The main focus of palliative care services is to improve patients' quality of life (QOL). The potential value of assessment of QOL in palliative care is being increasingly recognized. The McGill Quality of Life questionnaire (MQOL) is designed specifically for palliative care patients, but its cross-cultural validity needs to be determined before it can be applied in populations of different cultures and ethnic groups. The cross-cultural validity of MQOL was investigated using a translated and modified version in Chinese--the MQOL-HK--in 462 palliative care patients in Hong Kong. Results show that the MQOL-HK is acceptable, valid and reliable. There is good acceptability, construct validity, convergent and divergent validity, test-retest and inter-rater reliability. Our study confirms that QOL does have cross-culturally robust constructs. Principal components analysis shows that the domains of physical, psychological, existential and support are all relevant and applicable in Chinese culture. Multiple regression analysis reveals that existential domain is the most important domain in predicting overall QOL. 'Face', eating and sex are additional facets of QOL that also need to be considered. The worst physical symptom on admission is the item of QOL with the lowest score, which need more care and attention by palliative care workers. A cross-culturally validated QOL instrument cannot just help ensure an accurate evaluation of profile, determinants, and changes of QOL, but is also a valuable asset for future comparison and evaluation of palliative care services and interventions across the world.

This study aimed to better understand the meaning of desire for euthanasia. An hermeneutic approach was undertaken using a purposively selected sample of advanced cancer patients who desired euthanasia while receiving palliative care. Unstructured interviews were conducted with six participants, which were audiotaped, transcribed and analysed. This approach allowed in-depth exploration and interpretation of the patients' lived experience. The findings illustrated a timeline from previous wellness to approaching death with five major themes: (1) reality, (2) perception, (3) anticipation, (4) desire and (5) holding environment. The desire for euthanasia is not confined to physical or psychosocial concerns relating to advanced cancer, but incorporates hidden existential yearnings for connectedness, care and respect, understood within the context of the patients' lived experience. Euthanasia requests cannot be taken at face value but require in-depth exploration of their covert meaning, in order to ensure that the patients' needs are being addressed adequately.

Quality of life (QOL) is the main consideration in caring for advanced cancer patients, yet little is known about the QOL in the terminal phase. We profiled the QOL of 58 advanced cancer patients during their last 2 weeks of life using the McGill QOL questionnaire-Hong Kong version. The patients provided ratings of QOL an average of 5.6 (median 6) days pre-death. Palliative care services were successful in maintaining the total QOL score during the dying phase. The mean score was 7.0 of 10. Among the various domains, the physical and existential domains scored relatively poorly at 5.9 and 6 of 10, respectively. The worst physical symptom and meaning of life were the individual items with the poorest scores (4.8 and 5.4 of 10, respectively). Compared with admission, there was statistically significant improvement in the worst physical symptom (P = 0.02) and eating item (P = 0.002), but deterioration in physical well-being (P = 0.03), meaning of existence (P = 0.007), and satisfaction with oneself (P = 0.04). In conclusion, QOL evaluation during the terminal phase identifies important aspects requiring improvement during the last two weeks of life. Physical and existential domains of dying cancer patients needed more attention.

The philosophy of palliative care is holistic, paying attention to the multidimensional needs of the terminally ill in promoting quality of life and relieving suffering. These needs have to be viewed within their cultural, temporal and social contexts. Thus in conducting patient need-based research, the patients' perspectives are vital data in providing intimate insight into the core issues of any phenomenon under study. This paper aims to illustrate the usefulness of hermeneutic philosophy in palliative care research, as demonstrated in a study to understand the meaning of desire for euthanasia directly from the terminally ill. Two particular aspects of the study are emphasized, namely the research methodology and research process, rather than its findings regarding the meaning of desire for euthanasia. Hermeneutic philosophy parallels that of palliative care, as it also values human experience and social contexts. This approach allows in-depth understanding into a phenomenon in a humane and holistic manner, with adherence to methodological and scientific rigour. The process of hermeneutic interpretation can also promote evidence-based reflective practice. The adoption of a hermeneutic attitude in clinical practice can refine professional self-development in the art of communication and caring.

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