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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 health-related 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
66 (53%) excluded
•poor general condition •significant cognitive impairment
49 (47%) eligible
•QoL assessment (random order) •EuroQoL-5D-5L •MQOL
•Assessment of patient’s perception of each questionnaire
•time of completion •clarity •burden
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
05
1015202530354045
no problems slight problems moderate problems severe problems extreme problems
%
Index value: 0.23±0.331
Results – MQOL
5.0 (3.0, 6.0)
5.0 (3.0, 7.0)
6.33 (4.8, 7.5)
8.5 (6.5, 10.0)
5.8 (4.57, 6.67)
5.75 (3.0, 8.0)
Correlations between EQ-5D and MQOL
EQ-5D MQOL items
General QoL
Physical sympt.
(reversed)
Physical
well-
being
Psycho-logical
(reversed)
Existen-tial
Support Global score
Problems with mobility
-0,088 -0,050 -0,162 -0,140 -0,117 -0,037 -0,213
Problems with self-care
-0,254 -0,075 -0,154 -0,142 -0,141 -0,035 -0,210
Problems with usual activity
-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
• 3 patients refused completing MQOL (fatigue, annoyance)
• 4 patients regarded some MQOL questions revolting, or inadequate
P < 0.01
P < 0.01 P < 0.01
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