Dying Well : Missoula-Vitas Quality of Life Index : MVQOLI : A Developmental Approach

Assessing Quality of Life in the Terminally Ill: A Developmental Approach

Quality of life(QOL) assessments are increasingly recognized as an important measure for patients with major and potentially life-threatening illnesses and are of central importance to the field of palliative medicine and hospice care.

QOL assessment instruments developed for use with patients undergoing curative or life-prolonging treatment focus on symptoms and functional status. These tools have limited usefulness, however, for patients with advanced illness where functional status predictably declines over time.

Byock has crafted a developmental model for application to the study of personal experience at the end of life, and to the psychosocial interventions of palliative care. It has been proposed that persons retain an inherent opportunity for further development, or growth, at the end of life. Such growth is marked by a subjective sense of well being and an enhanced sense of meaning that can occur despite functional decline.

Building upon this developmental model and on published data identifying specific factors that impact QOL in the chronically ill, we have constructed and tested a patient self-assessment tool that is designed to measure the subjective, experienced QOL of patients with advanced illness.

The instrument contains 25 items that assess five dimensions of a person's subjective experience - symptoms, functional status, interpersonal relations, emotional well-being and transcendence.
Within each dimension three categories of items are included:

  • an assessment of those aspects of experience encompassed by the dimension,
  • the degree of satisfaction or dissatisfaction with those aspects of experience, and
  • a rating of the importance of the dimension to overall quality of life. The unique scoring protocol devised allows for the weighting of each dimension based upon the importance assigned to it by the patient.

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    This instrument was created by Ira Byock, MD and Melanie Merriman, PhD.
    Reference: Byock IR and Merriman MP. Measuring quality of life for patients with terminal illness: the Missoula-VITAS Quality of Life Index. Pall. Med. 12:231-244, 1998.
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