ArticleJournal of general internal medicine2026
Development and Evaluation of a Survey to Assess Clinician and Organizational Factors Associated with Goals of Care Communication.
Article in Journal of general internal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundGoals-of-care communication (GCC) is not commonly performed despite evidence that it contributes to better end-of-life outcomes. Clinician behavioral and organizational factors associated with GCC have not been systematically measured.
objectiveThis study aimed to develop and evaluate a survey instrument to assess these factors.
designWe adapted items from the "Determinants of Implementation Behavior" Questionnaire to develop the Goals of Care Communication survey (GCC Survey). We conducted cognitive interviews at two healthcare systems (University of California-Los Angeles, VA Greater Los Angeles Healthcare System). We administered the instrument cross-sectionally, and before and after serious illness communication skills training. We performed item-scale correlation analysis, confirmatory factor analysis, and assessed responsiveness to change on completed surveys.
participantsHealth professionals from both institutions participated in cognitive interviews, the administration of a cross-sectional survey, and surveys administered before and after serious illness communication training. MAIN MEASURES: GCC survey item responses. KEY
resultsThe final instrument includes 31 items representing six domains-1) Knowledge, skills, and beliefs (11 items); Expectations (3 items); 3) Beliefs about consequences (2 items); 4) Intentions (3 items); 5) Organizational context (8 items); and 6) Social influences and roles (4 items)-and 5 additional items that do not fall into any of the six domains. Confirmatory factor analysis indicated good fit for the 6 factors (confirmatory fit index = 0.939, root mean square error of approximation = 0.076). Four of the six domains improved following training in serious illness communication skills. A short form was found to have acceptable psychometric properties. Internal consistency reliabilities for the 3-item Knowledge, Skills, and Beliefs and 4-item Organizational Factors short-form scales were 0.93 and 0.95, respectively.
conclusionsThis study supports the reliability and validity of the GCC Survey, which can be utilized to inform quality improvement and research in the GCC.
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