Existential Quality of Life and Associated Factors in Cancer Patients Receiving Palliative Care - PubMed

Context: Enhancing quality of life (QoL) is a goal of palliative care. Existential QoL is an important aspect of this.

Objectives: This study sought to advance our understanding of existential QoL at the end of life through examining levels of Preparation and Completion, subscales of the QUAL-E, and their associated factors.

Methods: We used data from a multi-site study of 331 older cancer patients receiving palliative care. We examined levels of Preparation and Completion and their association with demographic, religious, and medical factors, and with the Patient Dignity Inventory.

Results: Preparation and Completion scores were moderately high. In adjusted models, being 10 years older was associated with an increase of 0.77 in Preparation (P = 0.002). Non-white patients had higher Preparation (1.03, P = 0.01) and Completion (1.56, P = 0.02). Single patients reported Completion score 1.75 point lower than those married (P = 0.01). One-point increase in intrinsic religiousness was associated with a 0.86-point increase in Completion (P = 0.03). One-point increase in terminal illness awareness was associated with 0.75-point decrease in Preparation (P = 0.001). A 10-point increase in symptom burden was associated with a decrease of 0.55 in Preparation (P < 0.001) and a decrease of 1.0 in Completion (P < 0.001). The total Patient Dignity Inventory score and all of its subscales were negatively correlated with Preparation (r from -.26 to -.52, all P < 0.001) and Completion (r from -.18 to -.31, all P < 0.001).

Conclusion: While most patients reported moderate to high levels of existential QoL, a subgroup reported low existential QoL. Terminal illness awareness and symptom burden may be associated with lower existential QoL.

1. 1. WHO Definition of Palliative Care. (2012, January 28). Retrieved October 10, 2020, from https://www.who.int/cancer/palliative/definition/en/
2. 1. Steinhauser KE, Christakis NA, Clipp EC, et al. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000. Nov 15;284(19):2476–82. doi: 10.1001/jama.284.19.2476. PMID: 11074777. - DOI - PubMed
3. 1. Gagnon P, Fillion L, Robitaille MA, et al. A cognitive-existential intervention to improve existential and global quality of life in cancer patients: A pilot study. Palliat Support Care. 2015;13(4):981–990. doi:10.1017/S147895151400073X - DOI - PMC - PubMed
4. 1. Lo C, Panday T, Zeppieri J, et al. Preliminary psychometrics of the Existential Distress Scale in patients with advanced cancer. Eur J Cancer Care (Engl). 2017. Nov;26(6). doi: 10.1111/ecc.12597. Epub 2016 Oct 24. PMID: 27778415. - DOI - PubMed
5. 1. Steinhauser KE, Clipp EC, Bosworth HB, et al. Measuring quality of life at the end of life: validation of the QUAL-E. Palliat Support Care. 2004. Mar;2(1):3–14. doi: 10.1017/s1478951504040027. PMID: 16594230. - DOI - PubMed