Life expectancy, quality of life, and hope among Japanese patients receiving home medical care

ABSTRACT BackgroundSpiritual care should be included in home medical care for patients with limited life expectancy. However, the effect of shortened life expectancy on patients’ quality of life (QOL) and hopes is poorly understood. MethodsThis multicenter cross-sectional study involved 29 home medical care centers in Japan. Exposures were life expectancy (≥ one year / ≥ six months to < one year / < six months) as assessed by home medical care physicians. The outcomes were QOL in home medical care measured via the Quality-of-Life Scale for Elderly Patients Receiving Professional Home Care (QOL-HC), the domain scores of health-related hope (“health,” “role and connectedness,” and “something to live for”), and decrease in life functioning measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Linear mixed models were fitted for analyses, with the facilities treated as clusters. ResultsShorter life expectancy was associated with higher WHODAS 2.0 scores and significantly lower “something to live for” scores (< six months vs. ≥ one year). In contrast, “role and connectedness” scores did not change remarkably with decreased life expectancy, whereas QOL-HC scores were significantly higher with shorter life expectancy. ConclusionHome medical care physicians who engage in spiritual care should facilitate thoughtful dialogue with their patients by recognizing declines in life functions and hope for fulfillment, which are associated with short life expectancy.