Quality of Life Flashcards
Quality of Life
“Health care decisions are made under uncertainty, whereby any decision may have a range of different outcomes. To make the “best” decision, potential outcomes need ordering and valuing. Such decisions are made both at the individual level, such as choosing the optimal treatment for a patient, and at the national level, such as choosing how to allocate resources between treatments for different patient groups and across different health conditions.”
Key words of quality of life
- life
-physical - satisfaction
- physiological
-social
WHOQOL-BREF (brief)
- Psychological
- Environment
-Social - Physical
- Social
Physical health
- Activities of daily living
-Dependence on medicinal substances and medical aids
-Energy and fatigue
-Mobility
-Pain and discomfort
-Sleep and rest
-Work Capacity
Psychological
- Bodily image and appearance
- Negative feelings
- Positive feelings
- Self-esteem
- Spirituality / Religion / Personal beliefs
- Thinking, learning, memory and concentration
Social relationships
- Personal relationships
- Social support
- Sexual activity
Environment
- Financial resources
- Freedom, physical safety and security
- Health and social care: accessibility and quality
- Home environment
- Opportunities for acquiring new information and -skills
- Participation in and opportunities for recreation / leisure activities
- Physical environment (pollution / noise / traffic / climate)
- Transport
Dijkers’s model of quality of life
1) social standards and priorities <> objective evaluations
2) achievements <>subjective evaluations and reactions
3) Individual ecxpectations and priorities
social standards and priorities
- Standards
- Values
achievments
Statuses
Performance
Possessions
Relationships
Accomplishments
Characteristics
Health
IndividualExpectationsand Priorities
Goals
Aspirations
Values
Standards
Desires
Needs
Wants
Health-related Quality of Life
- Clinical decisions often affect patients’ health-related quality of life (HRQoL).
- Evidence on patients’ HRQoL can be obtained using patient-reported outcome (PRO) measures.
Generic Measures
E.g. EQ-5D, Short Form 36 (SF-36) ,Nottingham Health Profile, The Sickness Impact Profile (SIP)
Wide variety of populations
+Usually a single instrument
+ Established reliability and validity
+ Allow comparison between conditions or interventions
- Do not focus on area of interest
- May not be responsive
Disease Specific Measures
E.g. The Asthma Quality of Life Questionnaire, Arthritis Impact Measurement Scale, Inflammatory Bowel Disease Questionnaire
Focus on problems associated with specific diseases, patient groups or areas of function
+ Clinically sensible
+ May be more responsive than generic instruments
- Do not allow comparison between conditions
- Limited in terms of populations and conditions
EQ-5D
> Most widely used generic PRO questionnaire internationally
> It is the instrument recommended by NICE
Asks patients to indicate whether they have no, some, or extreme problems on each of five dimensions of health:
Mobility
Self-care
Usual activities
Pain/discomfort
Anxiety/depression
Survey: questions basis
Questions can only be used for a specific group
Clinically / disease sensitive
More responded - honest answers
What are we doing?
- Monitoring the health system and identification of health problems
- Diagnosing and exploring health problems and health hazards in the community
3.Notify and educate people about health problems
- Mobilise partnerships, identify, and solve health problems in the community
- Develop policies and plans that support individual and social health efforts
- Implementing laws and regulations that protect health and ensure safety
- To provide basic health-care services and to provide health care when it is inaccessible
- Evaluate relevant public health and own health-care strengths
- Assess the efficiency, availability, and quality of health services
- Research new insights and innovative solutions to health problems.
Who are NICE?
People we trust to make decisions
Patient concerns
consider: meds, are they good for that patient specifically, how are the benefits and risks researched?
Some Personal Considerations
Personal situation
How to take the medicine
Preferences for treatment and expectations
Coping with side effects
Benefits
Age
Sexual activity
Professional Considerations
Life expectancy
Frailty
Time to benefit
Net benefit
Magnitude of benefit
Risk vs. benefit
Agree treatment targets with patient and/or carer
Examples include :Primary prevention
Symptom control for acute problems
Outcome expected
Stopping criteria
Required tests
Consider alternative approaches
Lifestyle change(s)
Self care (OTC medicines)
Non-pharmacological options
