The prognostic value of measuring health-related quality of life in hospice patients

Purpose: Better prognostic instruments are sorely needed for patients near the end of life. Health-related quality of life instruments designed for hospice patients have not been previously studied for their prognostic properties. This study evaluated the prognostic property of the Missoula-Vitas Quality of Life Index (MVQOLI) with hospice patients. Methods: A prospective, cross-sectional cohort design included all consecutive patients admitted to a hospice over a 19-month period. At admission to hospice, patients were asked to complete an MVQOLI. In addition, hospice nurses completed three functional status instruments. All patients were followed until death, study closure, or loss to follow-up. Results: The sample included 1047 patients, but only 231 (22%) were able to complete an MVQOLI at admission. Functional status data were collected on nearly all of the patients. The Karnofsky performance score, modified activity of daily living score, and descriptive symptom score were significantly associated with survival time. Using Cox regression models these functional status assessments were strongly associated with survival time (p < 0.001). However, the MVQOLI scores were not significantly associated with survival time, except for the function subscale (p = 0.045). Conclusion: The MVQOLI global, total, and four of the five weighted-domain baseline scores were not associated with survival time in hospice patients. Other methods for prognostication at the end of life are needed.