McGill Quality of Life Questionnaire (MQOL)

Abstract

The McGill Quality of Life Questionnaire (MQOL) is a specialized, 16-item Patient-Reported Outcome Measure developed to assess the multidimensional Quality of Life (QOL) in individuals facing life-limiting illnesses, particularly those receiving Palliative Medicine. Unlike generic QOL measures, the MQOL places significant emphasis on subjective, spiritual, and existential components—domains crucial for patients with advanced disease. The instrument utilizes an 11-point numeric rating scale and includes sections addressing overall well-being, physical symptoms, psychological status, and the existential domain issues such as purpose, meaning, and control.

Developed at McGill University, the MQOL is recognized for its relevance and sensitivity in clinical settings where patient conditions fluctuate rapidly. Its short recall period (the past two days) ensures that measurements are highly reflective of immediate subjective experience, which is valuable for evaluating the efficacy of palliative interventions.

Keywords

McGill Quality of Life Questionnaire, MQOL, quality of life, palliative care, advanced disease, existential domain, self-report measure, symptom burden, psychological well-being.

Authors

S. R. Cohen, B. M. Mount, M. I. Strobel, F. Bui, E. Bruera, M. Provost, J. Rowe, K. Tong.

Purpose

The primary purpose of the MQOL is to provide a sensitive and appropriate measure of Quality of Life (QOL) specifically tailored for individuals with advanced disease and those receiving care in the palliative care setting. Standard QOL instruments often fail to capture the unique concerns of this population, such as existential distress, loss of control, and complex symptom burden.

The MQOL aims to capture the patient’s subjective experience across multiple critical dimensions—physical, psychological, social, spiritual, and financial—over a short recall period (the past two days). This short time frame enhances the instrument’s utility for monitoring rapid changes in a patient’s condition and evaluating the immediate impact of therapeutic interventions in clinical settings.

Construct

The MQOL measures the construct of multi-dimensional Subjective Quality of Life (QOL), conceptualized as comprising several interconnected domains relevant to individuals facing terminal illness. These domains include the physical domain (symptoms and function), the psychological domain (mood, anxiety), the support domain (social support, feeling cared for), and critically, the existential domain.

The existential domain is the most defining feature of the MQOL, addressing complex concepts such as perceived meaning in life, sense of worth, feelings of control, and personal fulfillment regarding life goals. The inclusion of this domain acknowledges that QOL in advanced illness is heavily influenced by spiritual and philosophical well-being, necessitating a specific focus beyond mere physical symptom management.

Validity

Initial studies (Cohen et al., 1995) demonstrated strong preliminary validity and acceptability of the MQOL, particularly within the palliative care population. Content validity is supported by the instrument’s comprehensive coverage of domains identified as critical by patients with life-limiting illnesses, including items covering physical symptoms, mood, and existential concerns, which are often overlooked by other measures.

Subsequent multi-centre Canadian studies (Cohen et al., 1997) confirmed the validity of the MQOL, demonstrating its ability to distinguish between patients with varying levels of well-being and symptom distress. Research has consistently highlighted the strong contribution of the existential domain to the overall QOL score, supporting the scale’s construct validity in measuring the distinctive challenges faced by those with advanced disease.

Reliability

Studies examining the psychometric properties of the MQOL, particularly in clinical and palliative settings, have reported acceptable to good levels of internal consistency across its domains. Reliability is typically evaluated using measures such as Cronbach’s alpha for the subscales and the overall score, demonstrating that the items within each domain consistently measure the same underlying construct.

The instrument’s design, focusing on the previous two days, contributes to high sensitivity to change, which is a critical aspect of its clinical reliability, allowing clinicians and researchers to reliably track short-term fluctuations in patient well-being and response to treatment.

Factor Analysis

Factor analysis performed on the MQOL has consistently supported a multidimensional structure, often yielding four primary factors or domains. These factors typically align with the physical symptoms, psychological well-being, support, and the unique existential/spiritual domain.

The findings from factor analytic studies reinforce the theoretical framework of the MQOL, confirming that QOL, especially in advanced illness, is not a unitary concept but rather a complex interaction of these distinct dimensions. The clear separation of the existential domain as a strong, independent factor underscores the instrument’s primary contribution to QOL measurement in the palliative care field.

Instrument

Test Type: Self-report questionnaire; Patient-Reported Outcome Measure (PROM)

Format: 16 core items, primarily using 11-point numeric rating scales (0-10 or 1-10) anchored by descriptive phrases (e.g., “Very bad” to “Excellent,” or “Not at all” to “Extremely”). Includes an optional open-ended section (Part D).

Language Available: English (Original), and various translations are available for use in international palliative care research.

Population Group: Clinical population; specifically individuals with advanced, life-limiting illnesses, such as cancer or AIDS.

Age Group: Adults (typically 18+).

Population Details: Patients undergoing active treatment or receiving specialized hospice and palliative care services.

Test Methodology: Psychological Assessment administered via self-report or interviewer-administered format, measuring subjective experience over a two-day recall period.

Keywords

Palliative care, hospice, quality of life measurement, oncology, symptom management, advanced cancer, existential distress, psychological assessment, PROM.

Authors

Author ORCID Identifier: Information not provided in source material.

Affiliation Email addresses: Information not provided in source material.

Correspondence Address: Information not provided in source material.

