Hermann P. G. Schneider, Alastair H. MacLennan and David Feeny

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Presentation transcript:

Hermann P. G. Schneider, Alastair H. MacLennan and David Feeny Quality of life Hermann P. G. Schneider, Alastair H. MacLennan and David Feeny

A definition of health-related quality of life HRQOL represents those parts of quality of life that directly relate to an individual’s health includes the domains of physical, psychological, social, spiritual, and role functioning, as well as general well-being Spilker and Revicki , 1996

Levels of quality of life Components of each domain Broad domains Physical, Psychological, Economic, Spiritual, Social Overall assessment of well-being In their totality, these three levels constitute the scope of quality of life Cramer & Spilker , 1998

Rationale for using health-related quality of life measures Goal of therapy is to make patients feel better Physiological measures may change without people feeling better People may feel better without measurable change in physiological function Trade-offs between treatment effects and side-effects The output of the health-care system is quality-adjusted survival / health-related quality of life. Why not measure it? Guyatt, Feeny, Patrick, 1993

Assessment of measures of HRQOL Acceptability Burden Reliability Validity Responsiveness Interpretability Usefulness Feeny et al., 1999

Most widely used measures within 3921 reports Instrument No. of records SF-36 408 WHOQOL 24 Sickness Impact Profile 111 Healthy Years Equivalent Nottingham Health Profile 93 Beck Depression Inventory 23 EORTC QLQ-C30 82 Asthma Quality of Life Questionnaire 21 QALY 79 McGill Pain Questionnaire 19 EuroQOL 77 WOMAC 18 Health Assessment Questionnaire 62 Hospital Anxiety and Depression Scale Arthritis Impact Measurement Scales 59 Duke Health Profile 17 Quality of Wellbeing Scale 53 SF-12 15 General Health Questionnaire 43 Psychological General Wellbeing Scale Health Utilities Index 41 St George‘s Respiratory Disease Questionnaire COOP Charts 33 MOS-HIV 14 Functional Assessment of Cancer 32 Rotterdam Symptom Check List Garratt et al., 2002

The EuroQOL Instrument Best imaginable health state Mobility I have no problem in walking about I have some problems in walking about I am confined to bed Self-care I have no problems with self-care I have some problems washing or dressing myself I am unable to wash or dress myself Usual activities I have no problems with performing my usual activities (e.g. work , study , housework , family or leisure activities) I have some problems with performing my usual activities I am unable to perform my usual activities Pain / discomfort I have no pain or discomfort I have moderate pain or discomfort I have extreme pain or discomfort Anxiety / depression I am not anxious or depressed I am moderately anxious or depressed I am extremely anxious or depressed Worst imaginable health state Kind P, 1996

Health-related quality of life Issues in menopause and aging Importance of placebo effect in studies on symptoms Lack of standardization of reporting of symptoms Few studies consider HRQOL impact on partner Specific instruments for menopause and aging Generic instrument to capture chronic conditions and side-effects Utility measures to reflect preferences of patients and community Feeny, 2006