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
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
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
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 0-100 scale Refers to THE DAY OF ASSESSMENT
McGill Quality of Life questionnaire 17 items scored on a numerical rating scale 0-10 1 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
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
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
% Results EQ-5D 40 45 30 35 20 25 10 15 0 5 Index value: 0.23±0.331 no problems slight problems moderate problems severe problems extreme problems
EQ-5D self-assessed health status using the 0-100 VAS rating % Median: 50 (30, 60)
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)
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
Patients perception of QoL questionnaires P < 0.01 P < 0.01 P < 0.01 3 patients refused completing MQOL (fatigue, annoyance) 4 patients regarded some MQOL questions revolting, or inadequate
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
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