PP-16 Validating the coping with death scale short version (CDS-SV) for palliative and end-of-life care professionals: a think-aloud study in the UK and Ireland

Introduction Death competence, the ability to manage emotional, cognitive, and relational demands around dying, is essential for professionals in palliative and end-of-life care. The Coping with Death Scale-Short Version (CDS-SV) has demonstrated psychometric validity in Spain and Argentina, but content validity in UK and Irish contexts, where cultural norms, roles, and healthcare systems differ significantly remains underexplored. Aims To evaluate the content validity of the CDS-SV for use in UK and Irish palliative care settings, focusing on relevance, comprehensibility, and comprehensiveness. Methods A qualitative think-aloud methodology was used with a diverse sample of generalist and specialist professionals (n = 14). Participants verbalised their thoughts while completing the CDS-SV, offering real-time insights into item interpretation. Data were analysed using reflexive thematic analysis and interpreted using COSMIN guidelines for evaluating patient-reported outcome measures. Results Participants endorsed the scale’s overall relevance but identified concerns regarding phrasing, limited representation of cultural and spiritual dimensions, and inconsistent contextual alignment with the practical realities of UK and Irish palliative care settings. Items were often interpreted through the lens of systemic pressures and relational dynamics. Concerns were raised regarding implementation which enables supportive use. Emotional and procedural knowledge were seen as context-dependent, and reflective practice was an underrepresented competency. These findings suggest that while the CDS-SV captures core aspects of death competence, it requires revision to reflect UK and Irish practice realities. Conclusion Minor adaptations to the CDS-SV could enhance its conceptual clarity, cultural inclusivity, and ethical applicability, strengthening its utility as a formative tool in palliative care. Impact This study contributes the development of culturally valid tools for assessing death competence, thereby advancing meaningful implementation strategy. Results align with wider international calls for improvements in training, workforce support, and policy, supporting emotionally sustainable care, resilience and retention in palliative services.