A longitudinal study of palliative care: patient-evaluated outcome and impact of attrition.
BACKGROUND
The current article evaluated the course of patient-assessed symptomatology in specialized palliative care and tested for bias due to patient attrition in measures of initial symptomatology and treatment outcome.


METHODS
Over 2 years, 267 consecutive, eligible patients were referred to a department of palliative care. Upon arrival, 201 patients consented to participate in a questionnaire-based evaluation of quality of life (QOL). Of these, 175 patients participated, and 142, 119, and 95 participated in the study at 1, 2, and 3 weeks, respectively. Weekly, participants completed the self-assessment questionnaires European Organization for Research and Treatment of Cancer QLQ-C30, Edmonton Symptom Assessment System, Hospital Anxiety and Depression Scale, and Multidimensional Fatigue Inventory. Physicians used the Mini Mental State Examination to evaluate cognitive function. Changes from the initial symptom scores for each week were calculated. Initial scoring and change after 1 week were tested for association with completion level, i.e., whether the patient completed questions at 1, 2, 3, or 4 time points.


RESULTS
High initial symptom intensity and significant improvements over time were observed for pain, lack of appetite, nausea/vomiting, sleeplessness, constipation, and overall QOL/well-being. For some symptoms, initial scores were significantly higher in patients who dropped out, but the changes over the first week were not significantly different between completion levels for any symptom.


CONCLUSIONS
Improvement in symptom intensity was identified. Dropout was associated with higher initial symptomatology but not with poorer outcome of palliative treatment.
Strömgren
Annette S
AS
Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark. as06@bbh.hosp.dk
Sjogren
Per
P
Goldschmidt
Dorthe
D
Petersen
Morten Aagaard
MA
Pedersen
Lise
L
Hoermann
Linda
L
Groenvold
Mogens
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006304:Health Status; D006801:Humans; D017567:Karnofsky Performance Status; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D010166:Palliative Care / Q000592:standards*; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome