Quality of Life of Palliative Patients

1. Quality of life (QOL) of palliative care patients is a major focus for the palliative care teams irrespective of the settings of health care provision. Discuss determinants of level of quality of life in palliative care 20 marks

Improving quality of life (QOL) is recognized as an important goal of palliative care. Thus, Q O L assessment has become an important measure for clinical care planning, for programmatic quality improvement, and for research in the comparison of existing therapies and clinical trials of new therapies. Clinch and Shipper have suggested that QOL could be the most appropriate outcome measure of terminal care because it is focused on what happens to the patient, measuring the effect of physiological change (such as pain reduction that enables greater freedom of ambulation) rather than only the fact of physiological change. In addition, well-constructed Q O L measurement tools evaluate the comprehensive outcomes of all interventions. The recent SUPPORT study of terminal care revealed the need for new methods to enhance communication, decision-making, and symptom control in terminal care. When combined with established function and symptom assessment scales, information derived from a patient-reported QOL assessment tool could provide the basis for improved goal definition. The recognition of meaningful and achievable goals may, in turn, facilitate communication and improved sharing of decision-making and care planning by physicians and their terminally ill patients.

Socio-economic status:

 Education, employment, income.

There is a joint consent that socio-economic status has on impact on QOL. Employment influences both physical and mental health status and overall health although the effect on physical health was twice as big. Employment was a positive predictor for good physical health after three to four years. Employment constitutes a big part of the daily life of people. It can provide structure, a social support network, role identity and meaning. The exact association between employment and QOL, however, remains unproven. Probably this is a bi-directional relationship: good QOL could be a requirement to be able to work, or work could be a source of well-being. There are indications for an association between financial situation and QOL. A low versus middle or high income is associated with a lower mental and overall health. Yet, income may be not the best measure to assess financial situation. Data concerning expenditures, family composition, financial insecurity and financial worries could provide useful additional information. Education has also been linked to health related QOL and the relationship would be linear (i.e. higher education associated with higher health related QOL). An education of less than five years is negatively associated with mental health after six months and with physical health change after 12 months. It is possible that a lower education is a proxy of a lower socio-economic status in general, but it could also represent a poorer ability to understand the therapy recommendations. This leads to less informed, less involved and less empowered patients which affects their QOL.