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Health Promotion and Disease Prevention > Lecture 5: Quality of life > Flashcards

Lecture 5: Quality of life Flashcards

1
Q

What is the central aim of any health promotion program/ preventive intervention/ lifestyle intervention?

A

Improvement of health and Quality of Life

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2
Q

What are the 5 central aspects of the precede model?

A

1. Health promotion (educational strategies + policy, regulation, organization)
2. Predisposing, reinforcing and enabling factors
3. Behavior, lifestyle and environment
4. Health
5. QoL

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3
Q

What other two models include the assessment of QoL

A
  • Intervention Mapping
  • Intervention Logic model
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4
Q

What is Quality of Life?

A

The is no one defenition but..

QoL can be defined as an individual’s or group’s perceived physical, mental and social health over time

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5
Q

What are the fundaments of QoL?

A
  • Subjective
  • An individuals or groups perspective of health
  • Multidimensional
  • Its a Patient reported outcome (PRO)
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6
Q

What is the differece between QoL and HQoL?

A

Health related quality of life (HQoL) places more emphasis on physical and mental health, whereas QoL additionally also includes social/occupational components such as poverty, violence, poor housing conditions and air pollution

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7
Q

What are the most important aspects of QoL?

A
  • Vitality
  • Mental & physical functioning
  • Well-being
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8
Q

Name a few concepts/ terms related to QoL

A
  • Health status
  • Functional status
  • (General) Well-being
  • Perceived health
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9
Q

What is the issue with QoL and related concepts/ terms? And how can this be adressed?

A
  • There is limited consencus about the concept
  • Concepts/ terms should be defined, operationalized and appropriate instruments should be used to measure them

Operationalize = “turning abstract concepts into measurable observations/ outcomes involves clearly defining your variables etc.”

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10
Q

What are possible outcomes for QoL?

A
  • Pain
  • Worries about disease progression
  • Fatigue
  • Vitality
  • Limitations in daily functioning
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11
Q

Why would you want to measure QoL?

A
  • To evaluate (farmaceutical) treatment
  • To evaluate (medical) intervention + side effects
  • To improve symptom relief, care or rehabilitation
  • To facilitate communication with patients
  • For medical decision making
  • Tracking of population health
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12
Q

How can QoL be measured?

A
  • Questionnaires
  • Interviews
  • PRO (patient reported outcomes)
  • PROMS (patient reported outcome measures)
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13
Q

Choice of QoL questionnaires are based on…

A
  • Study objective
  • Characteristics of the population
  • Quality criteria of questionnaires
  • Comparable studies (instruments)
  • Availability of norm-values
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14
Q

What are the 3 criteria for good questionnaires?

A
  1. Validity
  2. Reliability
  3. Responsiveness
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15
Q

Validity =

A

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

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16
Q

Reiability =

A

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

17
Q

Responsiveness

A

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

18
Q

What types of questionnaires/ measures of QoL are the there?

A
  1. Generic
  2. Disease specific
19
Q

Explain what is meant by generic questionnaires/ measures and provide some examples

A

They are broad multidimensional measures, designed to measure QoL in diverse patient groups, age groups and sometimes in healthy persons

  • Short Form Health survey (sf-36)
  • WHO quality of life instrument (WHOQOL-100)
  • Questions on Life Satisfaction (FLZ)
  • McGrill Qol questionnaire
  • VAS
20
Q

What are the main advantages of generic measures?

A
  • Suitable for use across a broad range of health problems, including healthy populations
  • Can be used for comparisons between treatments for different patient groups to assess comparative effectiveness
  • Broad scope has the potential to capture the influence of co-morbidity on health, as well as unexplained positive or negative effects of an intervention
21
Q

Explain what is meant by disease specific measures and provide some examples

A

Measures QoL in specific diagnostic groups or patient populations

  • Diabetes Symptom Checklist (DSC)
  • St. George’s Respiratory Questionnaire
  • Minnesota Living with Heart Failure (MLHF) questionnaire
22
Q

What are the main advantages of disease specific measures?

A
  • Targeted focus makes them clinically relevant
  • Do not contain any items or health dimensions that are not relevant to the disease
  • Acceptability is likely to be high because the instrument has clear relevance to patients
23
Q

What are the main advantages of using valid, reliable, and responsive QoL questionnaires

A

Improves evidence
Multi comparisons:
- Between diseases/ disorders/ healthy people
- Cross-cultural
- Age-groups
- Include norm values
- etc.

24
Q

Checklist for choosing an instrument (8 items)

A

Documentation
Is there formal written documentation about the instrument?

Development
Are the aims and intended usage of the instrument clearly defined?

Validation
How comprehensive has the validation process been?

Target population
Is the instrument suitable for your target population?

Feasibility
Is the method of administration feasible?

Languages and cultures
Has the instrument been tested with patients from relevant cultural and ethnic background?

Scoring
Is the scoring procedure defined?

Interpretation
Are there guidelines for interpreting the scale scores?

25
Q

What are barriers for using QoL questionnaires?

A
  • Lack of high quality questionnaires
  • Health care professionals perception that their experience is sufficient to asses QoL
  • Time consuming
  • Costs
  • Shortage of staff to conduct surveys and analyse data
26
Q

What are ways in which QoL can improve parient care and outcomes?

A

1. Widening the parameters of benefit
E.g., clinical trials incorporating QoL assessments can provide more information and help clarify the relative harms and benefits of palliative chemotherapy, and aid patient decisions when survival gains are small.

2. Indicating a need for supportive interventions
E.g., can help determine types of supportive interventions that may be needed to reduce side-effects

3. As a prognostic indicator
E.g., assessment of QoL has been shown to provide a better estimate of survival than measurement of tumour size. And QoL could be used as a surrogate endpoint for
survival in clinical trials.

4. Aiding decision-making

5. Informing resource allocation and healthcare policy
QALYs are utilised by health economists to calculate the cost–utility of different interventions.

27
Q

New technologies to asses QoL?

A
  • Automated collection of questionnaire PROs via touch screens and smart pens that can be used easily
  • Talking touch screens have also been used successfully with illiterate patients.

Health Promotion and Disease Prevention (11 decks)

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