A Systematic Review of Factors Affecting Quality of Life and Quality of Death in Hospice and Palliative Care Users

Abstract

In this study, we conducted a systematic review of hospice and palliative care users to analyze research trends, measurement methods, and influencing factors related to the ‘quality of life’ and ‘quality of death’.

We analyzed 36 articles meeting our selection criteria, published domestically and abroad within the last decade (2013-2022). These articles spanned 18 countries, with ‘quality of life’ discussed in 26 (72.2%) and ‘quality of death’ in 10 (27.8%). All 36 studies used surveys to measure quality of life and quality of death. In quality of life studies, the patients themselves were the primary respondents, but in quality of death studies, third parties (caregivers or medical staff) were surveyed after the patient's death.

A total of 22 scales were used across 26 studies to measure quality of life, and 4 scales were used in the 10 studies that focused on quality of death. Additionally, 23 studies used a total of 32 scales to measure other aspects, such as anxiety, depression, and pain. Among the 36 studies, 24 revealed that care system-related factors, including access to hospice and palliative care, duration, and timing of referral, influenced quality of life and quality of death among hospice and palliative care users. Furthermore, demographic characteristics and the place of death were reported as factors influencing the quality of death, while physical and psychological symptoms, financial burden, prognostic awareness, and spiritual beliefs were noted as factors affecting the quality of life.

This study underscores the insufficiency of attention given to measurement tools and research related to the quality of death compared to that devoted to the quality of life and suggests a conceptual classification of death. Future efforts should involve a deeper exploration of the relationship between the concepts of quality of life and quality of death, the development of measurement tools, ways to make improvements in the areas identified as influencing factors, and the implementation of research to enhance the quality of death, thereby contributing to overall improvements in the quality of life and death experiences of patients nearing the end of life.