Case 7 - Quality of Life

Question 1

what is the WHO definition of 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.

Question 2

what is health related quality of life

Answer 2

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

Question 3

how do people measure their own quality of life

Answer 3

a person’s general evaluation of their life and how it aligns to their values, goals and expectations

Question 4

what are quality adjusted life years

Answer 4

measure of the state of health of a person or group in which the benefits in terms of length of life, are adjusted to reflect the QoL

Question 5

what is one quality of life year equal to

Answer 5

one year of life in perfect health

Question 6

what considerations are also included in this

Answer 6

ADLs
freedom from pain
mental ill health and well-being

Question 7

what is a cost effective QALY

Answer 7

less than £20,000 per QALY is considered to be clearly cost effective

Question 8

when must other sorts of benefits or considerations be evident

Answer 8

when it is £20,000-£30,000 per QALY

Question 9

what happens if it is more than £30,000 per QALY

Answer 9

a strong case needs to be made for the technology to be recommended (NICE)

Question 10

what factors are included when assessing QoL

Answer 10

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

Question 11

what are the objective measures of health status

Answer 11

mortality rate
morbidity rate
measures of functioning

Question 12

what is mortality rates

Answer 12

how many people die in one year compared to the year before

Question 13

what are subjective measures of health status

Answer 13

QoL

Question 14

what are patient reported outcomes

Answer 14

any clinical symptoms reported directly by the patient

Question 15

how to measure the cost of clinical treatment

Answer 15

symptom assessment vs assessment toxicity

Question 16

what are patient reported outcome measures (PROMS)

Answer 16

standardised, validated questionnaires that are completed by patients to ascertain:
- perceptions of their health status
- perceived level of impairment
- disability
- health related quality of life

Question 17

what are the benefits of PROMS

Answer 17

• promotes active patient involvement
• provides patient centred focus in consultations
• facilitates tailored and holistic care which can improve QoL
• enable standardised monitoring of patient outcomes

Question 18

what to do on an individual level

Answer 18

inform patient choice
facilitate communication between healthcare teams to provide tailored care
identify those most in need

Question 19

what to do on a population level

Answer 19

audit and quality assurance
effectiveness data for treatments
for policy (e.g NICE)

Question 20

what are generic quality of life measurements

Answer 20

short form-36
Nottingham health profile
sickness impact profile
WHOQoL-100

Question 21

what are the six sections of the Nottingham health profile

Answer 21

physical mobility
pain
sleep
social isolation
emotional reaction
energy
(rate from worst health to best health)

Question 22

what are the uni dimensional measurements

Answer 22

general health questionnaire
hospital anxiety and depression scale (HADS)
beck depression inventory (BDI)
McGill pain questionnaire
self esteem scale

Question 23

what are the multidimensional measurements

Answer 23

assess health in a broad sense
‘how do you rate your state of health on a scale from 1-10”

Question 24

what is the individualised approach

Answer 24

schedule for evaluating individual quality of life

Question 25

what is the standardised measurement

Answer 25

Barthel index - how independent the person is

Question 26

what can quality of life measures do

Answer 26

screen for hidden problems
facilitate communication
improve shared decision making
monitor change more accurately

Question 27

what is reliability

Answer 27

measures consistently over time and between people

Question 28

what is validity

Answer 28

measures what it set out to measure

Question 29

what is sensitivity

Answer 29

ability to detect changes in quality of life

Question 30

what is responsiveness

Answer 30

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

Question 31

what is the adapted HRQoL model

Answer 31

LOOK UP DIAGRAM

Question 32

according to the model, what are the characteristics of the individual

Answer 32

demographic
developmental
psychological
biological factors

Question 33

what are the characteristics of the environment

Answer 33

either social or physicals

Question 34

what does biological function focus on

Answer 34

function of cells, organs and systems
assessed through lab tests, physical assessment, medial diagnosis

Question 35

what are the symptoms

Answer 35

physical
emotional
cognitive

Question 36

what is the functional status

Answer 36

physical
psychological
social
role function

Question 37

what is good health a subjective measure of

Answer 37

biological function
symptoms
functional status

Question 38

what is overall quality of life

Answer 38

subjective wellbeing
satisfaction with life as a whole

Question 39

what do the arrows in the diagram represent

Answer 39

the dominant causal associations

Question 40

when judging our quality of life, what do we do?

Answer 40

use a frame of reference to help understand the question
decide ‘standards of comparison’
decide on a ‘sampling strategy’ - which part of my life should I asess