Factors important to patients' quality of life at the end of life. Academic Article Article uri icon

Overview

MeSH

  • Adult
  • Aged
  • Attitude to Death
  • Caregivers
  • Drug Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Meditation
  • Middle Aged
  • Pastoral Care
  • Physician-Patient Relations
  • Prospective Studies
  • United States

MeSH Major

  • Models, Statistical
  • Neoplasms
  • Quality of Life
  • Terminal Care
  • Terminally Ill

abstract

  • When curative treatments are no longer options for patients dying of cancer, the focus of care often turns from prolonging life to promoting quality of life (QOL). Few data exist on what predicts better QOL at the end of life (EOL) for advanced cancer patients. The purpose of this study was to determine the factors that most influence QOL at the EOL, thereby identifying promising targets for interventions to promote QOL at the EOL. Coping With Cancer is a US multisite, prospective, longitudinal cohort study of 396 advanced cancer patients and their informal caregivers who were enrolled from September 1, 2002, through February 28, 2008. Patients were followed up from enrollment to death a median of 4.1 months later. Patient QOL in the last week of life was a primary outcome of Coping With Cancer and the present report. The following set of 9 factors, preceded by a sign indicating the direction of the effect and presented in rank order of importance, explained the most variance in patients' QOL at the EOL: 1 = (-) intensive care unit stays in the final week (explained 4.4% of the variance in QOL at the EOL), 2 = (-) hospital deaths (2.7%), 3 = (-) patient worry at baseline (2.7%), 4 = (+) religious prayer or meditation at baseline (2.5%), 5 = site of cancer care (1.8%), 6 = (-) feeding-tube use in the final week (1.1%), 7 = (+) pastoral care within the hospital or clinic (1.0%), 8 = (-) chemotherapy in the final week (0.8%), and 9 = (+) patient-physician therapeutic alliance at baseline (0.7%). The vast majority of the variance in QOL at the EOL, however, remained unexplained. Advanced cancer patients who avoid hospitalizations and the intensive care unit, who are less worried, who pray or meditate, who are visited by a pastor in the hospital/clinic, and who feel a therapeutic alliance with their physicians have the highest QOL at the EOL.

publication date

  • August 13, 2012

has subject area

  • Adult
  • Aged
  • Attitude to Death
  • Caregivers
  • Drug Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Meditation
  • Middle Aged
  • Models, Statistical
  • Neoplasms
  • Pastoral Care
  • Physician-Patient Relations
  • Prospective Studies
  • Quality of Life
  • Terminal Care
  • Terminally Ill
  • United States

Research

keywords

  • Journal Article
  • Multicenter Study

Identity

Language

  • eng

PubMed Central ID

  • PMC3806298

Digital Object Identifier (DOI)

  • 10.1001/archinternmed.2012.2364

PubMed ID

  • 22777380

Additional Document Info

start page

  • 1133

end page

  • 1142

volume

  • 172

number

  • 15