Background
Quality of life (QoL) is implicit in the definition of palliative care as recognised by The World Health Organization (2018): "Palliative care is an approach that improves the quality of life for patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual." [2,11]
QoL in palliative care includes the concepts of compassionate care and of dying with dignity. [2-4] Dignity is related to personal identity and feelings of value and self-worth. [1] Compassion and compassionate care have particular relevance to the psychological and spiritual issues at the end-of-life and can be important in the appeasement of suffering. [3]
Evidence Summary
Dignity and QoL are complex and subjective and will each mean different things to different people. They include physical, social, psychological and spiritual well-being, and feelings of value and self-worth. Quality of life (QoL) in palliative care includes the concepts of compassionate care and of dying with dignity. [1,5]
Palliative care has been shown to be associated with improvements in QoL and symptom burden of people receiving palliative care. However, outcomes for carers are inconclusive and poorly represented in high-quality literature. [6,7]
Care planning and clear, respectful and empathetic communication can contribute positively to the sense of dignity and the quality of life of people receiving palliative care. [4,7,12,13] Also important are correct and timely assessment and management of physical symptoms (particularly pain), psychological symptoms (particularly anxiety and depression) and spiritual needs. [5-7]
The sense of dignity is readily influenced by a number of external factors. Care plans which address the areas of life on which a person’s dignity is based can readily contribute to an improved quality of life. [1] Dignity therapy is a brief individualised psychotherapy which offers people an opportunity to reflect on issues that are important to them or other things that they would like to recall or transmit to others. [9,14,15] Dignity therapy, developed in 2002, has been shown to be well-accepted by older adults at the end of their life and for their family and carers. [9,14,15] Evidence suggests that dignity therapy can raise levels of meaning of life, quality of life and spiritual well-being of residents in aged care. However, an effect on lowering depression or distress has not been clearly demonstrated. [9,14,15]
In the assessment of palliative care for residents of aged care facilities, five comprehensive geriatric assessments (CGAs) were reviewed in a meta-analysis. [8] The McMaster Quality of Life Scale (MQLS) was shown to have strong validity and reliability. The interRAI Palliative Care instrument covers all domains of the Guidelines for A Palliative Approach to Residential Aged Care and demonstrated high inter-rater reliability and suitability as a care planning tool. The Palliative Care Outcome Scale (POS) was shown to be a suitable instrument to assess not only patients who are cognitively able to participate but also people with moderate or severe dementia. [8]
Quality Statement
Overall, the evidence (from guidelines, systematic reviews (SRs), integrative reviews and a narrative review) is of good to high quality.
Page updated 10 January 2018