6 health-related quality of life Flashcards
What is health-related QoL?
subjective
differs across countries and cultures
evaluation of health
impact of illness or treatment on QoL
What matters to you?
Wealth, Health, Happiness, Personal Safety, Clean Air, Age, Gender, Income Level
there is more to life than cold economic statistics
Better Life Index
What are the differences of hrQoL to QoL and wellbeing?
hrQoL is related to health only
other than that, used interchangeably as synonyms
no clear distinction possible
What are five other definitions of QoL?
“the value assigned to duration of life as midified by the impairments, functional states, perceptions and social opportunities that are influenced by disease, injury, treatment or policy” (patrick and ericson, 1993)
“a personal statement of the positivity or negativity of attributes that characterise one´s life” (Grant et al., 1990)
“a broad ranging concept affected in a complex way by the persons physical health, psychological state, level of independence, social relationships and their relationship to salient features in their environment” (WHOQoL Group, 1993)
“functional status, caner and treatment specific symptoms, psychological distress, social interaction, financial impact, perceived health status and overall quality of life” (European Organisation for Research on Treatment of Cancer)
“physical functioning, social functioning, role limitations due to physical problems, role limitations due to emotional problems, mental health, energy/
vitality, pain and general health perception” (Rand Corporation health batteries)
What dimensions did Fallowfield define as constructing QoL?
psychological (mood, emotional distress, adjustment to illness),
social (relationships, social and leisure activities),
occupational (paid and unpaid work) and
physical (mobility, pain, sleep and appetite)
What perspective should be adopted when evaluating QoL?
psychological process perspective
→ constructed from individual evaluations of personally salient aspects of quality of life
=> standard needs approach
consensus
How can QoL be measured?
unidimensional measures
multidimensional measures
individual quality of life measures
What are examples of unidimensional measures for QoL?
many focus on one particular aspect of health
Goldberg (1978) - General Health Questionnaire
Hospital anxiety and depression scale (HAD) (Zigmond and Snaith 1983)
Beck depression inventory (BDI) (Beck et al. 1961)
McGill pain questionnaire, which assesses pain levels (Melzack 1975);
measures of self-esteem, such as the selfesteem scale (Rosenberg 1965) and the self-esteem inventory (Coopersmith 1967);
measures of social support (e.g. Sarason et al. 1983, 1987);
measures of satisfaction with life (e.g. Diner et al. 1985);
and measures of symptoms (e.g. deHaes et al. 1990).
What are examples of multidimensional measures for QoL?
broadest sense
composite scales
When there are several content-related subscales defined for a subject area, the subscales are combined into a composite scale
What are problems when measuring QoL?
- different assessment methods: no generalisation possible
- terms differ (QoL, WB, health status, satisfaction, …)
- some results of QoL measures are in opposite direction of mortality and morbidity data
-> is the intervention useful? - QoL -> endpoint
-> but isn’t it a predictor of longevity?
What are approaches to measurement for hrQoL?
- assessing some aspect of health status
SF36
SIP
NHP
barthel Index
Karnofsky Index
symptom check lists
measures of psychological problems
-> multidimensional
-> lack of underlying theory
-> relationship between scales and items remains obscure - measures from health economics
QALYs
-> quality adjusted life years
basic assumption: a rational person would prefer a shorter life with satisfactory health than a longer life with impairment
-> judgment is totally subjective
-> equivalence of QoL??
-> tendency to adapt to illnesses, perspective shift?? - conceptual models or theories
e.g. QoL = emotional response to circumstances, impact of illness on functioning, …
-> needs model: when needs are met, it is best
- self-evaluation instruments
psychometrics (items have equal value)
What did a study examining the patient perspective of health and QoL find?
health has four main components:
(A) Being healthy/being free from disease;
(B) Functioning normally
(C) experiencing wellbeing
(D) having a healthy lifestyle
QoL has five main components:
(A) Being healthy/being free from disease;
(B) Functioning normally
(C) having a positive outlook on life
(D) Living conditions
(E) Having a good social network
=> distinct psychosocial elements
=> patients health does not automatically correspond to their QoL
What did one study examining the impact of QoL on cancer patients find?
HRQoL - mental health - social support - physical function
corresponded to survival
age, stage of cancer, type of treatment
- all four factors were able to predict mortality even beyond the three below
- having good physical function and mental health carried as much value as having stage 2 breast cancer or receiving chemotherapy as part of their treatment
- changes in baseline HRQoL regardless of three factors, led to significant changes in predicting mortality
reduce risk of 50% for any three factor variant
‘To what extent can physical components be separated from the other psychosocial factors on measuring and/or promoting quality of life?’.
=> need for more holistic approach
What two main questionnaires correspond to hrQoL?
SF36 Questionnaire
RAND developed the 36-Item Short Form Health Survey (SF-36) in 1992
-> assess health status in clinical practice, …
-> medical background
-> eight health concepts: physical + social functioning, limitations, pain, mental health, emotional constraints, vitality, health perception
-> breadth and depth
EQ-5D Questionnaire
mobility, selfcare, usual activities, pain/discomfort, anxiety/depression
-> evaluating treatment outcomes and setting health-care priorities
-> vertical thermometer scale (three levels of severity)
-> time-trade-off
How is health status generally measured?
Whether you are (subjectively or objectively) healthy
Objective measures
- Mortality rates - ‘Has the number of people who have died this year gone up, gone down or stayed the same?’
- Morbidity rates - ‘How many people are presenting with X disease?’
Subjective measures
- Subjective health status - include a rating of your own health. Aka HrQOL in the literature
What did this study find?
Aspects of quality of life, anxiety, and depression among persons diagnosed with cancer during adolescence: A long-term follow-up study
Up to 6 months after diagnosis the cancer group reports lower levels of mental health and vitality and a higher level of depression than the reference group. At 18 months after diagnosis a reverse situation occurs and at 48 months after diagnosis the cancer group reports a higher level of vitality and lower levels of anxiety and depression than the reference group.
-> positive psychological change after initial period of high stress
-> resilience and strength!!
