Lecture 5 Quality of life

Question 1

What is the central issue of health promotion, preventive interventions, and lifestyle interventions?

Answer 1

The health problem

Question 2

What is the aim of health promotion, preventive interventions, and lifestyle interventions?

Answer 2

The prevention and/or reduction of the seriousness or complications of the health problem. With an improvement in health and QoL.

Question 3

What is quality of life?

Answer 3

The functioning of individuals on physical, mental and social level and their subjective evaluation.
However, there is not ‘one’ definition.

Question 4

What are the fundaments of Quality of Life?

Answer 4

Subjective
An individual’s perception of how an illness and its treatment affect health
Multidimensional
Patient reported outcome (PRO)

Question 5

What are some related terms or concepts to QoL?

Answer 5

Health status
Functional status
(General) well-being
Perceived health

Question 6

With the many related concepts and the limited consensus about the concept, what is a solution in terms of making the QoL concrete?

Answer 6

Define it
Operationalize it
Use instruments

Question 7

What is operationalization?

Answer 7

turning abstract concepts into measurable observations/outcomes. It involves clearly defining your variables and determining your instrument

Question 8

What are some quality of life outcomes?

Answer 8

Pain
Worries about disease progression
Fatigue
Vitality
Limitations in daily functioning

Question 9

Name the reasons why we measure quality of life?

Answer 9

Evaluate (farmaceutical) treatment
Evaluate (medical) interventions + side effects
Improving symptom relief, care or rehabilitation
Facilitating communication with patients
Medical decision-making
Tracking of population health

Question 10

Name ways of measuring quality of life.

Answer 10

Questionnaires (quant)
Interviews, focus groups, case studies (qual)
PRO (patient reported outcomes)
PROM (patient reported outcome measures)

Question 11

On what do you base your choice of your quality of life questionnaire?

Answer 11

Study objective
Characteristics of the population (disease, age, ethnicity etc.)
Quality criteria of questionnairs
Comparable studies (instruments)
Availability of norm-values

Question 12

What are criteria for good questionnaires? Explain the advantages of using them.

Answer 12

Validity, reliability, and responsiveness.

It improves evidence and gives multi-comparisons (cross cultural, between ages, diseases, include norm values)

Question 13

What is validity?

Answer 13

The degree to which an instrument measures what it is supposed to measure

Question 14

What is reliability?

Answer 14

The degree to which an instrument can produce consistent results, and consistent results on different moments in time, when there is no evidence of change.

Question 15

What is responsiveness?

Answer 15

An instrument’s ability to detect changes when a patient improves or deteriorates.

Question 16

What are the two types of quality of life measures?

Answer 16

Generic and disease specific

Question 17

What are generic quality of life measures? Give examples.

Answer 17

Broad multidimensional measures, designed to measure quality of life in diverse patient groups, age groups and sometimes in healthy persons.
Examples: SF-36, VAS, questions on life satisfaction

Question 18

What are the main advantages of generic measures?

Answer 18

Suitable for broad range of health problems (even unhealthy people)
Used for comparison between treatments for different patient groups to assess comparative effectiveness
Broad scope, have potential to capture influence of co-morbidity on health, unexpected positive/negative effects of an intervention as well.

Question 19

What does disease specific type of quality of life measure mean? Give examples.

Answer 19

Measuring quality of life in specific diagnostic groups or patient populations.
Examples: diabetes symptom checklist, St. George’s respiratory Questionnaire.

Question 20

What are the advantages of disease specific measures?

Answer 20

The targeted focus can make disease specific instruments clinically relevant.
They do not contain any items or health dimensions not relevant to the disease.
Acceptability of the instrument is likely to be high due to relevance to the patients.

Question 21

What are the barriers in using quality of life questionnaires?

Answer 21

Lack of high quality
Perception of health care professionals that their experience is sufficient enough to asses QoL.
Time consuming
Costs
Shortage of staff to conduct surveys and analyze data.

Question 22

What are the two health form QoL outcomes?

Answer 22

Primary - the ‘cause’
Secondary - comorbid ish.

For instance for DM2 primary is glucose as primary, but overweight and central obesity as secondary.

Question 23

How to choose an instrument

Answer 23

• Documentation
• Development
• Validation
• Feasibility
• Languages and cultures
• Scoring
• Interpretation

Question 24

Health-related QoL (HRQoL)
HQoL
QoL

Answer 24

Health-related QoL (HRQoL): Includes the physical, functional, social and emotional well-being

• Helps widening the parameters of benefit
• Indicating a need for supportive interventions

HQoL: physical and mental
QoL: physical, mental and social