QUALITY-OF-LIFE IN CANCER-PATIENTS - USE OF A REVISED HOSPICE INDEX

PURPOSE: Improving or maintaining the quality of life for persons with cancer is a major goal of end-of-life care; however, to measure quali ty-of-life outcomes, a valid and reliable measure is needed. The purpo se of this project was to report the psychometric properties of the re vised Hospice Quality of Life Index (HQLI) including validity and reli ability for hospice patients with cancer. DESCRIPTION: Data were colle cted from home care hospice patients with cancer (n=255) and a group o f apparently healthy adults in the community (n=32). The revised HQLI is a 28-item self-report instrument that includes three subscales: Psy chophysiological Well-being, Functional Well-being, and Social/Spiritu al Well-being. RESULTS: Evidence for validity was provided in three wa ys. First, factor analysis confirmed the three subscales (Psychophysio logical, Functional, and Social/Spiritual Well-being). Second, a weak significant correlation was found between the Eastern Cooperative Onco logy Group Performance Status Rating scores and HQLI scores (r=.26, P= .00). Third, the HQLI was able to discriminate between hospice patient s with cancer and apparently healthy adults (lambda = .34, P=.00). In addition, the mean scores of these two groups were significantly diffe rent (t=6.64: P= .00). However, only a minimal difference in scores wa s found on the Social/Spiritual Well-being subscale between the cancer and healthy groups. Reliability for the revised HQLI was high for bot h the total scale (alpha=.88) and the subscales (alpha= .82-.85). CLIN ICAL IMPLICATIONS: Emphasis has been placed recently on understanding quality of life from the patients perspective. The development of a va lid and reliable tool can guide care givers in providing meaningful qu ality-of-life issues and to maintain direction over a critical aspect of their care. Of note from this study, the significant difference in social/spiritual well-being suggest that patients are able to appraise their functional abilities realistically and still maintain their soc ial network and spiritual beliefs. Indeed, it may be that patients giv e family relationships and spiritual beliefs greater focus during a te rminal illness.