The quality of life of hospice patients: Patient and provider perceptions

Abstract

The purposes of this study were to describe the quality of life (QOL) of terminally ill patients in a home-based hospice program and to examine the relationship between QOL data and patients' symptom distress, ability to function, interpersonal communication (support from family and friends), well-being (their affairs in order), and transcendence (religious comfort/support) as recorded in their charts. QOL was measured by the Missoula-Vitas Quality of Life Index (MVQOLI), an instrument designed specifically for use with terminally ill patients. The study was conducted over a three-year period with 129 terminally ill patients enrolled in a home-based hospice program of care. The MVQOLI was administered to patients within 20 days of their admission to hospice. A retrospective chart review was conducted to determine patients' levels of symptom distress, ability to function, social support, whether or not their affairs were in order, and religious comfort/support. The mean age of participants in this study was 67, with 54.3 percent male and 45.7 percent female. Cancer was the primary diagnosis for 92.2 percent of the sample, and 35 percent of these patients had a diagnosis of lung cancer. Of the 7.8 percent non-cancer diagnoses, five were diagnosed with AIDS, four with chronic obstructive pulmonary disease, and one with chronic heart failure. The results of this study revealed positive scores on the five dimensions of the MVQOLI QOL scale, indicating that within 20 days of admission to hospice, patients rated their QOL as good to very good. Data obtained from the chart review also indicated that patients did not experience a great deal of symptom distress (e.g., pain, nausea, shortness of breath, and restlessness). A significant correlation existed between age and QOL; number of interventions and pain levels; and marital status, well-being, interpersonal relationships, and transcendence. Shortness of breath and well-being were significantly correlated with QOL. There was no significant correlation between gender, race, or closeness to death and the five dimensions of the MVQOLI and chart review assessments.

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

“…Clinicians' discussion of hospice independently increased the likelihood of hospice use (OR=5.3, 95% CI=2. [3][4][5][6][7][8][9][10][11][12][13].…”

“…1 Studies have shown that hospice provides quality care for patients at the end of life, with a high satisfaction rate for patients and families. [2][3][4] Nevertheless, this service is underutilized, and many of those who enroll do not subsequently live long enough to fully benefit from hospice care. 2,[5][6][7] Lack of clinicians' discussion about hospice with the patient and family has been identified as a barrier to hospice use, 8,9 supported by retrospective studies, in which caregivers, asked to recall their conversations with clinicians, frequently report an absence of communication about hospice or treatment options.…”

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

“…113 A study surveying patients enrolled in one hospice program reported good or very good QOL during their admission, although this was not always the case at initial presentation. 114 Additionally, patients may live longer when palliative needs are considered during the course of their chronic illness. HF patients enrolled in hospice have been found to have longer survival than those not enrolled in hospice.…”

The MVQOLI successfully captured quality of life in African palliative care: a factor analysis

“…Because the five-factor solution closely resembles the original subscale structure, and internal consistency of the tool using the original scoring method and including all 25 subscale items was good (Cronbach a 5 0.78), we suggest that the original tool structure and scoring methodology are used on a preliminary basis in this population. This has the advantage of enabling data collected using the tool in Africa to be compared with the results of other studies reporting MVQOLI subscale and total QOL scores [17,18,43].…”