{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:06:28Z","timestamp":1787069188924,"version":"build-2736575974"},"reference-count":71,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,10]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Although individuals with dementia who reside in nursing homes are particularly susceptible to developing delirium, this condition is rarely recognised in these settings. Detection of delirium requires validated and reliable tools for this setting that can be applied by nursing staff. The primary objective of the study is to assess the comprehensibility, practicality and inter-rater reliability of two delirium detection tools (4 A\u2019s test (4AT) and 4-item delirium superimposed on dementia (4-DSD)) and one tool for assessing both the diagnosis and severity of delirium (Delirium Rating Scale-Revised-98 (DRS-R-98)) in people with dementia who reside in nursing homes when used by nurses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The comprehensibility and practicality of the German versions of the 4AT, 4-DSD and DRS-R-98 will be evaluated using cognitive interviews in accordance with the consensus-based standards for the selection of health measurement instruments framework. On the basis of the results of the cognitive interviews, a manual for each of the three tools will be developed and finalised by an expert panel. Finally, the inter-rater reliability and measurement error of the three tools will be determined using the manuals. For this purpose, a total of 70 residents from six nursing homes will be assessed by at least two nurses. The data analysis will include descriptive statistics and inter-rater reliability assessment for individual items (kappa value) and total scores (Intraclass correlation coefficients).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study will assess the comprehensibility, practicality and inter-rater reliability of the 4AT, 4-DSD and DRS-R-98 for use in residents with dementia in nursing homes. The project was approved by the medical ethics committee of the University of Oldenburg (reference number: 2025-093).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      The inter-rater reliability study was registered in the German Clinical Trials Register. Registration number: DRKS00037458 (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.drks.de\/search\/de\/trial\/DRKS00037458\/details\">https:\/\/www.drks.de\/search\/de\/trial\/DRKS00037458\/details<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-112357","type":"journal-article","created":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T06:10:47Z","timestamp":1766643047000},"page":"e112357","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Content validity, practicality and testing of the reliability of various tools for the detection and screening of delirium in residents with dementia in German nursing homes: a study protocol"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5448-8822","authenticated-orcid":false,"given":"Johanna Christina","family":"Seiters","sequence":"first","affiliation":[{"name":"School VI - School of Medicine and Health Sciences, Carl von Ossietzky Universit\u00e4t Oldenburg, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0108-4459","authenticated-orcid":false,"given":"Vincent","family":"Molitor","sequence":"additional","affiliation":[{"name":"School VI - School of Medicine and Health Sciences, Carl von Ossietzky Universit\u00e4t Oldenburg, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4848-2507","authenticated-orcid":false,"given":"Alessandro","family":"Morandi","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy"},{"name":"Intermediate Care Unit, Azienda Speciale Comunale Cremona Solidale, Cremona, Italy"},{"name":"Institute of Research and Parc Sanitari Pere Virgili, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6858-4282","authenticated-orcid":false,"given":"Tania","family":"Zieschang","sequence":"additional","affiliation":[{"name":"School VI - School of Medicine and Health Sciences, Carl von Ossietzky Universit\u00e4t Oldenburg, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5094-3723","authenticated-orcid":false,"given":"Martin N","family":"Dichter","sequence":"additional","affiliation":[{"name":"Medical Faculty and University Hospital Cologne, Institute of Nursing Science, University of Cologne, Cologne, Nordrhein-Westfalen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5108-158X","authenticated-orcid":false,"given":"Burkhard","family":"Haastert","sequence":"additional","affiliation":[{"name":"mediStatistica Dr Burkhard Haastert, Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Erdmann","sequence":"additional","affiliation":[{"name":"CBWK