Objectives: To validate the QUAL-E, a new measure of quality
of life at the end of life.
Methods: We conducted a cross-sectional study to assess the
instrument's psychometric properties, including the QUAL-E's
associations with existing measures, evaluation of robustness across
diverse sample groups, and stability over time. The study was conducted
at the VA and Duke University Medical Centers, Durham, North Carolina,
in 248 patients with stage IV cancer, congestive heart failure with
ejection fraction ≤20%, chronic obstructive pulmonary disease with
FEV1 ≤ 1.0 l, or dialysis-dependent end stage renal
disease. The main outcome measures included QUAL-E and five comparison
measures: FACIT quality of life measure, Missoula-VITAS Quality of Life
Index, FACIT-SP spirituality measures, Participatory Decision Making
Scale (MOS), and Duke EPESE social support scales.
Results: QUAL-E analyses confirmed a four-domain structure
(25 items): life completion (α = 0.80), symptoms
impact (α = 0.87), relationship with health care
provider (α = 0.71), and preparation for end of life
(α = 0.68). Convergent and discriminant validity were demonstrated
with multiple comparison measures. Test–retest reliability
assessment showed stable scores over a 1-week period.
Significance of results: The QUAL-E, a brief measure of
quality of life at the end of life, demonstrates acceptable validity
and reliability, is easy to administer, performs consistently across
diverse demographic and disease groups, and is acceptable to seriously
ill patients. It is offered as a new instrument to assist in the
evaluation of the quality and effectiveness of interventions targeting
improved care at the end of life.