Quality of life at the end of life.
BACKGROUND
Little is known about self-perceived quality of life (QOL) near the end of life, because such information is difficult to collect and to interpret. Here, we describe QOL in the weeks near death and determine correlates of QOL over time, with emphasis on accounting for death and missing data.


METHODS
Data on QOL were collected approximately every week in an ongoing randomized trial involving persons at the end of life. We used these data to describe QOL in the 52 weeks after enrollment in the trial (prospective analysis, N = 115), and also in the 10 weeks just prior to death (retrospective analysis, N = 83). The analysis consisted of graphs and regressions that accounted explicitly for death and imputed missing data.


RESULTS
QOL was better than expected until the final 3 weeks of life, when a terminal drop was observed. Gender, race, education, cancer, and baseline health status were not significantly related to the number of "weeks of good-quality life" (WQL) during the study period. Persons younger than 60 had significantly higher WQL than older persons in the prospective analysis, but significantly lower WQL in the retrospective analysis. The retrospective results were somewhat sensitive to the imputation model.


CONCLUSIONS
In this exploratory study, QOL was better than expected in persons at the end of life, but special interventions may be needed for persons approaching a premature death, and also for the last 3 weeks of life. Our descriptions of the trajectory of QOL at the end of life may help other investigators to plan and analyze future studies of QOL. Methodology for dealing with death and the high amount of missing data in longitudinal studies at the end of life needs further investigation.
Department of Biostatistics, University of Washington, Seattle, Washington 98195, USA. pdiehr@u.washington.edu
Paula
P
Diehr
William E
WE
Lafferty
Donald L
DL
Patrick
Lois
L
Downey
Sean M
SM
Devlin
Leanna J
LJ
Standish
D000293:Adolescent; D000328:Adult; D000368:Aged; D001293:Attitude to Death; D003627:Data Interpretation, Statistical; D005260:Female; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011594:Psychometrics / Q000379:methods*; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D012647:Self-Assessment; D018434:Sickness Impact Profile; D013727:Terminal Care; D019452:Terminally Ill / Q000523:psychology*; D013997:Time Factors