Clarenbachwerke, K\u00f6ln, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0182-5373","authenticated-orcid":false,"given":"Falk","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"School VI - School of Medicine and Health Sciences, Carl von Ossietzky Universit\u00e4t Oldenburg, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4910-8413","authenticated-orcid":false,"given":"Rebecca","family":"Palm","sequence":"additional","affiliation":[{"name":"School VI - School of Medicine and Health Sciences, Carl von Ossietzky Universit\u00e4t Oldenburg, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"key":"2026010703480985000_15.12.e112357.1","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5th edn. Washington, DC, 2022.","DOI":"10.1176\/appi.books.9780890425787"},{"key":"2026010703480985000_15.12.e112357.2","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1038\/s41572-020-00223-4","article-title":"Delirium","volume":"6","author":"Wilson","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"2026010703480985000_15.12.e112357.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60688-1"},{"key":"2026010703480985000_15.12.e112357.4","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1111\/jgs.18780","article-title":"Delirium in long-term care and the myth of Proteus","volume":"72","author":"Bellelli","year":"2024","journal-title":"J Am Geriatr Soc"},{"key":"2026010703480985000_15.12.e112357.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-020-01723-4","article-title":"A call to action for delirium research: Meta-analysis and regression of delirium associated mortality","volume":"20","author":"Aung Thein","year":"2020","journal-title":"BMC Geriatr"},{"key":"2026010703480985000_15.12.e112357.6","doi-asserted-by":"crossref","DOI":"10.1111\/wvn.70027","article-title":"Mortality Risk Following Delirium in Older Inpatients: A Systematic Review and Meta-Analysis","volume":"22","author":"P\u00e9rez-Ros","year":"2025","journal-title":"Worldviews Evid Based Nurs"},{"key":"2026010703480985000_15.12.e112357.7","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-022-00698-7"},{"key":"2026010703480985000_15.12.e112357.8","doi-asserted-by":"crossref","DOI":"10.3390\/healthcare10081544","article-title":"Delirium in Nursing Home Residents: A Narrative Review","volume":"10","author":"Komici","year":"2022","journal-title":"Healthcare (Basel)"},{"key":"2026010703480985000_15.12.e112357.9","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.3233\/JAD-190391","article-title":"Delirium Predisposing and Triggering Factors in Nursing Home Residents: A Cohort Trial-Nested Case-Control Study","volume":"70","author":"P\u00e9rez-Ros","year":"2019","journal-title":"J Alzheimers Dis"},{"key":"2026010703480985000_15.12.e112357.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12877-022-03573-8","article-title":"Nurses\u2019 competence in recognition and management of delirium in older patients: development and piloting of a self-assessment tool","volume":"22","author":"Hoch","year":"2022","journal-title":"BMC Geriatr"},{"key":"2026010703480985000_15.12.e112357.11","doi-asserted-by":"crossref","DOI":"10.3389\/fnagi.2021.626127","article-title":"Delirium: A Marker of Vulnerability in Older People","volume":"13","author":"Bellelli","year":"2021","journal-title":"Front Aging Neurosci"},{"key":"2026010703480985000_15.12.e112357.12","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2318-12-55","article-title":"Improving recognition of delirium in clinical practice: a call for action","volume":"12","author":"Teodorczuk","year":"2012","journal-title":"BMC Geriatr"},{"key":"2026010703480985000_15.12.e112357.13","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/j.jagp.2022.04.003","article-title":"Identifying Delirium in Persons With Moderate or Severe Dementia: Review of Challenges and an Illustrative Approach","volume":"30","author":"Fong","year":"2022","journal-title":"Am J Geriatr Psychiatry"},{"key":"2026010703480985000_15.12.e112357.14","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6955-7-4","article-title":"Detection of delirium by nurses among long-term care residents with dementia","volume":"7","author":"Voyer","year":"2008","journal-title":"BMC Nurs"},{"key":"2026010703480985000_15.12.e112357.15","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1590\/0047-2085000000298","article-title":"Prevalence of dementia in long-term care institutions: a meta-analysis","volume":"70","author":"Fagundes","year":"2021","journal-title":"J Bras Psiquiatr"},{"key":"2026010703480985000_15.12.e112357.16","doi-asserted-by":"crossref","unstructured":"Mansutti I , Muzzana C , Vater V , et al . Delirium in nursing homes and long-term care facilities: findings of