Byock I R, Merriman M P
VITAS Healthcare Corporation, Miami, FL 33131, USA.
Palliat Med. 1998 Jul;12(4):231-44. doi: 10.1191/026921698670234618.
Quality of life (QOL) is an important outcome measure in caring for terminally ill patients. The Missoula-VITAS Quality of Life index (MVQOLI) has been developed to provide a measure of quality of life that is meaningful to both clinicians and patients. Unique features of the instrument include its focus on the terminal phase of life, the item structure and a scoring system that allows the weighting of each dimension of QOL by the respondent, and the subjective wording of the items that allows respondents to interpret the measured elements according to their own experience. The validity and reliability of the patient-reported survey instrument were tested by administering the 25-item questionnaire to 257 patients in 10 community-based hospices. Participants were incurably ill with predicted survival of six months or less. Exclusion criteria included inability to communicate, dementia, or psychological symptoms that might be intensified by completing the index. Reliability and validity of the new index were examined using standard statistical and psychometrical analyses. The MVQOLI demonstrated internal consistency (Cronbach's alpha = 0.77). MVQOLI total scores were correlated with scores on the Multidimensional Quality of Life Scale--Cancer 2 and with patient-reported global QOL ratings. MVQOLI scores did not correlate with observer-rated functional status scores indicating divergent validity. The MVQOLI could be completed by patients of varied educational level, age, functional status, and length of time with a terminal illness. The instrument is designed to contribute to the task of planning care by evaluating patient-identified sources of distress, strength and satisfaction, including issues of life closure. This information contributes to crafting highly specific interventions. Further studies are necessary to determine the usefulness of the instrument in measuring outcomes of end-of-life care in nonhospice settings, and for racial and diagnostic groups under-represented in this sample.
生活质量（QOL）是临终患者护理中的一项重要结果指标。密苏拉 - 维塔斯生活质量指数（MVQOLI）已被开发出来，以提供一种对临床医生和患者都有意义的生活质量衡量标准。该工具的独特之处包括其对生命末期阶段的关注、项目结构以及一个评分系统，该系统允许受访者对生活质量的各个维度进行加权，还有项目的主观措辞，使受访者能够根据自己的经历来解释所测量的要素。通过向10个社区临终关怀机构的257名患者发放这份包含25个项目的问卷，对患者报告的调查工具的有效性和可靠性进行了测试。参与者患有不治之症，预计存活时间为六个月或更短。排除标准包括无法沟通、痴呆或可能因完成该指数而加重的心理症状。使用标准的统计和心理测量分析来检验新指数的可靠性和有效性。MVQOLI显示出内部一致性（克朗巴哈系数α = 0.77）。MVQOLI总分与多维生活质量量表 - 癌症2的得分以及患者报告的总体生活质量评分相关。MVQOLI得分与观察者评定的功能状态得分不相关，表明具有区分效度。不同教育水平、年龄、功能状态以及患有绝症时间长短的患者都可以完成MVQOLI。该工具旨在通过评估患者确定的痛苦、优势和满意度来源，包括生命终结问题，来为护理计划任务做出贡献。这些信息有助于制定高度具体的干预措施。有必要进行进一步研究，以确定该工具在非临终关怀环境中测量临终护理结果的有用性，以及在本样本中代表性不足的种族和诊断群体中的情况。
