2050. Measuring Quality of Life at the End of Life: Validation of the QUAL-E
Karen E Steinhauser, PhD, Durham VAMC and Duke University Medical Center, EC Clipp, Durham VAMC and Duke University Medical Center and Duke University School of Nursing, HB Bosworth,
Durham VAMC and Duke University Medical Center, M McNeilly,
Duke University Medical Center, NA Christakis,
Department of Health Care Policy, Harvard Medical School, CI Voils,
Durham VAMC, JA Tulsky,
Durham VAMC and Duke University Medical Center
Objectives: To validate the QUAL-E, a new measure of quality of life at the end of life.
Methods: Cross-sectional study to assess the instrumentís psychometric properties, including the QUAL-Eís associations with existing measures, evaluation of robustness across diverse sample groups, and stability over time.
Setting: VA and Duke University Medical Centers, Durham North Carolina
Participants: 248 patients with stage IV cancer, congestive heart failure with ejection fraction £ 20%, chronic obstructive pulmonary disease with FEV1£ 1.0 liter, or dialysis-dependent end stage renal disease.
Main Outcome Measure: QUAL-E and five comparison measures: FACT-G quality of life measure, Missoula-VITAS Quality of Life Index, FACIT-SP spirituality measures, Participatory Decision Making Scale (MOS), and Duke EPESE social support scales.
Results: QUAL-E analyses confirmed a 4-domain structure (25 items): life completion (a=.80), symptoms (a=.87), relationship with health care provider (a=.71), and preparation for end of life (a=.68). Convergent and discriminant validity were demonstrated with multiple comparison measures. Test-retest reliability assessment showed stable scores over a one-week period.
Conclusions: The QUAL-E, a brief measure of quality of life at the end of life, demonstrates acceptable validity and reliability, is easy to administer, performs consistently across diverse demographic and disease groups, and is acceptable to seriously ill patients. It is offered as a new instrument to assist in the evaluation of the quality and effectiveness of interventions targeting improved care at the end of life.