a scoping review of detection tools. Eur Geriatr Med 2025. doi:10.1007\/s41999-025-01250-8","DOI":"10.1007\/s41999-025-01250-8"},{"key":"2026010703480985000_15.12.e112357.17","doi-asserted-by":"crossref","DOI":"10.3390\/geriatrics8010022","article-title":"Recognition of Delirium Superimposed on Dementia: Is There an Ideal Tool?","volume":"8","author":"Shrestha","year":"2023","journal-title":"Geriatrics (Basel)"},{"key":"2026010703480985000_15.12.e112357.18","doi-asserted-by":"crossref","DOI":"10.1186\/s12909-025-07078-x","article-title":"Development of a curriculum for interdisciplinary e-learning on delirium in nursing homes-a modified Delphi study","volume":"25","author":"Molitor","year":"2025","journal-title":"BMC Med Educ"},{"key":"2026010703480985000_15.12.e112357.19","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afu021"},{"key":"2026010703480985000_15.12.e112357.20","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1016\/j.jamda.2021.02.029","article-title":"The 4-DSD: A New Tool to Assess Delirium Superimposed on Moderate to Severe Dementia","volume":"22","author":"Morandi","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"2026010703480985000_15.12.e112357.21","doi-asserted-by":"publisher","DOI":"10.1176\/appi.neuropsych.13.2.229"},{"key":"2026010703480985000_15.12.e112357.22","unstructured":"National Institute for Health and Care Excellence: Guidelines . Delirium: Prevention, diagnosis and management in hospital and long-term care. London: National Institute for Health and Care Excellence (NICE), 2023."},{"key":"2026010703480985000_15.12.e112357.23","doi-asserted-by":"crossref","first-page":"16","DOI":"10.12688\/amrcopenres.12973.1","article-title":"Validation of the 4AT tool for delirium assessment in specialist palliative care settings: protocol of a prospective diagnostic test accuracy study [version 1; peer review: 2 approved]","volume":"3","author":"Arnold","year":"2021","journal-title":"AMRC Open Res"},{"key":"2026010703480985000_15.12.e112357.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2020.12.022"},{"key":"2026010703480985000_15.12.e112357.25","doi-asserted-by":"crossref","first-page":"103374","DOI":"10.1016\/j.ajp.2022.103374","article-title":"Diagnostic accuracy of the 4AT for delirium: A systematic review and meta-analysis","volume":"80","author":"Hou","year":"2023","journal-title":"Asian J Psychiatr"},{"key":"2026010703480985000_15.12.e112357.26","doi-asserted-by":"crossref","first-page":"20","DOI":"10.3390\/ijerph17207515","article-title":"Diagnostic Test Accuracy of the 4AT for Delirium Detection: A Systematic Review and Meta-Analysis","volume":"17","author":"Jeong","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2026010703480985000_15.12.e112357.27","first-page":"189","article-title":"Interrater Reliabilit\u00e4t und \u00dcbereinstimmungsvalidit\u00e4t des 4AT zur Erfassung des postoperativen Delirs: Eine Kohortenstudie","volume":"36","author":"Muzzana","year":"2023","journal-title":"Hogrefe AG"},{"key":"2026010703480985000_15.12.e112357.28","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1007\/s40520-023-02447-2","article-title":"Diagnostic accuracy of the Dutch version of the 4AT for delirium detection in a mixed patient population and setting","volume":"35","author":"Pouw","year":"2023","journal-title":"Aging Clin Exp Res"},{"key":"2026010703480985000_15.12.e112357.29","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-015572","article-title":"Protocol for validation of the 4AT, a rapid screening tool for delirium: a multicentre prospective diagnostic test accuracy study","volume":"8","author":"Shenkin","year":"2018","journal-title":"BMJ Open"},{"key":"2026010703480985000_15.12.e112357.30","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afaa224"},{"key":"2026010703480985000_15.12.e112357.31","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1002\/gps.4615","article-title":"Validating the 4A\u2019s test in screening for delirium in a culturally diverse geriatric inpatient population","volume":"32","author":"De","year":"2017","journal-title":"Int J Geriatr Psychiatry"},{"key":"2026010703480985000_15.12.e112357.32","doi-asserted-by":"crossref","first-page":"3186","DOI":"10.1097\/00007632-200012150-00014","article-title":"Guidelines for the process of cross-cultural adaptation of self-report measures","volume":"25","author":"Beaton","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"key":"2026010703480985000_15.12.e112357.33","unstructured":"Mokkink LB . COSMIN study design checklist for patient-reported outcome measurement instruments. 