To evaluate the construct validity and internal consistency of the ‘Care Of the Dying Evaluation’ (CODETM) in a global setting.

CODETM post-bereavement survey (August 2017 to September 2018). Respondents were next-of-kin adult cancer patients (≥ 18 years old) who died within 22 study site hospitals in seven countries: Argentina, Brazil, Germany, Norway, Poland, the United Kingdom, and Uruguay. Internal reliability was tested using Cronbach alpha (α) and exploratory and confirmatory factor analysis (EFA and CFA). The capacity to differentiate the quality of treatment depending on location (Palliative Care Units (PCUs)) and nation (Poland, where the majority of fatalities occurred in PCUs) of care was used to assess known group validity. Effect sizes were used to quantify differences (ES).

About 914 CODETM surveys were returned (54% response rate). About 527 (58%) male dead patients; 610 (67%) female next-of-kin who were most usually the spouse/partner’ (411, 45%). EFA discovered four criteria with high dependability scores: ‘Overall care,’ ‘Communication and support,’ ‘Trust, respect, and dignity,’ and ‘Symptom management’ with good reliability scores (α = 0.628 – 0.862). The 4-factor model was validated by CFA; they were highly connected, and a bifactor model suited the data well. The ES for quality of care in PCUs was 0.727, whereas the ES for Poland was 0.657, demonstrating CODETM‘s sensitivity to detect variations.

Good evidence supports the validity and reliability of CODETM for measuring the quality of care given in the final days of life in an international environment.