# Development, Translation, and Validation of the Japanese Quality of Dying and Death Questionnaire for Families of ICU Patients

## TL;DR

This study developed and validated a Japanese version of a questionnaire to assess the quality of dying and death in ICU patients, ensuring it is culturally and linguistically appropriate for Japan.

## Contribution

The study introduces a culturally adapted Japanese ICU-QODD questionnaire with validated reliability and validity for use in Japanese ICU settings.

## Key findings

- The Japanese ICU-QODD achieved strong content validity with a mean scale-level CVI exceeding 0.90.
- The questionnaire demonstrated robust reliability with an intraclass correlation coefficient above 0.7 for most items.
- Known-groups analysis showed lower QODD scores for patients admitted from the ward, indicating discriminative validity.

## Abstract

Background and aim: Intensive care unit (ICU) mortality rates are notably high. Several studies outside Japan indicate that the Quality of Death and Dying (QODD) in ICUs is often rated lower compared with settings such as hospices or specialized palliative care units. However, there are no tools to directly evaluate QODD in ICUs that are appropriate to Japanese culture and medicine. Consequently, no study has been conducted in Japanese ICU settings. This study aimed to develop a Japanese version of the QODD Questionnaire 3.2A (ICU-QODD) and to evaluate its reliability and validity.

Methods: The ICU-QODD was translated into Japanese following the guidelines for translation, adaptation, and validation of instruments. A pilot test involving an expert panel and family members of 40 ICU survivors helped establish the content validity index (CVI). Further testing with 59 bereaved family members evaluated validity through convergent and known groups analyses, while reliability was assessed through internal consistency and test-retest methods.

Results: The pilot test confirmed the face and content validity of the Japanese ICU-QODD. Following revisions, all items achieved a CVI of 0.78 or higher, with an average scale-level CVI exceeding 0.90. One item with low CVI was excluded, resulting in a finalized 24-item version. The ICU-QODD demonstrated strong construct validity, with significant domain correlations to the total score. Known-groups analysis revealed lower QODD scores for patients admitted from the ward (p=0.03). Internal consistency and reliability were robust, with the intraclass correlation coefficient generally above 0.7 (range: 0.705-0.964, p<0.001).

Conclusions: The Japanese version of the ICU-QODD translated in this study demonstrates satisfactory validity and reliability, making it suitable for clinical use in Japan, and adapted to the country’s medical, cultural, and linguistic context.