7 - quality of life

Question 1

what is quality of life?

Answer 1

= 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

Question 2

what is health-related quality of life (HRQoL)?

Answer 2

the impact of disease or illness on key aspects of physical, social and psychological functioning

Question 3

what are the biopsychosocial components in HRQoL?

Answer 3

• physical : functioning, pain and fatigue
• psychological : thoughts, feelings, self-esteem, identity
• social : relationships, life roles

Question 4

what is QoL based on?

Answer 4

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

Question 5

what is quality adjusted life years (QALY)?

Answer 5

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

Question 6

what is 1 OALY equal to?

Answer 6

1 year of life in perfect health

Question 7

what considerations are included in QALY?

Answer 7

• ADLs
• freedom from pain
• mental ill health and wellbeing

Question 8

NICE guidelines and cost-effectiveness

Answer 8

Question 9

what factors are included when assessing QoL?

Answer 9

• health status
• patient reported outcomes
• patient reported outcome measures (PROMS)

Question 10

how can health status be measured objectively and subjectively?

Answer 10

objective measures — mortality rates, morbidity rates, measures of functioning

subjective measures — QoL

Question 11

what are patient recorded outcomes?

Answer 11

• 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

Question 12

what are patient reported outcome measures (PROMS)?

Answer 12

> 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

Question 13

what are the benefits of PROMS in clinical practice?

Answer 13

• 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

Question 14

PROMS on an individual vs population level

Answer 14

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

Question 15

what are some illness specific measures for QoL?

Answer 15

• arthritis impact measurement scale 2 (AIMS-2)
• simplified psoriasis index

Question 16

what are some generic measures for QoL?

Answer 16

• 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

Question 17

uni-dimensional measures examples

Answer 17

• 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

Question 18

multidimensional health measures questions examples

Answer 18

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?

Question 19

what is SEIQoL?

Answer 19

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

Question 20

what is the Barthel Index?

Answer 20

• standardised measure
• establishes how independent a person is
• completed by health care staff and assumes there is consensus in answers

eg. mobility, dressing, stairs

Question 21

what are limitations of standardised scales?

Answer 21

• 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

Question 22

in general do we under or overestimate the quality of life of others?

Answer 22

underestimate

Question 23

what is reliability?

Answer 23

measures consistently over time and between people

Question 24

what is validity?

Answer 24

measures what it sets out to measure

Question 25

what is sensitivity?

Answer 25

ability to detect changes in QoL?

Question 26

what is responsiveness?

Answer 26

ability to distinguish clinically important changes as the result of an intervention

Question 27

what is the adapted HRQoL model?

Answer 27

Question 28

what characteristics of the individual influence health outcomes?

Answer 28

• demographic
• developmental
• psychological
• biological factors

Question 29

how are characteristics of the environment categorised?

Answer 29

either social or physical

social:
- family
- friends
- healthcare providers

physical:
- home
- neighbourhood
- workplace

Question 30

what does biological function focus on and how is it assessed?

Answer 30

• function of cells, organs and organ systems
• assessed through lab tests, physical assessment, medial diagnoses

Question 31

what types of symptoms are perceived by the patient?

Answer 31

• physical
• emotional
• cognitive

Question 32

what does functional status comprise of?

Answer 32

• physical
• psychological
• social
• role function

Question 33

general health perceptions refers to a subjective rating that includes all of the health concepts that proceed it within the model. what are these?

Answer 33

• biological function
• symptoms
• functional status

Question 34

overall quality of life in the model

Answer 34

• subjective wellbeing
• satisfaction with life as a whole

Question 35

how do we combat a response shift in measuring QoL?

Answer 35

• 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?

Question 36

what 3 appraisals are combined to formulate our responses - judgements relating to QoL?

Answer 36

1. frame of reference
2. standards of comparison
3. 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