Evaluating the utility of the QUAL-EC in the clinical care of patients with advanced cancer.
Bibliographic record
Abstract
e18204 Background: Improvement of quality of life (QoL) is a fundamental goal of care for people with advanced cancer. The Quality of Life at the End of Life (QUAL-E) instrument was developed to measure four domains: Symptom control; Relationship with healthcare provider; Preparation for end of life (concerns about loved ones); and Life completion. Piloting the QUAL-E with Australian palliative inpatients (n = 52) demonstrated acceptability and face validity. A reduced 17-item instrument, the QUAL-E-Cancer (QUAL-EC), validated with Canadian patients (n = 464) was recommended to assess QoL in people with advanced cancer. This study evaluated the utility and feasibility of the QUAL-EC by: • Exploring associations between QUAL-EC domain scores and distress. • Exploring in-depth responses to the QUAL-EC when administered as an interview. Methods: A cross-sectional, mixed methods design was used. Convenience sampling recruited patients with advanced cancer and a prognosis of less than 12 months from a tertiary hospital. Participants completed the QUAL-EC and the Distress Thermometer Screening Tool4 (DT). Qualitative data collection involved digital recordings of QUAL-EC interviews. Results: The accrual target of 25 inpatients (78% response) and 25 outpatients (96% response) was reached. The mean age was 59.9 years. The most common diagnoses were mesothelioma (26%), and cancers of the lung (22%) and brain (10%). Patients’ DT scores indicated that 39.6% were experiencing severe distress (score ≥ 7) while 40% reported moderate distress (score 4-6). Levels of distress significantly correlated with two QUAL-EC domains: Symptom control (r= 0.52, p < 0.001) and Preparation for end of Life (r= 0.32, p < 0.05). Qualitative analysis described the influence of pervasive emotional stress, bothersome symptoms, and psychosocial factors on QUAL-EC responses. Conclusions: Distress was associated with either symptom burden, or concerns about loved ones. When distress is identified on screening, the QUAL-EC offers potential as an instrument capable of nuanced assessment to direct intervention towards psychosocial or physical and symptom-related concerns.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.037 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".