title: Evaluation of the Missoula-VITAS Quality of Life Index--revised: research tool or clinical tool?
abstract: BACKGROUND
  Quality of life (QOL) is a central outcome measure in caring for seriously ill patients. The Missoula-VITAS Quality of Life Index (MVQOLI) is a 25-item patient-centered index that weights each of five QOL dimensions (symptoms, function, interpersonal, wellbeing, transcendence) by its importance to the respondent. The measure has been used to assess QOL for hospice patients, and has been found to be somewhat complex to use and analyze.
  
  
  OBJECTIVE
  This study aimed to simplify the measure, and evaluate the reliability and validity of a revised version as either a research or clinical tool (i.e., "psychometric" versus "clinimetric").
  
  
  METHODS
  Two data collection efforts are described. The psychometric study collected QOL data from 175 patients at baseline, 3-5 days, and 21 days later. The implementation study evaluated the feasibility and utility of the MVQOLI-R during over six weeks of use.
  
  
  METHODS
  End-stage renal patients on dialysis, hospice, or long-term care patients participated in the psychometric study. The implementation study was done in hospice, home health, and palliative care settings.
  
  
  METHODS
  The MVQOLI-R and the Memorial Symptom Assessment Scale.
  
  
  RESULTS
  The psychometric and implementation studies suggest that the MVQOLI-R performs well as a clinical tool but is not powerful as an outcome research instrument. The MVQOLI-R has the heterogeneous structure of clinimetric tools, and demonstrated both relevance and responsiveness. Additionally, in a clinical setting the MVQOLI-R was useful therapeutically for stimulating communication about the psychosocial and spiritual issues important to the tasks of life completion and life closure.
  
  
  CONCLUSIONS
  The MVQOLI-R has clinical utility as a patient QOL assessment tool and may have therapeutic utility as a tool for fostering discussion among patients and their clinicians, as well as for helping patients identify sources of suffering and opportunities during this time in their lives.
authors.affiliation: QualityMetric Incorporated, Waltham, Massachusetts, USA. xschwartz@qualitymetric.com
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Schwartz
authors.forename: Melanie P
authors.initials: MP
authors.lastname: Merriman
authors.forename: George
authors.initials: G
authors.lastname: Reed
authors.forename: Ira
authors.initials: I
authors.lastname: Byock
mesh_terms: D000368:Aged; D003625:Data Collection / Q000379:methods; D004522:Educational Status; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D008297:Male; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D006435:Renal Dialysis; D015203:Reproducibility of Results; D019452:Terminally Ill / Q000523:psychology*