Quality Of Life Flashcards
List 3 commonly used measures of health.
- morbidity
- morality
- patient-based outcomes
What are patient-based outcomes? How do they normally work?
Patient-based outcomes assess well-being from the patients point of view - they work by comparing scores before and after treatment over longer periods
Why are patient-based outcomes being more predominantly used?
There has been an increase in conditions where the aim is managing, as opposed to curing, the condition
Give 2 examples of a patient-based outcome.
- health-related quality of life (HRQoL)
- patient-reported outcome measure (PROM)
Give 2 reasons why using PROMs may be beneficial.
- improve the clinical management of patients
- comparison of providers (hospitals)
What 4 clinical procedures in the NhS are currently using PROMs?
- hip replacements
- knee replacements
- groin hernia
- varicose veins
Define health-related quality of life.
Quality of life in clinical medicine represents the functional effect of an illness and its consequent therapy on a patient, as perceived by the patient
How may you measure the HRQoL using a PROM?
By using questionnaires known as instruments
What is an instrument? Briefly describe 2 types.
An instrument is a type of questionnaire that can be used to makes health-related quality of life (HRQoL):
- generic instrument - can be used with any population
- specific instrument - evaluates a series of health dimensions for a specific condition or disease
List 3 advantages and 3 disadvantages of generic instruments.
Advantages include:
- they can be used for a broad range of health problems
- they can be used if theres no existing disease-specific instrument
- they enable comparisons across treatment groups
Disadvantages include:
- they are inherently less detailed
- they may be too general and loss relevance to the condition
- they may be less sensitive to changes that result from an intervention
What is the SF-36 an example of? How is it scored?
The SF-36 is an example of a generic instrument - questions to 8 dimensions are scored, and within each dimension are added together - a score from each dimension is then calculated
List the 8 dimensions that compose an SF-36.
- physical functioning
- social functioning
- role functioning (physical)
- role functioning (emotional)
- bodily pain
- vitality
- general health
- mental health
In an SF-36, are the separate dimensions added together to give an overall score? Why?
No - this can make interpretation difficult in some cases and makes generalisations of results (ignoring outliers)
What is the EuroQol EQ-5D?
A generic instrument that generates a single index value for health status on which full health is assigned a value of 1 and death is assigned a value of 0
Where is a EuroQol EQ-5D particularly useful?
It is particularly useful in economic evaluations
What 5 dimensions does the EuroQl EQ-5D comprise? What 3 levels may these be rated?
- mobility
- self-care
- usual activities
- pain/discomfort
- anxiety/depression
- these are all rated as either no problem, moderate problem, or extreme problem
What 3 types of specific instrument are there? Give an example of each.
- disease specific eg arthritis impact measurement scale
- site specific eg Oxford hip score
- dimension specific eg McGill pain questionnaire
List 2 advantages and 2 disadvantages of specific instruments.
Advantages: - very relevant content - sensitive to change Disadvantages: - comparison is limited - may not detect unexpected effects
What is a long term condition?
Manifestations that vary day-to-day and can be controlled, but not cured
What does an ageing population mean I’m regards to the prevalence of long term conditions?
Long term conditions will increase with an ageing population
What percentage of healthcare in England is directed towards caring for those with a long term condition?
70%
Give an example of a long term condition, and briefly discuss its pathology and symptoms.
Rheumatoid arthritis, caused by an autoimmune attack at joints - symptoms include joint swelling, pain, fatigue and osteoporosis
How is a sociological approach to long term conditions distinct?
It focuses on how long term condition impact on social interaction and performance, concerning the effects of long term conditions and the experiences of the patients, and is interested in now these patients manage their everyday lives
What is an illness narrative?
A patients description of their own experiences suffering from a long term condition
List the 5 sociological theories of long term conditions.
- illness work
- every day life work
- emotional work
- biographical work
- identity work
In the illness work theory, why is optimum self management often difficult to achieve?
There are poor rates of adherence to the treatment, due to a reduced quality of life (side effects), and simply just a poor psychological wellbeing
In everyday life work, what 2 forms of management are there, and what do they entail?
- coping - the cognitive processes involved in dealing with illness
- strategy - actions and processes involved in managing the condition and its impact
In everyday life work, what is normalisation?
Attempting to keep your pre-illness lifestyle and identity intact, or re-designing your new life as a ‘normal’ life
What coping mechanism is often associated with emotional work?
Downplaying pain and symptoms, in an attempt to present a ‘cheery self’
How may social work have an impact of an individual’s role in society?
They may now be extremely dependent on others, which may lead to feelings of uselessness - this is particularly damaging in younger individuals
What does biographical work entail?
The ‘loss of self’ where the former self image seems to crumble away - it entails the interaction between the body and identity
What type of grief can biographical work lead to?
Grief of their former self or life, with the idea they have lost what they once took for granted
What is a huge issue in identity work?
The illness itself can become the defining aspect of identity of an individual, affecting how an individual sees themselves and how others see the sufferer of the condition
What is considered a defining word of identity stigma? How is this defined?
Stigma - a negatively defined condition or behaviour conferring ‘deviant’ status
What types of stigma exist?
- discreditable and discrediting stigma
- felt and enacting stigma
What is the difference between a discreditable stigma and a discredited stigma?
- a discreditable stigma is one that involves no physical manifestations (eg some mental illnesses, HIV)
- a discredited stigma is on that involves physical manifestations or knowledge of a previous stigma (eg physical abnormalities or past suicide attempts)
What is the difference between an enacted stigma and a felt stigma?
- an enacted stigma is the real experience of prejudice and discrimination (stigma) as a consequence of a condition
- a felt stigma is the fear of experiencing an enacted stigma, encompassing a feeling of shame
