Evaluating the utility of the QUAL-EC in the clinical care of patients with advanced cancer — ASN Events
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  3. Evaluating the utility of the QUAL-EC in the clinical care of patients with advanced cancer

Evaluating the utility of the QUAL-EC in the clinical care of patients with advanced cancer (#463)

Susan Slatyer 1 2 , Anna Nowak 3 , Catherine Pienaar 4 , Anne Wilkinson 4 , Anil Tandon 5 , Mark Wallace 4
  1. School of Nursing and Midwifery, Curtin University, BENTLEY, WA, Australia
  2. Centre for Nursing Research, Sir Charles Gairdner Hospital, NEDLANDS, WA, Australia
  3. The University of Western Australia, CRAWLEY, WA, Australia
  4. School of Nursing and Midwifery, Edith Cowan University, JOONDALUP, WA, Australia
  5. Palliative Care Service, Sir Charles Gairdner Hospital, NEDLANDS, WA, Australia

Improvement of quality of life (QoL) is a fundamental goal of care for people with advanced cancer. The Quality of Life at the End of Life (QUAL-E) instrument was developed to measure four domains: Symptom control; Relationship with healthcare provider; Preparation for end of life (concerns about loved ones); and Life completion1. Piloting the QUAL-E with Australian palliative inpatients (n=52) demonstrated acceptability and face validity2. A reduced 17-item instrument, the QUAL-E-Cancer (QUAL-EC), validated with Canadian patients (n=464) was recommended to assess QoL in people with advanced cancer3.
Aims
This study evaluated the utility and feasibility of the QUAL-EC by:
• Exploring associations between QUAL-EC domain scores and distress.
• Exploring in-depth responses to the QUAL-EC when administered as an interview.
Methods
A cross-sectional, mixed methods design was used. Convenience sampling recruited patients with advanced cancer and a prognosis of less than 12 months from a tertiary hospital. Participants completed the QUAL-EC and the Distress Thermometer Screening Tool4 (DT). Qualitative data collection involved digital recordings of QUAL-EC interviews.
Results
The accrual target of 25 inpatients (78% response) and 25 outpatients (96% response) was reached. The mean age was 59.9 years. The most common diagnoses were mesothelioma (26%), and cancers of the lung (22%) and brain (10%). Patients’ DT scores indicated that 39.6% were experiencing severe distress (score ≥7) while 40% reported moderate distress (score 4-6). Levels of distress significantly correlated with two QUAL-EC domains: Symptom control (r=0.52, p<0.001) and Preparation for end of Life (r=0.32, p<0.05). Qualitative analysis described the influence of pervasive emotional stress, bothersome symptoms, and psychosocial factors on QUAL-EC responses.
Conclusions
Distress was associated with either symptom burden, or concerns about loved ones. When distress is identified on screening, the QUAL-EC offers potential as an instrument capable of nuanced assessment to direct intervention towards psychosocial or physical and symptom-related concerns.

  1. Steinhauser K, Bosworth H, Clipp E, McNeilly M, Christakis N, Parker J, et al. Initial assessment of a new instrument to measure quality of life at the end of life. Journal of Palliative Medicine. 2002;5:829-41.
  2. Wilkinson A, Slatyer S, McCullough K, Williams A. Exploring the Quality of Life at the End of Life (QUAL-E) instrument with Australian palliative care hospital patients. Journal of Palliative Care. 2014;30:16-23.
  3. Lo C, Burman D, Swami N, Gagliese L, Rodin G, Zimmermann C. Validation of the QUAL-EC for assessing quality of life in patients with advanced cancer. European Journal of Cancer. 2011;47:554-60.
  4. Reproduced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Distress Management (V.2.2013). © 2013 National Comprehensive Cancer Network, Inc. Available at: NCCN.org. Accessed December 13, 2013. To view the most recent and complete version of the NCCN Guidelines®, go on-line to NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.
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