This abstract was presented at the Society of General Internal Medicine Conference, Spring 2001.
QUALITY OF LIFE PERSISTS AT THE END OF LIFE, by Jean S. Kutner, David E. Nowels, Cordt Kassner, Lucinda L. Bryant, University of Colorado Denver, Denver, CO
PURPOSE: Maximizing quality of life (QOL) at the end of life (EOL) is a central goal of hospice and palliative care. The purpose of this study was to describe QOL among patients receiving hospice care and to determine whether QOL at the EOL is associated with particular patient characteristics, such as diagnosis or functional status.
METHODS: Cross-sectional study conducted in the Population-based Palliative Care Research Network (PoPCRN) among English-speaking adults who consented and had a Short Portable Mental Status Questionnaire (SPMSQ) adjusted score of less than 5. Data were collected via an interviewer-administered questionnaire. QOL was measured by the McGill QOL Questionnaire (MQOL). Descriptive statistics, t-tests, and ANOVA (SPSS version 10) were used to describe the population and determine associations between the variables of interest.
RESULTS: 66/82 (80%) individuals from 14 PoPCRN sites consented to and were able to participate. 56% were female, 89% were white, 39% were cared for at home, and 53% had a cancer diagnosis. The median age was 76 years, median Karnofsky score 50%, and median time between hospice admit and interview was 49 days. MQOL responses (range 0 - 10; 0=bad, 10=good) indicate that these patients had few physical symptoms, but the ones they had were problematic (single troublesome symptom score=4.4). The MQOL subscale scores indicate that these patients were less troubled by psychosocial and existential issues than by physical symptoms: Total MQOL score=7.1, Physical well-being score=6.0, Physical symptom overall score=5.9, Psychological symptom score=7.1, Existential well-being score=7.4, Support score=8.6. There were no significant associations between age, marital status, gender or length of hospice care and any of the QOL scores. A Karnofsky score of less than 50% was associated with worse Existential well-being (6.9 vs. 7.9, p=0.017) while a cancer diagnosis was associated with greater existential well-being (7.8 vs. 6.9, p=0.047). Being cared for at home and a cancer diagnosis were both associated with a greater sense of Support (9.2 vs. 8.2, p=0.005; 9.0 vs. 8.1, p=0.042).
CONCLUSIONS: Among this older, terminally ill population receiving hospice care, whose functional level was poor and for whom physical symptoms were troublesome, quality of life persisted. Quality of life was particularly preserved among patients with cancer, those who were cared for at home and those who had better functional status.