Validation of the QUAL-EC for assessing quality of life in patients with advanced cancer.
OBJECTIVE
Improving quality of life is the main goal of palliative cancer care. However, there is a lack of measures validated specifically for advanced cancer. The purpose of this study was to validate the Quality of Life at the End of Life (QUAL-E) measure in a sample of patients with advanced cancer.


METHODS
Data were analysed for 464 patients with advanced cancer who were participating in a randomised controlled trial of early palliative care intervention versus routine care. Patients completed the 26-item QUAL-E, the Functional Assessment of Cancer Therapy (FACT-G) quality of life measure and measures of spiritual well-being, performance status, symptom burden, satisfaction with care and communication with health care providers. We conducted a confirmatory factor analysis on the QUAL-E to test for the hypothesised four-factor structure and examined construct validity by calculating correlations with relevant scales.


RESULTS
A 17-item reduced version of the QUAL-E, the QUAL-E-Cancer (QUAL-EC) achieved an acceptable fit to a four-factor model. Both the full and reduced versions of the QUAL-E were internally reliable and showed good construct validity. Symptom Control was correlated with other measures of physical functioning; Relationship with Healthcare Provider was correlated with satisfaction with care and better physician and nurse communication; Preparation for End of Life was strongly associated with emotional well-being; and Life Completion was strongly associated with social and spiritual well-being.


CONCLUSIONS
Due to its good factor structure and sound psychometrics, we recommend the reduced QUAL-EC scale to assess quality of life in patients with advanced cancer.
Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, 610 University Ave., Toronto, Ontario, Canada.
Christopher
C
Lo
Debika
D
Burman
Nadia
N
Swami
Lucia
L
Gagliese
Gary
G
Rodin
Camilla
C
Zimmermann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D010166:Palliative Care; D017060:Patient Satisfaction; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires / Q000592:standards*; D019452:Terminally Ill / Q000523:psychology*