A longitudinal study of within-person trajectories in quality of life in patients receiving early palliative care.

ABSTRACT

PURPOSE: To reveal the within-person trajectories in quality of life (QOL) in patients receiving early palliative care. Previous studies have mostly focused aggregated trajectories, based on all research participants combined, whereas this study focused on within-person trajectories in QOL and on whether the variability in QOL trajectories across patients is substantial enough to raise doubts about aggregated trajectories. METHODS: Twenty-five older persons in early palliative care completed the McGill Quality of Life Questionnaire multiple times. Reliable change analyses provided estimates of the occurrence of statistically significant within-person change. RESULTS: There was reliable, within-person variation in QOL scores across time, more so for physical than for psychological aspects of well-being. Changes in QOL scores occurred for most patients but the trajectories were not linear and there was no common trend in the nonlinear patterns. CONCLUSIONS: Reliable change across time can be identified in persons receiving early palliative care. However, the trajectories are notably variable and patient-specific. The high degrees of within-person variability across time suggests the importance of repeated QOL assessments and of dynamic tailoring of clinical treatments.

This study describes the quality of life (QOL) trajectories of 25 persons in early palliative care for life-limiting chronic conditions. Previous studies have mostly focused on aggregated trajectories for all research participants combined. In contrast, this study focused on within-person trajectories in QOL and on whether the variability in QOL trajectories across patients is substantial enough to question the meaningfulness of aggregated trajectories. There was both between-patient and within-person variation in QOL scores across time and no common trend. For some patients, the change was for improving scores across time. For other patients the change was for worsening scores across time. And for still other patients, the changes were reliable but not linear. The trajectories are thus quite variable and patient-specific. The variability in QOL trajectories is substantial enough to raise concerns about aggregated trajectories. The high degrees of within-person variability across time suggests the importance of repeated QOL assessments and of dynamic tailoring of clinical treatments.