7 - quality of life Flashcards
what is quality of life?
= it is a broad ranging concept affected in a complex way by a person’s physical health, psychological state, level of independence, social relationships and their relationship to salient features in their environment
= a person’s general evaluation of their life and how it aligns to their values, goals and expectations
what is health-related quality of life (HRQoL)?
the impact of disease or illness on key aspects of physical, social and psychological functioning
what are the biopsychosocial components in HRQoL?
- physical : functioning, pain and fatigue
- psychological : thoughts, feelings, self-esteem, identity
- social : relationships, life roles
what is QoL based on?
a person’s own perceptions and evaluations
- should not presume someone has a bad QoL just because they have a long term condition, for example
what is quality adjusted life years (QALY)?
a measure of the state of health of a person or group in which the benefits in the terms of length of life, are adjusted to reflect the QoL
what is 1 OALY equal to?
1 year of life in perfect health
what considerations are included in QALY?
- ADLs
- freedom from pain
- mental ill health and wellbeing
NICE guidelines and cost-effectiveness
what factors are included when assessing QoL?
- health status
- patient reported outcomes
- patient reported outcome measures (PROMS)
how can health status be measured objectively and subjectively?
objective measures — mortality rates, morbidity rates, measures of functioning
subjective measures — QoL
what are patient recorded outcomes?
- any clinical outcome reported directly by the patient
- provide a patient-focused assessment of the impact of a treatment on the patient’s symptoms and functional ability
- symptom assessment vs treatment toxicity
what are patient reported outcome measures (PROMS)?
> standardised, validated questionnaires that are completed by patients to ascertain:
- perceptions of their health status
- perceived level of impairment
- disability
- health-related QoL
increasingly used in clinical setting to inform individual patient care
what are the benefits of PROMS in clinical practice?
- promotes active patient involvement
- provides patient-centred focus in consultations
- facilitates tailored and holistic care which can improve QoL
- enables standardised monitoring of patient outcomes
PROMS on an individual vs population level
individual:
- inform patient choice
- facilitate communication between healthcare teams to provide tailored care
- identify those most in need
population:
- audit and quality assurance
- effectiveness data for treatments
- for policy eg. NICE
what are some illness specific measures for QoL?
- arthritis impact measurement scale 2 (AIMS-2)
- simplified psoriasis index
what are some generic measures for QoL?
- Short Form-36 (SF-36)
- Nottingham Health Profile — grouped into 6 sections: physically mobility, pain, sleep, social isolation, emotional reaction, and energy. rate from worst health — best health
- Sickness Impact Profile
- WHOQoL-100
uni-dimensional measures examples
- general health questionnaire - mood eg. have you recently been able to concentrate on whatever you’re doing? have you recently been feeling happy or depressed?
- Hospital Anxiety and Depression Scale (HADS)
- Beck Depression Inventory (BDI)
- McGill pain questionnaire
- Self-esteem Scale
multidimensional health measures questions examples
how would you describe your health — excellent/good/fair/poor
how would you rate your state of health on a scale of 1-10, where 1 is worst possible and 10 is the best?
what is SEIQoL?
Schedule for Evaluating Individual Quality of Life
— what are the 5 most important areas of your life at present - the things which make your life a relatively happy or sad one at the moment…. the things that you feel determine the quality of your life?
eg. family, relationships, health, finances, living conditions, work, social life, leisure activities, and religion/spiritual life
these are then weighted in terms of important
rate how satisfied they are with each thing separately
what is the Barthel Index?
- standardised measure
- establishes how independent a person is
- completed by health care staff and assumes there is consensus in answers
eg. mobility, dressing, stairs
what are limitations of standardised scales?
- people define QoL and related domains in different ways using different criteria
- role of self-efficacy (general and disease specific) and expectations/future oriented cognitions
in general do we under or overestimate the quality of life of others?
underestimate
what is reliability?
measures consistently over time and between people
what is validity?
measures what it sets out to measure
what is sensitivity?
ability to detect changes in QoL?
what is responsiveness?
ability to distinguish clinically important changes as the result of an intervention
what is the adapted HRQoL model?
what characteristics of the individual influence health outcomes?
- demographic
- developmental
- psychological
- biological factors
how are characteristics of the environment categorised?
either social or physical
social:
- family
- friends
- healthcare providers
physical:
- home
- neighbourhood
- workplace
what does biological function focus on and how is it assessed?
- function of cells, organs and organ systems
- assessed through lab tests, physical assessment, medial diagnoses
what types of symptoms are perceived by the patient?
- physical
- emotional
- cognitive
what does functional status comprise of?
- physical
- psychological
- social
- role function
general health perceptions refers to a subjective rating that includes all of the health concepts that proceed it within the model. what are these?
- biological function
- symptoms
- functional status
overall quality of life in the model
- subjective wellbeing
- satisfaction with life as a whole
how do we combat a response shift in measuring QoL?
- use a ‘frame of reference’ to help us understand the question
- decide ‘standards of comparison’ :
eg. am i worse off than last time?
are other people better off than me? - decide on a ‘sampling strategy’ — which part of my life should i assess?
what 3 appraisals are combined to formulate our responses - judgements relating to QoL?
- frame of reference
- standards of comparison
- sampling strategy
straight after an injury someone’s QoL may decrease, but after a few months may increase despite no change in their health status
