title: Quality of life among patients receiving palliative care in South Africa and Uganda: a multi-centred study.
abstract: BACKGROUND
  Quality of life (QOL) is a core outcome of palliative care, yet in African settings there is a lack of evidence on patients' levels of QOL. We aimed to describe QOL among patients with incurable, progressive disease receiving palliative care in South Africa and Uganda, to compare QOL in cancer and HIV, to determine how domains of QOL correlate with overall QOL, and compare levels of QOL in this population with those in other studies using the same tool.
  
  
  METHODS
  A cross-sectional survey was conducted using the Missoula Vitas Quality of Life Index (MVQOLI), a 26-item QOL questionnaire with five subscales (Function, Symptom, Interpersonal, Well being, Transcendent) covering physical, social, psychological and spiritual domains and one global QOL item. One item in each subscale assesses the subjective importance of the domain on a score from 1 (least important) to 5 (most important), used to weight the contribution of the subscale towards the Total QOL score. The tool was translated into 6 languages and administered to consecutively recruited patients at four facilities in South Africa and one in Uganda.
  
  
  RESULTS
  285 patients were recruited, with a mean age of 40.1; 197 (69.1%) were female. Patients' primary diagnoses were HIV (80.7%), cancer (17.9%) and other conditions (1.4%). The mean global QOL score was 2.81 (possible range 0 (worst) to 5 (best)); mean Total score 17.32 (possible range 0 to 30). Patients scored most poorly on Function (mean 0.21), followed by Well being (2.59), Symptoms (5.38), Transcendent (5.50), Interpersonal (9.53) (possible range for subscale scores -30 to 30). Most important to patients were: close relationships (mean 4.13), feeling at peace (4.12), sense of meaning in life (4.10), being active (3.84), physical comfort (2.58). Cancer patients were predominantly recruited at three of the sites; hence comparison with HIV-infected patients was restricted to these sites. HIV+ patients (n = 115) scored significantly worse than cancer patients (n = 50) on Well being (Z = -2.778, p = 0.005), Transcendence (Z = -2.693, p = 0.007) and Total QOL (Z = -2.564, p = 0.01). Global QOL score was most weakly correlated with Total QOL (r = 0.37) and the Transcendent subscale was most highly correlated (r = 0.77) (both p < 0.001). Patients receiving palliative care in South Africa and Uganda exhibited significantly poorer QOL compared to similar populations in the USA.
  
  
  CONCLUSIONS
  Feeling at peace and having a sense of meaning in life were more important to patients than being active or physical comfort, and spiritual wellbeing correlated most highly with overall QOL. It is therefore vital to identify and meet the psychological and spiritual care needs of patients, as well as to assess and treat pain and other symptoms. Our finding that patients scored most poorly on the Function domain warrants further research.
authors.affiliation: King's College London, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London SE5 9PJ, UK. lucy.selman@kcl.ac.uk
authors.forename: Lucy E
authors.initials: LE
authors.lastname: Selman
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.forename: Godfrey
authors.initials: G
authors.lastname: Agupio
authors.forename: Natalya
authors.initials: N
authors.lastname: Dinat
authors.forename: Julia
authors.initials: J
authors.lastname: Downing
authors.forename: Liz
authors.initials: L
authors.lastname: Gwyther
authors.forename: Thandi
authors.initials: T
authors.lastname: Mashao
authors.forename: Keletso
authors.initials: K
authors.lastname: Mmoledi
authors.forename: Tony
authors.initials: T
authors.lastname: Moll
authors.forename: Lydia Mpanga
authors.initials: LM
authors.lastname: Sebuyira
authors.forename: Barbara
authors.initials: B
authors.lastname: Ikin
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology*; D036301:Qualitative Research; D011788:Quality of Life; D018434:Sickness Impact Profile; D012944:Social Support; D013019:South Africa; D029181:Spirituality; D019452:Terminally Ill / Q000523:psychology*; D014454:Uganda; D055815:Young Adult