# Cross-cultural adaption and psychometric validation of Importance of Good Death-Indonesian version for patients with advanced cancer

## TL;DR

This study adapted and validated a questionnaire to assess what Indonesian cancer patients value most in a good death, finding five key areas: comfort, relationships, preparation, support, and meaning.

## Contribution

The study provides a culturally adapted and psychometrically validated tool for assessing end-of-life priorities in Indonesian advanced cancer patients.

## Key findings

- The Indonesian version of the questionnaire has five factors explaining 59.1% of total variance.
- The tool demonstrated excellent internal consistency with a Cronbach's alpha of 0.91.
- The questionnaire reflects cultural values such as family support and spiritual preparation for death.

## Abstract

To adapt and test the psychometric properties of the Importance of Good Death Questionnaire for Indonesian patients with advanced cancer.

The original instrument underwent a rigorous process of forward and backward translation, complemented by an expert panel review to ensure cultural and conceptual equivalence and to evaluate content validity. A total of 447 patients with advanced cancer were recruited via convenience sampling from two government hospitals in Solo and Samarinda, Indonesia, between September 2022 and February 2023. The sample was then divided into two groups. Sample 1 (n ​= ​265) was used for exploratory factor analysis to establish the initial factor structure of the Indonesian version, and Sample 2 (n ​= ​182) was used for confirmatory factor analysis to validate construct validity. No significant differences in demographics or clinical variables were observed between the two samples.

Following the expert panel review, the instrument underwent exploratory factor analysis and confirmatory factor analysis, resulting in a final Indonesian version containing 24 items across five factors: comfort, relationship closure, preparation for death, support from others, and life meaning. The five-factor model accounted for 59.1% of the total variance. Specifically, comfort explained 40% of the variance, relationship closure explained 9.2%, preparation for death explained 5%, support from others explained 2.8%, and life meaning explained 2.1%. Internal consistency was excellent, with an overall Cronbach's alpha of 0.91 and factor-specific alpha values ranging from 0.73 to 0.93.

The study results indicate that the Importance of Good Death-Indonesian version has good psychometric properties and is a valid and reliable instrument to assess the importance of good death in an Indonesian advanced cancer population. In nursing practice, the instrument can guide culturally responsive end-of-life care by identifying patients’ priorities across five domains. This enables nurses to develop individualized care plans, address pain and symptom needs, facilitate meaningful family interactions, support spiritual or practical preparation for death, and inform palliative care decision-making.

Talking about death is never easy; yet understanding what makes a “good death” is essential for improving care at the end of life. This study adapted and tested the Importance of Good Death questionnaire for use with Indonesian patients with advanced cancer. Through surveys with 447 patients, the Indonesian version identified five key areas people value most: comfort, relationship closure, preparation for death, support from others, and life meaning. The tool showed strong reliability and cultural relevance, reflecting Indonesia's spiritual traditions and family-centered values. For nurses and other health professionals, this tool offers practical guidance to tailor care, including managing pain, supporting family connections, and addressing spiritual needs. Therefore, patients can face the end of life with dignity and peace.