| This study's purpose was to examine the elements of quality of life (QOL) for terminally ill elders, throughout end of life, to identify and classify potential trajectories of QOL. A total of 13 advanced cancer patients with a prognosis of 4–6 months to live, 63–78 years, with 5 female caregivers, were interviewed over the last months of patients' lives, using a simultaneously triangulated, multivariate, replicated, single-subject, repeated measures design. Weekly interviews consisted of a schedule of measures of quality of life, physical, psychological, social, and spiritual functioning, including Ferrans & Powers Quality of Life Index, McGill Quality of Life Questionnaire, Karnofsky Performance Status, Memorial Symptom Assessment Scale, NEECHAM Confusion Scale, Hospital Anxiety and Depression Scale, Family APGAR, Systems of Belief Inventory, and an Interview Guide.; Various trajectories of QOL were identified: Stable QOL, Erratic QOL, Gradual Incline QOL, and Indeterminate QOL (patients unable to complete more than 4 QOL ratings). Reported physical and psychological symptoms and psychological outlook/perspective varied with different patterns of QOL. The most prevalent symptoms, in order of frequency reported, were lack of energy/fatigue, pain, drowsiness, lack of appetite, dry mouth, shortness of breath, feeling bloated, and nausea. Erratic QOL patients had elevated levels of anxiety.; After physical status, patients most frequently addressed the topic of family in discussing QOL. The following themes emerged: relationship with spouse, relationship with children, grandchildren/extended family, children's relationship with God, children's maturity/independence, and children's relationship with each other. Patients and caregivers were asked their expectations of healthcare providers and the following themes emerged: honest communication, competent care/symptom management, cure, prolong life, prompt treatment, and uncertain expectations.; This new discovery of individual trajectories of QOL has important implications for theory, practice, and research. Accurately using QOL as an outcome measure requires consideration of the individual's trajectory of QOL. Interventions to decrease anxiety may stabilize the trajectory of QOL. Clinicians should attend to patients' and families' expectations of care, which for these terminally ill advanced cancer patients in the United States, was first of all, honest communication. |
