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

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)

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