Case 7 - Quality of Life Flashcards
what is the WHO definition of 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.
what is health related quality of life
the impact of disease or illness on key aspects of physical, social and psychological functioning
how do people measure their own quality of life
a person’s general evaluation of their life and how it aligns to their values, goals and expectations
what are quality adjusted life years
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
what is one quality of life year equal to
one year of life in perfect health
what considerations are also included in this
ADLs
freedom from pain
mental ill health and well-being
what is a cost effective QALY
less than £20,000 per QALY is considered to be clearly cost effective
when must other sorts of benefits or considerations be evident
when it is £20,000-£30,000 per QALY
what happens if it is more than £30,000 per QALY
a strong case needs to be made for the technology to be recommended (NICE)
what factors are included when assessing QoL
health status
patent reported outcomes
patient reported outcome measures (PROMS)
what are the objective measures of health status
mortality rate
morbidity rate
measures of functioning
what is mortality rates
how many people die in one year compared to the year before
what are subjective measures of health status
QoL
what are patient reported outcomes
any clinical symptoms reported directly by the patient
how to measure the cost of clinical treatment
symptom assessment vs assessment 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 quality of life
what are the benefits of PROMS
- 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
what to do on an individual level
inform patient choice
facilitate communication between healthcare teams to provide tailored care
identify those most in need
what to do on a population level
audit and quality assurance
effectiveness data for treatments
for policy (e.g NICE)
what are generic quality of life measurements
short form-36
Nottingham health profile
sickness impact profile
WHOQoL-100
what are the six sections of the Nottingham health profile
physical mobility
pain
sleep
social isolation
emotional reaction
energy
(rate from worst health to best health)
what are the uni dimensional measurements
general health questionnaire
hospital anxiety and depression scale (HADS)
beck depression inventory (BDI)
McGill pain questionnaire
self esteem scale
what are the multidimensional measurements
assess health in a broad sense
‘how do you rate your state of health on a scale from 1-10”
what is the individualised approach
schedule for evaluating individual quality of life
what is the standardised measurement
Barthel index - how independent the person is
what can quality of life measures do
screen for hidden problems
facilitate communication
improve shared decision making
monitor change more accurately
what is reliability
measures consistently over time and between people
what is validity
measures what it set out to measure
what is sensitivity
ability to detect changes in quality of life
what is responsiveness
ability to distinguish clinically important changes as a result of an intervention
what is the adapted HRQoL model
LOOK UP DIAGRAM
according to the model, what are the characteristics of the individual
demographic
developmental
psychological
biological factors
what are the characteristics of the environment
either social or physicals
what does biological function focus on
function of cells, organs and systems
assessed through lab tests, physical assessment, medial diagnosis
what are the symptoms
physical
emotional
cognitive
what is the functional status
physical
psychological
social
role function
what is good health a subjective measure of
biological function
symptoms
functional status
what is overall quality of life
subjective wellbeing
satisfaction with life as a whole
what do the arrows in the diagram represent
the dominant causal associations
when judging our quality of life, what do we do?
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
