General and family medicine physicians’ perception of the concept of good death: a contribution to the validation of the scale

TL;DR

This study validates a Portuguese version of a scale measuring physicians' perceptions of a good death, showing it works well for general and family medicine doctors.

Contribution

The study provides psychometric validation of the Concept of a Good Death scale for GFM physicians in Portugal.

Findings

The Portuguese version of the scale has good internal consistency (α = 0.839).

A three-factor model (Closure, Personal Control, and Clinical domains) explained 53% of the variance.

The factor structure was mostly consistent with the original version, except for one item.

Abstract

General and Family Medicine (GFM) physicians play a key role in end-of-life care, yet there is limited knowledge about how they understand and value the components of a good death in their clinical practice. The Concept of a Good Death scale, originally developed by Schwartz et al., offers a validated instrument to explore its meaning. The present study aims to conduct a psychometric validation of the Portuguese version of the Concept of a Good Death instrument among GFM physicians in Portugal.

A cross-sectional methodological validation study was conducted between December 2024 and February 2025 using an online questionnaire. The study sample consists of 200 GFM physicians. The questionnaire included sociodemographic questions, previous experience with illness or death, and the 17-item Concept of a Good Death scale. Principal component analysis was performed to explore the factor structure. Internal consistency was assessed using Cronbach’s alpha.

Among the 200 participants initially recruited, one participant refused to provide informed consent after reading the study presentation, and another submitted an incomplete response, omitting most of the instrument’s items. These two cases were excluded from the analyses, resulting in a final sample of 198 physicians, corresponding to a response rate of 99%. Principal component analysis supported a three-factor model (Closure, Personal Control, and Clinical domains) accounting for 53% of the total variance. The overall internal consistency of the scale was good (α = 0.839). The factor structure was generally consistent with the original version, except for one item, potentially reflecting the clinical perspective of the sample.

The Portuguese version of the Concept of a Good Death scale demonstrates good psychometric properties among GFM physicians. Its application may support better understanding of healthcare professionals’ perceptions of a good death, promote more person-centered end-of-life care and contribute to palliative care education. Further studies are recommended to validate the scale across other professional and cultural groups and to strengthen its validation through approaches such as confirmatory factor analysis.

The online version contains supplementary material available at 10.1186/s12875-025-03113-4.