A self-evaluated assessment suitable for seriously ill hospice patients

Abstract

Current quality of life (QOL) assessments, whilst being suitable for patients undergoing active treatment, are often too cumbersome for patients who are in the terminal phase of their illness, and may themselves produce distress. In an attempt to measure QOL in these patients a simple assessment was piloted (PEPS - patient evaluated problem score) in which patients were asked to identify and grade major problems as they perceived them and also to grade problems previously identified by the medical and nursing staff. A global QOL score and a self-administered WHO score completed the assessment. Of 70 patients admitted to the unit over a seven-month period, 44 completed questionnaires, 38 in full. Subsequently, uptake has been far greater (due to establishment of the method as part of routine care) with 73% of all patients admitted to our unit completing PEPS. Overall, a mean of 5.6 problems per patient were identified, of which 14% were psychosocial. Of those patients who completed questionnaires, 58% identified problems not picked up by the nursing and medical staff; 52% of these were psychosocial problems. Of 28 patients who died having previously completed questionnaires 22 had done so in the previous three weeks including eight in the previous seven days. PEPS has proved very useful in the management of patients, enabling the identification of previously unrecognized or underrated problems, particularly of a psychosocial nature, and also as a means of evaluating progress. It is readily acceptable to patients, even those close to death.