2019. Available: www.cosmin.nl"},{"key":"2026010703480985000_15.12.e112357.34","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1177\/08850666231199986","article-title":"The Validity and Applicability of the Revised Delirium Rating Scale (DRS-R98) for Delirium Severity Assessment in a Critical Care Setting","volume":"39","author":"Almuhairi","year":"2024","journal-title":"J Intensive Care Med"},{"key":"2026010703480985000_15.12.e112357.35","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1093\/ageing\/afae227","article-title":"Core outcome set for studies evaluating interventions to prevent or treat delirium in long-term care older residents: international key stakeholder informed consensus study","volume":"53","author":"Russell","year":"2024","journal-title":"Age Ageing"},{"key":"2026010703480985000_15.12.e112357.36","doi-asserted-by":"publisher","DOI":"10.1002\/gps.1577"},{"key":"2026010703480985000_15.12.e112357.37","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afn298"},{"key":"2026010703480985000_15.12.e112357.38","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.psym.2015.03.005","article-title":"Performance of the Delirium Rating Scale-Revised-98 Against Different Delirium Diagnostic Criteria in a Population With a High Prevalence of Dementia","volume":"56","author":"Sepulveda","year":"2015","journal-title":"Psychosomatics"},{"key":"2026010703480985000_15.12.e112357.39","doi-asserted-by":"publisher","DOI":"10.1002\/gps.1906"},{"key":"2026010703480985000_15.12.e112357.40","doi-asserted-by":"crossref","DOI":"10.1002\/trc2.12355","article-title":"Emergency department care transition barriers: A qualitative study of care partners of older adults with cognitive impairment","volume":"8","author":"Gettel","year":"2022","journal-title":"Alzheimers Dement (N Y)"},{"key":"2026010703480985000_15.12.e112357.41","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afw130"},{"key":"2026010703480985000_15.12.e112357.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2008.05.011"},{"key":"2026010703480985000_15.12.e112357.43","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.51.5.425"},{"key":"2026010703480985000_15.12.e112357.44","doi-asserted-by":"crossref","first-page":"30","DOI":"10.4306\/pi.2011.8.1.30","article-title":"Korean version of the delirium rating scale-revised-98: reliability and validity","volume":"8","author":"Lee","year":"2011","journal-title":"Psychiatry Investig"},{"key":"2026010703480985000_15.12.e112357.45","doi-asserted-by":"publisher","DOI":"10.3310\/hta23010"},{"key":"2026010703480985000_15.12.e112357.46","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-020-01179-5","article-title":"COSMIN Risk of Bias tool to assess the quality of studies on reliability or measurement error of outcome measurement instruments: a Delphi study","volume":"20","author":"Mokkink","year":"2020","journal-title":"BMC Med Res Methodol"},{"key":"2026010703480985000_15.12.e112357.47","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.genhosppsych.2021.03.010","article-title":"Validation of the Delirium Diagnostic Tool-Provisional (DDT-Pro) in a skilled nursing facility and comparison to the 4 \u2019A\u2019s test (4AT)","volume":"70","author":"Sep\u00falveda","year":"2021","journal-title":"Gen Hosp Psychiatry"},{"key":"2026010703480985000_15.12.e112357.48","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajp.2021.102918","article-title":"Reliability and validity of the Japanese version of the 4A\u2019s Test for delirium screening in the elderly patient","volume":"67","author":"Hasegawa","year":"2022","journal-title":"Asian J Psychiatr"},{"key":"2026010703480985000_15.12.e112357.49","doi-asserted-by":"crossref","first-page":"17","DOI":"10.9734\/jpri\/2023\/v35i237420","article-title":"4 AT Delirium Assessment Tool in Hospitalized Non-ICU Patients (\u226565 Years): A Systematic Review on Validity and Reliability","volume":"35","author":"Hassabo","year":"2023","journal-title":"J Pharm Res Int"},{"key":"2026010703480985000_15.12.e112357.50","doi-asserted-by":"crossref","first-page":"110684","DOI":"10.1016\/j.jclinane.2022.110684","article-title":"PRe-Operative Prediction of postoperative DElirium by appropriate SCreening (PROPDESC) development and validation of a pragmatic POD risk screening score based on routine preoperative data","volume":"78","author":"Menzenbach","year":"2022","journal-title":"J Clin Anesth"},{"key":"2026010703480985000_15.12.e112357.51","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.1003"},{"key":"2026010703480985000_15.12.e112357.52","doi-asserted-by":"publisher","DOI":"10.1007\/s11135-017-0574-8"},{"key":"2026010703480985000_15.12.e112357.53","unstructured":"Pflegeberufegesetz vom 17. Juli 2017 (BGBl. I S. 2581), das zuletzt durch Artikel 2a des Gesetzes vom 12. Dezember 2023 (BGBl. 2023 I Nr. 359) ge\u00e4ndert worden ist. Bundesrepublik Deutschland; 2017."