Measuring the structure and process of end-of-life care in Korea: Validation of the Korean version of the care evaluation scale (CES)

Context. A reliable and valid measure of structure and process of end-of-life care is important for improving the outcomes of care. Objectives. This study examined the validity and reliability of the Korean version of Care Evaluation Scale (CES), which was developed in Japan to evaluate structure and process of palliative care from the perspective of bereaved family members. Methods. Standard forward-backward translation and a pilot test were conducted. A multicenter cross-sectional survey was conducted with bereaved family members (n = 501) of patients who had died from cancer two to six months before the study. Descriptive analyses were performed. The reliability of the CES was tested by Cronbach's alpha. The dimensional structure was assessed using confirmatory factor analyses. Concurrent and discriminant validity were tested by correlation with the overall satisfaction with care, patient's overall quality of life (QoL), and family member's own QoL as measured by the EQ-5D. Results. Participants could complete the CES readily, with low missing response rates. Cronbach's alpha for internal consistency was 0.93 overall, and ranged from 0.88 to 0.94 for subdomains. The hypothesized 10 subscale model of the CES appeared to fit the data (goodness-of-fit index = 0.854). The overall score of the CES moderately correlated with overall satisfaction with care (r = 0.54, P < 0.001), more weakly correlated with the patient's QoL (r = 0.32, P < 0.001), but did not correlate with the family member's QoL (r = 0.03, P = 0.548). Conclusion. The CES was found to be a reliable and a valid measure of the necessity for improvement in the structure and process of end-of-life care from bereaved family members' perspectives.