4 Quality of life assessment in palliative care day services

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IntroductionThe outcome measure used to assess Quality of Life (QoL) can have a crucial effect on the interpretation of any findings in palliative care.AimsTo compare the sensitivity to change of the Schedule for the Evaluation of Individual Quality of Life-Direct Weighing (SEIQol-DW), the McGill Quality of Life Questionnaire (MQOL) and the Short Form 36 (SF-36) among patients receiving Palliative Care Day Services (PCDS).MethodsPatients were recruited from PCDS. The same questionnaires were administered at 2 time points, approximately 3 weeks apart. A measure of dependency (the Barthel Index) was used to determine whether patients remain stable/deteriorate over time.AnalysisStandardised response mean (SRM) was used to determine the relative sensitivity of each instrument for those patients who had changed in their Barthel scores (Garratt et al 1994).ResultsForty four patients (median 69 years, range 49–86) were recruited. Follow-up data was obtained from 25 (56.8%) patients. Of these 25 patients, 14 (56%) patients changed according to the Barthel Index with 7 (50%) patients defined as increased dependency.The responsiveness of the SEIQoL-DW was larger than those of the other questionnaires (SRM=0.73) for those patients who showed an increased dependency over time. The SF-36 Bodily Pain subscale demonstrated a larger responsiveness than the other questionnaires (SRM=0.82) for those patients who showed a decrease dependency over time.ConclusionsThe SEIQoL appears to be a good outcome measure for charting the progress of patients who are deteriorating over time. However none of the questionnaires were particularly good at demonstrating improvements over time.Reference1. Garratt AM, Ruta DA, Abdalla MI, Russell IT. SF-36 health survey questionnaire: II. Responsiveness to changes in health status in four common clinical conditions. Quality in Health Care1994;3:186–192.

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