},{"key":"2026010703480985000_15.12.e112357.54","unstructured":"Pflegeberufe, B.-L.-A., Eckpunkte f\u00fcr die in L\u00e4nderzust\u00e4ndigkeit liegenden Ausbildungen zu Assistenz- und Helferberufen in der Pflege. Bundesanzeiger (BAnz AT 17.02.2016 B3); 2016."},{"key":"2026010703480985000_15.12.e112357.55","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1027\/1614-2241\/a000075","article-title":"The Cognitive Interviewing Reporting Framework (CIRF)","volume":"9","author":"Boeije","year":"2013","journal-title":"Methodology (Gott)"},{"key":"2026010703480985000_15.12.e112357.56","unstructured":"Lenzner T , Hadler P , Neuert CE . Cognitive pretesting. Mannheim GESIS \u2013 Leibniz Institute for the Social Sciences (GESIS \u2013 Survey Guidelines); 2024."},{"key":"2026010703480985000_15.12.e112357.57","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1055\/s-0034-1394443","article-title":"Das kognitive Interview \u2013 Ein Instrument zur Entwicklung und Validierung von Erhebungsinstrumenten","volume":"54","author":"Pohontsch","year":"2015","journal-title":"Rehabilitation (Bonn)"},{"key":"2026010703480985000_15.12.e112357.58","doi-asserted-by":"crossref","first-page":"345","DOI":"10.3233\/NPM-210848","article-title":"Effective questionnaire design: How to use cognitive interviews to refine questionnaire items","volume":"15","author":"Balza","year":"2022","journal-title":"J Neonatal Perinatal Med"},{"key":"2026010703480985000_15.12.e112357.59","unstructured":"Dean E , Caspar R , McAvinchey G , et al . Developing a low-cost technique for parallel cross-cultural instrument development: the question appraisal system (qas-04). In: Hoffmeyer-Zlotnik JHP , Harkness J , eds. Methodological aspects in cross-national research. Mannheim, 2005: 31\u201346."},{"key":"2026010703480985000_15.12.e112357.60","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afm108"},{"key":"2026010703480985000_15.12.e112357.61","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-017-0907-4","article-title":"How accurate is the \u201cSurprise Question\u201d at identifying patients at the end of life? A systematic review and meta-analysis","volume":"15","author":"White","year":"2017","journal-title":"BMC Med"},{"key":"2026010703480985000_15.12.e112357.62","doi-asserted-by":"crossref","DOI":"10.5395\/rde.2024.49.e3","article-title":"Sample size determination for conducting a pilot study to assess reliability of a questionnaire","volume":"49","author":"Bujang","year":"2024","journal-title":"Restor Dent Endod"},{"key":"2026010703480985000_15.12.e112357.63","doi-asserted-by":"publisher","DOI":"10.1191\/0962280204sm365ra"},{"key":"2026010703480985000_15.12.e112357.64","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"2026010703480985000_15.12.e112357.65","doi-asserted-by":"publisher","DOI":"10.1037\/\/0033-2909.88.2.322"},{"key":"2026010703480985000_15.12.e112357.66","unstructured":"Efron B , Tibshirani RJ . An introduction to the bootstrap. 1998."},{"key":"2026010703480985000_15.12.e112357.67","unstructured":"DGGG; DGPPN; DGN . Einwilligung von Menschen mit Demenz in medizinische Ma\u00dfnahmen: Interdisziplin\u00e4re S2k-Leitlinie f\u00fcr die medizinische Praxis. Stuttgart Kohlhammer; 2020."},{"key":"2026010703480985000_15.12.e112357.68","unstructured":"Einwilligung von Menschen mit Demenz in medizinische Ma\u00dfnahmen. Interdisziplin\u00e4re S2k-Leitlinie f\u00fcr die medizinische Praxis (AWMF-Leitlinie Registernummer 108\u2013001). W. Kohlhammer GmbH; 2020."},{"key":"2026010703480985000_15.12.e112357.69","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2018.05.011"},{"key":"2026010703480985000_15.12.e112357.70","unstructured":"Alzheimer Europe Report . Overcoming ethical challenges affecting the involvement of people with dementia in research: recognising diversity and promoting inclusive research. Europe Dementia in Europe Ethics Report; 2019."},{"key":"2026010703480985000_15.12.e112357.71","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1177\/14713012241299015","article-title":"Participation of persons living with dementia in research: A means to address epistemic injustice","volume":"24","author":"Halonen","year":"2025","journal-title":"Dementia (London)"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-112357","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:51:16Z","timestamp":1767786676000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-112357"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":71,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,24]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bmjopen-2025-112357"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-112357","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}