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Development and Validation of a Collaborative Behaviors Objective Assessment Tool for End-of-Life Communication Journal of Palliative Medicine Volume 17 Number 1 2014




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


Measurements: Inter-rater reliability was measured using percent agreement and kappa; internal consistency

was measured using Cronbacha??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

Cronbacha??s alpha of 0.806. For the nursing CBOAT there was 81% agreement, with a kappa of 0.686 and

Cronbacha??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.

Author List

Blackhall LJ, Erickson JM, Brashers V, Owen J, Thomas S


Jeanne M. Erickson PhD, RN Associate Professor in the College of Nursing department at University of Wisconsin - Milwaukee