Determinants of quality of life in patients near the end of life: a longitudinal perspective.

PURPOSE/OBJECTIVES to describe the quality of life (QOL) of patients near the end of life and to identify determinants of their QOL. DESIGN descriptive, longitudinal. SETTING university-affiliated cancer center, two private oncologists' offices, and patients' homes. SAMPLE 80 patients with either stage IIIb or IV lung cancer newly diagnosed in the previous month or recurrent lung cancer with distant disease. METHODS patients were interviewed for responses to instruments to assess demographic, physical, psychosocial, and spiritual characteristics. Baseline data were collected at the patients' places of oncology care. Home visits were made for the two-month and four-month data collection points. MAIN RESEARCH VARIABLES QOL; symptom frequency, severity, and distress; functional status; anxiety; depression. FINDINGS fifty percent of patients died within five months of their lung cancer diagnosis. Patients reported a relatively high QOL that did not change significantly as they approached the end of life. Symptom distress was the strongest determinant of QOL, followed by symptom severity, symptom frequency, and depression. CONCLUSIONS QOL was most affected by symptoms experienced in patients with advanced lung cancer, particularly distress associated with symptoms. Interventions for symptom management must be implemented at diagnosis because patients in this population may approach the end of life quickly. IMPLICATIONS FOR NURSING a routine and thorough symptom assessment is imperative for patients with advanced lung cancer. Attention to symptom distress is important because of its effect on QOL.