From Theory to Practice: Measuring end-of-life communication quality using multiple goals theory

Objectives To describe how multiple goals theory can be used as a reliable and valid measure (i.e., coding scheme) of the quality of conversations about end-of-life issues. Methods We analyzed conversations from 17 conversations in which 68 participants (mean age = 51 years) played a game that prompted discussion in response to open-ended questions about end-of-life issues. Conversations (mean duration = 91 min) were audio-recorded and transcribed. Communication quality was assessed by three coders who assigned numeric scores rating how well individuals accomplished task, relational, and identity goals in the conversation. Results The coding measure, which results in a quantifiable outcome, yielded strong reliability (intra-class correlation range = 0.73–0.89 and Cronbach's alpha range = 0.69–0.89 for each of the coded domains) and validity (using multilevel nonlinear modeling, we detected significant variability in scores between games for each of the coded domains, all p-values <0.02). Conclusions Our coding scheme provides a theory-based measure of end-of-life conversation quality that is superior to other methods of measuring communication quality. Practice implications Our description of the coding method enables researches to adapt and apply this measure to communication interventions in other clinical contexts.