Development and validation of a collaborative behaviors objective assessment tool for end-of-life communication.

Context: Helping families make end-of-life decisions requires close collaboration between physicians and nurses. However, medical and nursing students have little formal training in how to collaborate in this task, and few instruments are available to measure collaborative behaviors.

Objectives: The objective of this project was to develop and validate observational assessment tools to measure specific interprofessional competencies in medical and nursing students related to end-of-life discussions.

Design: A literature search for evidence-based guidelines and competencies and focus groups with an expert panel of nurses and physicians were used to outline best collaborative practice behaviors for nurses and physicians in an end-of-life decision making simulation. The panel used these practice-behavior checklists to rate videotaped student scenarios and then refined the checklists for validity and clarity until the tools had acceptable inter-rater reliability.

Setting: The setting was a workshop teaching end-of-life communication to third-year nursing and medical students.

Measurements: Inter-rater reliability was measured using percent agreement and kappa; internal consistency was measured using Cronbach's alpha.

Results: Collaborative behaviors objective assessment tools (CBOATs) for nursing and medical students were developed. For the medical CBOAT we found 85% agreement between raters, with an overall kappa of 0.744 and Cronbach's alpha of 0.806. For the nursing CBOAT there was 81% agreement, with a kappa of 0.686 and Cronbach's alpha of 0.845.

Conclusions: Development of an end-of-life CBOAT clarified the important collaborative behaviors needed by physician and nurse. The resulting instruments provide a helpful guide for teaching interprofessional sessions related to the end of life and measuring student outcomes using an objective strategy.