Assessing the Reliability and Validity of Quality of Death and Dying Index Among Chinese Hospice and Palliative Care...

Background: There is a critical need for tools to evaluate the quality of end-of-life care from the perspective of palliative care professionals. Currently, suitable instruments for this purpose are scarce in China. Objective: To translate the Quality of Death and Dying Index (QODDI) into Chinese and assess its reliability and validity among palliative care professionals. Design: A cross-sectional survey was conducted in November 2023 among 1174 health care professionals (doctors, nurses, social workers) in Shanghai, China. Following systematic translation and cultural adaptation, the Chinese QODDI's internal consistency was measured with Cronbach's alpha, and test-retest reliability was assessed with 49 responses over 6 months. Dimensionality was examined through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), while concurrent validity was assessed using correlations with the Good Death Inventory (GDI). Results: The Chinese QODDI showed high internal consistency (α = 0.979) and moderate test-retest reliability (intraclass correlation coefficient = 0.696, p < 0.001). The EFA revealed a three-factor structure (physical/holistic care, interpersonal support/communication, and informational support). The CFA showed overall good model fit (χ²/df = 4.8, root mean square error of approximation = 0.057, comparative fit index = 0.974, standardized root mean square residual = 0.017, normed fit index = 0.967). Convergent validity was strong, with average variance extracted values for all factors exceeding 0.82. Concurrent validity was supported by significant correlations between QODDI and the GDI (ρ = 0.506, p < 0.001). Conclusions: The Chinese-translated QODDI is a reliable and valid tool for assessing end-of-life care quality in China, with potential applications in research and clinical practice.