluation of ethical climate in Japan.

Attitudes and Barriers of Physicians toward Palliative Care in Critical Care Setting:Qualitative Content Analysis Using Open-ended Data from Nationwide Self-administrated Questionnaire Survey in Japan

Purpose: Palliative care implementation should take into account the perceptions and acceptability of healthcare providers. This study aimed to identify physicians’ perceptions of palliative care and barriers to palliative care practice in the critical care setting. Methods: A nationwide, self-administered questionnaire was distributed to physicians working in intensive care units, and free-text data were qualitatively analyzed. Results: The questionnaire was sent to 873 respondents, and 436 responded (50% response rate). Of these, 95 (11%) who responded to the open-ended sections were included in the analysis. Conclusion: Japanese physicians working in ICUs recognized that palliative care was their role and practiced it as part of their usual care. They felt, however, that the practice was difficult and not sufficient. Barriers to practice included the lack of human resources and availability of palliative care teams, and the lack of uniformity in the perception of palliative care in the critical care setting.

Development of a Scale for the Japanese Version of the Quality of Dying and Death in the Intensive Care Unit Instrument for Use by Nurses

We conducted a questionnaire survey of nurses to develop a scale for the Japanese version of the Quality of Dying and Death in the Intensive Care Unit (ICU-QODD) instrument for use by nurses. The questionnaire was based on “patient’s experience at the end of life” in ICU-QODD for health professionals in the United States. We assessed whether it could be used as a comprehensive evaluation tool. Respondents included 1,372 nurses for factor validity and internal consistency, and 39 nurses for test-retest reliability. Two factors, “physical symptoms” and “dignity” that comprised 6 items were identified. Cronbach’s alpha values were 0.89 and 0.75, respectively. Intraclass correlation coefficients were 0.62 and 0.72, respectively. Sufficient reliability and validity were confirmed. It was suggested that 6 out of 15 items could be used as for comprehensive evaluation of the ICU-QODD.