Quality of life in palliative care: An analysis of quality-of-life assessment

Abstract

The principal aim of palliative care is to improve patients' quality of life. This is more complicated than it seems. There is no generally accepted way to assess quality of life. Through an extensive literature research multiple instruments were found. Of these, four were chosen to be examined further (Schedule for the Evaluation of Individual Quality of Life – Direct Weighting (SEIQoL-DW), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire – Core 15 – of Palliative Care (EORTC QLQ-C15-PAL), Rotterdam Symptom Checklist (RSCL), and Palliative Care Outcome Scale (POS)). These were used with patients in a German palliative care ward. Staff and patients were interviewed on their understanding of quality of life and its assessment. The results of literature research, interviews, and application of the instruments were then collated and critically evaluated. It became obvious that a deliberate choice of an instrument has a great impact on practicability and outcome in a clinical setting. The EORTC QLQ-C15-PAL seems particularly useful for (international) studies; it leads to clear and easily comparable results. For routine use in clinical palliative care, however, it seems too impersonal to represent more than a rough idea of patients' actual quality of life. Applying the RSCL, the researcher could gain a basic overview of symptoms and psychological condition of his patients – even though it seems too rigid to allow a deeper insight in quality of life. The POS offers additional insight via an open question and a staff questionnaire. This could provide particularly helpful information for clinical routine – provided patients can cope with its more complex format. The SEIQoL-DW seems to be best suited for use in a clinical situation even though its use can be challenging for both researcher and patient. Assessment requires both parties to interact directly, which seems to have a beneficial impact on relationship and communication. It is the most flexible assessment instrument of those analysed here and therefore seems to be best suited to investigate such a complex matter as quality of life.