Measuring quality of life for patients with terminal illness: the Missoula–VITAS® quality of life index

Abstract

Quality of life (QOL) is an important outcome measure in caring for terminally ill patients. The Missoula-VITAS Quality of Life index (MVQOLI) has been developed to provide a measure of quality of life that is meaningful to both clinicians and patients. Unique features of the instrument include its focus on the terminal phase of life, the item structure and a scoring system that allows the weighting of each dimension of QOL by the respondent, and the subjective wording of the items that allows respondents to interpret the measured elements according to their own experience. The validity and reliability of the patient-reported survey instrument were tested by administering the 25-item questionnaire to 257 patients in 10 community-based hospices. Participants were incurably ill with predicted survival of six months or less. Exclusion criteria included inability to communicate, dementia, or psychological symptoms that might be intensified by completing the index. Reliability and validity of the new index were examined using standard statistical and psychometrical analyses. The MVQOLI demonstrated internal consistency (Cronbach's alpha = 0.77). MVQOLI total scores were correlated with scores on the Multidimensional Quality of Life Scale--Cancer 2 and with patient-reported global QOL ratings. MVQOLI scores did not correlate with observer-rated functional status scores indicating divergent validity. The MVQOLI could be completed by patients of varied educational level, age, functional status, and length of time with a terminal illness. The instrument is designed to contribute to the task of planning care by evaluating patient-identified sources of distress, strength and satisfaction, including issues of life closure. This information contributes to crafting highly specific interventions. Further studies are necessary to determine the usefulness of the instrument in measuring outcomes of end-of-life care in nonhospice settings, and for racial and diagnostic groups under-represented in this sample.

Buddhist-Derived Loving-Kindness and Compassion Meditation for the Treatment of Psychopathology: a Systematic Review

“…Meditation participants met with the meditation instructor on a weekly basis to discuss any issues with the training. Following completion of the intervention and compared to the other allocation conditions, participants in the combined LKM and massage group demonstrated significant improvements in quality of life (Missoula-VITAS Quality of Life Index [Byock & Merriman, 1998]). There were no significant differences for standalone LKM or massage therapy compared to treatment as usual.…”

Understanding their Options: Determinants of Hospice Discussion for Older Persons with Advanced Illness

“…25 Health status variables included self-rated health ("excellent," "very good," "good," "fair," or "poor") and symptom assessment, using the Edmonton symptom assessment scale. 26 Psychosocial variables included overall quality of life ("best possible," "good," "fair," "poor," or "worst possible"), 27 perceived prognosis (patients were asked, "If you had to take a guess, how long do you think that you might have to live?," with responses of "<1 month," "1-6 months," "7-12 months," "13-23 months," "2-5 years," "6-10 years," or ">10 years"), willingness to undergo major or minor therapies if they would return the patient to his/her current state of health (major therapies were described as "being in the intensive care unit, receiving surgery, or having a breathing machine" and requiring a hospital stay of "at least a month," while minor therapies were described as "[having] intravenous antibiotics and oxygen," and requiring "a few days to a week" in the hospital), and knowledge about alternatives to hospitalization (patients were asked a series of questions: "If your illness should become worse than it is now, what, if anything, has your doctor told you about how you could be treated?," followed by, "If you were sick enough that you potentially would need the hospital, do you think that you would have any choices other than being hospitalized?," and if so, "What is/are the choices?," followed by, "If you wanted to stay out of the hospital, do you know of any services that could help you?," and if so, "What are they?"). Health status and psychosocial variables were obtained at every interview.…”

Evaluating the Quality of Dying and Death

“…34 We searched the literature and selected studies of dying patients that addressed the conceptual domains or used measures to assess quality of life or quality of dying. 5,20,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] Concepts and domains from these measures were identified and listed for possible inclusion into the conceptual model and operational definition.…”