Factors Important to Patients' Quality of Life at the End of Life

Abstract

Context When curative treatments are no longer options for dying cancer patients, the focus of care often turns from prolonging life to promoting quality-of-life (QOL). Limited data exist on what predicts better QOL at the end-of-life (EOL) for advanced cancer patients. Objective To determine the factors that most influence QOL at the EOL, thereby, identifying promising targets for interventions to promote EOL QOL. Design, Setting, Participants Coping with Cancer (CwC1) is a US multi-site, prospective, longitudinal cohort study of advanced cancer patients (n=396 patients) and their informal caregivers, who were enrolled between September 2002 and February 2008. Patients were followed from enrollment to death a median of 4.1 months later. Main Outcome Measure Patient QOL in the last week of life was the primary outcome of both CwC1 and the present report. Results The following set of 9 factors, preceded by a sign indicating the direction of the effect and presented in rank-order of importance, explained the most variance in patients’ EOL QOL: #1=(−) ICU stays in the final week (explained 4.40% of the variance in EOL QOL), #2 = (−) hospital deaths (2.70%), #3 =(−) patient worry at baseline (2.70%), #4 = (+) religious prayer or meditation at baseline (2.50%), #5 = site of cancer care (1.80%), #6 = (−) feeding-tube use in the final week (1.10%), #7 = (+) pastoral care within the hospital/clinic (1.10%), #8 = (−) chemotherapy in the final week (0.90%), and #9 = (+) patient-physician therapeutic alliance (0.70%) at baseline. Most of the variance in EOL QOL, however, remained unexplained (82.3%). Conclusions Advanced cancer patients who avoid hospitalizations and intensive care, who are not worried, who pray or meditate, who are visited by a pastor in the hospital/clinic, and who feel a therapeutic alliance with their physicians have the highest QOL at the EOL.

Intervention to Improve Care at Life’s End in Inpatient Settings: The BEACON Trial

“…57 We achieved a reduction in the use of nasogastric tubes. We were also able to increase use of the sublingual route.…”

Psychological and Behavioral Approaches to Cancer Pain Management

“…[75][76][77] Patients with advanced cancer who spend time in private religious activities before their diagnosis report higher quality of life, including symptoms such as pain. 78 Caring for a loved one who is dying and in pain is one of the most stressful experiences that one can go through. 79 Concern about pain is the second most frequent problem reported by relatives caring for patients with advanced cancer in the home.…”

Factors Predicting Bereaved Caregiver Perception of Quality of Care in the Final Week of Life: Implications for Health Care Providers

“…Research specific to factors impacting perceived quality of care is scarce; the authors selected predictor variables based on the existing literature and/or their own clinical experience regarding factors impacting caregiver quality of life, mental health, bereavement, and experience of EOL care. 18,30,31 Because CEQUEL is derived from Wave 2 interviews, other Wave 2 variables were not considered in order to make a stronger statement of predictive value. The authors selected for regression analyses only those items potentially modifiable in the clinical context, dividing them into conceptual categories detailed in Figure 3.…”