The usefulness of EuroQol and McGill Quality of Life questionnaires in palliative care in-patients

Transcription

1 The usefulness of EuroQol and McGill Quality of Life questionnaires in palliative care in-patients Ewa Deskur-Smielecka, Bogusław Stelcer, Aleksandra Kotlinska-Lemieszek, Katarzyna Wieczorowska-Tobis Poznan University School of Medical Sciences, Poland Chair and Department of Palliative Medicine Chair of Clinical Psychology

2 Background Palliative care is an approach that improves the quality of life (QoL) of patients and their families facing the problem associated with life-threatening illness (WHO) Instruments assessing QoL applicable to palliative care in-patients should be short and comprehensible, and should not impose additional burden on patients; however, they should cover various aspects of QoL, be reliable and valid

3 Aim: to assess the feasibility and validity of EuroQoL (EQ-5D), a generic healthrelated QoL instrument, as compared to the McGill Quality of Life Questionnaire (MQOL) in palliative care in-patients

4 EuroQoL-5D 5 dimensions each has 5 response categories (verbal rating scale) Mobility Self-care Usual activities (e.g. work, study, housework, family or leisure activities) Pain/discomfort Anxiety/depression Assessment of patient s overall health status on scale Refers to THE DAY OF ASSESSMENT

5 McGill Quality of Life questionnaire 17 items scored on a numerical rating scale question concerning general quality of life 4 questions concerning physical symptoms or problems 3 questions concerning physical symptoms and their intensity 1 question concerning physical well-being 4 questions concerning psychosocial problems 6 questions concerning existential well-being 2 questions concerning support 1 open question concerning things which had the greatest influence on patient s quality of life Refers to PAST 2 DAYS

6 Study design 125 consecutive patients admitted to the Palliative Care Unit of the University Hospital of Lord s Transfiguration in Poznan 49 (47%) eligible QoL assessment (random order) EuroQoL-5D-5L MQOL Assessment of patient s perception of each questionnaire time of completion clarity burden 66 (53%) excluded poor general condition significant cognitive impairment

7 Results - study population 17 men, 32 women Mean age 63±11 yrs Karnofsky Performance Status 50 (40; 50) (median (25th, 75th quartile)) Diagnoses: Gastrointestinal tract cancer: 15 (30.6%) pts Urogenital cancer: 15 (30.6%) pts Respiratory tract cancer: 7 (14.3%) pts Breast cancer: 6 (12.2%) pts Other cancers: 6 (12.2%) pts Reason for referral to palliative care in-patient unit: Symptom management: 29 pts Delirium: 1 pt Fatigue: 5pts Lack of social support at home: 10 pts Others: 3 pts

8 % Results EQ-5D Index value: 0.23±0.331 no problems slight problems moderate problems severe problems extreme problems

9 EQ-5D self-assessed health status using the VAS rating % Median: 50 (30, 60)

10 Results MQOL 5.0 (3.0, 6.0) 5.0 (3.0, 7.0) 5.75 (3.0, 8.0) 6.33 (4.8, 7.5) 8.5 (6.5, 10.0) 5.8 (4.57, 6.67)

11 Correlations between EQ-5D and MQOL EQ-5D Problems with mobility Problems with selfcare Problems with usual activity MQOL items General QoL Physical sympt. (reversed) Physical wellbeing Psychological (reversed) Existential Support Global score -0,088-0,050-0,162-0,140-0,117-0,037-0,213-0,254-0,075-0,154-0,142-0,141-0,035-0,210-0,122-0,109-0,252-0,109-0,157-0,077-0,220 Pain/discomfort -0,149 0,103-0,471* -0,064-0,448* -0,247-0,356* Anxiety/depression -0,294* -0,085-0,312* -0,615* -0,475* -0,269-0,619* Health state (VAS) 0,353* 0,0347 0,206 0,174 0,231 0,259 0,377* Index value 0,136 0,078 0,310* 0,287 0,333* 0,180 0,422* P < 0.05

12 Patients perception of QoL questionnaires P < 0.01 P < 0.01 P < patients refused completing MQOL (fatigue, annoyance) 4 patients regarded some MQOL questions revolting, or inadequate

13 Investigator s perception of QoL questionnaires EQ-5D time: 1-6 min MQOL time: 7-17 min completing questionnaires often transformed into discussions on patient s health and prognosis, or into a supportive talk 10 patients had problems with understanding VAS (EQ- 5D) and NRS (MQOL) Interviewers (investigators) might have involuntarily influenced patients responses

14 Conclusions assessment of QoL was unfeasible in significant number of palliative care in-patients EQ-5D was perceived as faster and clearer tool than MQOL, and imposed less burden on patients EQ-5D items showed moderate correlations with corresponding domains in MQOL, except for physical symptoms EQ-5D may be used as complementary quality of life assessment tool in palliative care in-patients, however, a recall mode might be more appropriate than assessing the status at the time of completion