Abstract
BackgroundDomains other than those commonly measured (physical, psychological, social, and sometimes existential/spiritual) are important to the quality of life of people with life-threatening illness. The McGill Quality of Life Questionnaire (MQOL) – Revised measures the four common domains. The aim of this study was to create a psychometrically sound instrument, MQOL – Expanded, to comprehensively measure quality of life by adding to MQOL-Revised the domains of cognition, healthcare, environment, (feeling like a) burden, and possibly, finance.MethodsConfirmatory factor analyses were conducted on three datasets to ascertain whether seven new items belonged with existing MQOL-Revised domains, whether good model fit was obtained with their addition as five separate domains to MQOL-Revised, and whether a second-order factor representing overall quality of life was present. People with life-threatening illnesses (mainly cancer) or aged > 80 were recruited from 15 healthcare sites in seven Canadian provinces. Settings included: palliative home care and inpatient units; acute care units; oncology outpatient clinics.ResultsGood model fit was obtained when adding each of the five domains separately to MQOL-Revised and for the nine correlated domains. Fit was acceptable for a second-order factor model. The financial domain was removed because of low importance. The resulting MQOL-Expanded is a 21-item instrument with eight domains (fit of eight correlated domains: Comparative Fit Index = .96; Root Mean Square Error of Approximation = .033).ConclusionsMQOL-Expanded builds on MQOL-Revised to more comprehensively measure the quality of life of people with life-threatening illness. Our analyses provide validity evidence for the MQOL-Expanded domain and summary scores; the need for further validation research is discussed. Use of MQOL-Expanded will enable a more holistic understanding of the quality of life of people with a life-threatening illness and the impact of treatments and interventions upon it. It will allow for a better understanding of less commonly assessed but important life domains (cognition, healthcare, environment, feeling like a burden) and their relationship to the more commonly assessed domains (physical, psychological, social, existential/spiritual).
Highlights
Domains other than those commonly measured are important to the quality of life of people with life-threatening illness
FINANCE on the Psychological separate aspect of quality of life (QOL) from the domains cross-load on all existing domains of domain (0.47)
The financial domain was removed from the final McGill Quality of Life Questionnaire (MQOL)-E because the standardized loading on the second-order factor was low (0.254, well below the 0.4 criterion) and its removal had little effect on the Comparative Fit Index (CFI) and Root Mean Square Error of Approximation (RMSEA) of the first-order (CFI = 0.96; RMSEA = 0.033) and second-order (CFI = 0.93, RMSEA = 0.043) models
Summary
Domains other than those commonly measured (physical, psychological, social, and sometimes existential/spiritual) are important to the quality of life of people with life-threatening illness. Creating QOL instruments requires a balance between comprehensive coverage of what is important to the QOL of the population and feasibility of completion, since there are many potentially relevant life domains, and each has many aspects. When QOL is the primary outcome, or it is feasible to have respondents complete a longer but still brief QOL questionnaire along with collection of other necessary data, it is important that the QOL measure be as comprehensive as possible. Domains widely accepted as essential for measuring the QOL of people who are ill include the physical, psychological/mental, and social – corresponding to the definition of health in the World Health Organization’s constitution [1]. For people with a life-limiting illness, the existential or spiritual domain is increasingly considered essential as well [2, 3]
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