Association Between Quality of Life, Demographic Characteristics, Physical Symptoms, and Unmet Needs in Inpatients Receiving End-of-Life Care

Abstract

Quality-of-life assessment is an important component of end-of-life care. The objective of this study was to evaluate the quality of life of patients in the final stage of their illness and its association with their demographic characteristics, physical symptoms, and unmet needs during their care. For data collection, the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire tool for quality of life measurements and the Patient Needs Assessment in Palliative Care questionnaire for determination of unmet needs were used. The study comprised 349 inpatients in the final stage of their illness. Differences were found in quality-of-life assessment with respect to the type of illness, gender, and age of the patients. There was an association between lower quality of life, symptom burden (pain), worse functional status, and unmet needs in the physical and psychosocial areas. Therefore, quality of life of terminal patients is tightly associated with good symptom management and high-quality nursing care. KEY WORDSend of life, quality of life, symptom, unmet needs E nd-of-life care issues have become a subject of interest of numerous experts since the mid-20th century, the time of epidemiologic transition in predominant causes of death. Rapidly progressing fatal infectious diseases have been replaced by chronic lifethreatening illnesses. Therefore, the end of life of many individuals has become a lengthy process, particularly if the illness is no longer influenced by causal treatment and significantly limits the patient. 1 As in other European countries, the most common causes of death in the Czech Republic have long been cardiovascular diseases (49% in 2012) and cancer (25% in 2012). In the last year of their lives, a great proportion of patients are, often repeatedly, admitted to the hospital. 2 Noncancer patients are more likely to be repeatedly hospitalized and less likely to receive hospice care than those with cancer. 3,4 Thus, end-of-life hospital care is mainly provided to terminal noncancer patients but also to a certain proportion of individuals with cancer.As a rule, end-of-life care is narrowly understood as comprehensive care for patients in the last several days or weeks of their lives or those with a prognosis of death within 6 months. 5,6 It involves understanding of the physical, psychological, spiritual, and practical dimensions of care; determination of the prognosis and subsequent discussion of the issues with patients and their families; setting the goals of care; and selecting a form of palliative care. 7 Both treatment and care should always be provided with respect to the patient's quality of life. The concept of quality of life in palliative care in both research and clinical practice is related to symptom control, physical and social functions, psychological well-being, the meaning of life, and existential questions. 8,9 Quality-of-life assessment is the most frequent topic of studies on end-of-life care. Some 80 instruments for assessing quality of life in end-...

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