Permissions & Fee and Test Year

The MQOL was initially published and validated in 1995 (Cohen et al.). Usage permissions should typically be sought directly from the primary authors or the authorizing institution (McGill University), although the scale is widely accessible for non-commercial research purposes.

The original PDF of the instrument can be downloaded here: www.npcrc.org/files/news/mcgill_quality_of_life.pdf. Another source PDF is available here: https://libres.uncg.edu/ir/uncg/f/Davis_uncg_0154M_10950.pdf.

Reference’s

• Cohen, S. R., Mount, B. M., Strobel, M. I., & Bui, F. (1995). The McGill Quality of Life Questionnaire: A measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliative Medicine, 9(3), 207–219.
• Cohen, S. R., Mount, B. M., Bruera, E., Provost, M., Rowe, J., & Tong, K. (1997). Validity of the McGill Quality of Life Questionnaire in the palliative care setting: A multi-centre Canadian study demonstrating the importance of the existential domain. Palliative Medicine, 11(1), 3–20.
• Cohen, R.S. & Mount, B.M. (2000). Living with Cancer: “Good” Days and “Bad” Days—What Produces Them? Cancer, 15; 89, 8: 1854-1865.
• Cohen SR et al. (2006). QOLLTI-F: Measuring family carer quality of life, Palliative Medicine 20(8):755-67.
• Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Stewart-Brown, Sl. (2007). The Warwick-Edinburgh Mental Well-being Scale (WEMWBS). In: Simmons C. A., Lehmann P. (eds). Tools for strengths-based assessment and evaluation, New York, NY: Springer, pp. 91-93. (2013). Google Scholar.

Items of the McGill Quality of Life Questionnaire (MQOL)

PART A

Considering all parts of my life—physical‚ emotional‚ social‚ spiritual‚ and financial—over the past 2 days the quality of my life has been:

Very bad 0 1 2 3 4 5 6 7 8 9 10 Excellent

PART B: PHYSICAL SYMPTOMS OR PHYSICAL PROBLEMS

1. For the questions in Part “B‚” please list the PHYSICAL SYMPTOMS OR BIGGEST PROBLEMS for you over the past 2 days. (Some examples are pain‚ tiredness‚ weakness‚ nausea‚ vomiting‚ constipation‚ diarrhea‚ trouble sleeping‚ shortness of breath‚ lack of appetite‚ sweating‚ and immobility. Feel free to refer to others if necessary).
2. Circle the number that best shows how big a problem each one has been for you OVER THE PAST 2 DAYS.
3. If‚ over the past 2 days‚ you had NO physical symptoms or problems‚ or only one or two‚ answer for each of the ones you have had and write “none” for the extra questions in Part B‚ then continue with Part C.

1. Over the past 2 days

One troublesome symptom has been: (Write symptom)

No problem 1 2 3 4 5 6 7 8 9 10 Tremendous problem

2. Over the past 2 days

Another troublesome symptom has been: (Write symptom)

No problem 1 2 3 4 5 6 7 8 9 10 Tremendous problem

3. Over the past 2 days

A third troublesome symptom has been: (Write symptom)

No problem 1 2 3 4 5 6 7 8 9 10 Tremendous problem

4. Over the past 2 days I have felt:

Physically terrible 1 2 3 4 5 6 7 8 9 10 Physically well

PART C

Please choose the number which best describes your feelings and thoughts OVER THE PAST 2 DAYS.

5. Over the past 2 days‚ I have been depressed:

Not at all 1 2 3 4 5 6 7 8 9 10 Extremely

6. Over the past 2 days‚ I have been nervous or worried:

Not at all 1 2 3 4 5 6 7 8 9 10 Extremely

7. Over the past 2 days‚ how much of the time did you feel sad?

Never 1 2 3 4 5 6 7 8 9 10 Always

8. Over the past 2 days‚ when I thought of the future‚ I was:

Not afraid 1 2 3 4 5 6 7 8 9 10 Terrified

9. Over the past 2 days‚ my life has been:

Utterly meaningless and without purpose 1 2 3 4 5 6 7 8 9 10 Very purposeful and meaningful

10. Over the past 2 days‚ when I thought about my whole life‚ I felt that in achieving life goals I have:

Made no progress whatsoever 1 2 3 4 5 6 7 8 9 10 Progressed to complete fulfillment

11. Over the past 2 days‚ when I thought about my life‚ I felt that my life to this point has been:

Completely worthless 1 2 3 4 5 6 7 8 9 10 Very worthwhile

12. Over the past 2 days‚ I have felt that I have:

No control over my life 1 2 3 4 5 6 7 8 9 10 Complete control over my life

13. Over the past 2 days‚ I felt good about myself as a person.

Completely agree 1 2 3 4 5 6 7 8 9 10 Completely disagree

14. To me‚ the past 2 days were:

A burden 1 2 3 4 5 6 7 8 9 10 A gift

15. Over the past 2 days‚ the world has been:

An impersonal‚ unfeeling place 1 2 3 4 5 6 7 8 9 10 Caring and responsive to my needs

16. Over the past 2 days‚ I have felt supported:

Not at all 1 2 3 4 5 6 7 8 9 10 Completely

PART D

(Optional Section)

Please list or describe the things that had the greatest effect on your quality of life in the past 2 days. Please tell us whether each thing you list made your quality of life better or worse during this time. If you need more space‚ please continue on the back of this page.