Quality of life
11 important questions on Quality of life
Dimensions of (health related) QOL
- psychological
- social
- (spiritual)
- environment
- income
- independence level
Wants vs Needs approach - e.g.
WANTS: is haarverlies voor dit individu vervelend? (Paul de Leeuw)
'proxy' or surrogate ratings
- Higher grades + faster learning
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Main uses of QOL assesment in health setting
2. treatment choices in individual patient care
3. evaluations to determine the best uses of health care resources
4. genral or population studies to evaluate QOL
Treatment comparisons in clinical trials
Where clinical outcomes, e.g. mortality following cardiac revascularisation, are the primary outcome, differences in QOL scores only become influential where two or more treatments achieve equivalent benefit on a primary outcome variable.
Treatment choice in individual patient care
Evaluations to determine the best uses of health care resources
- Interventiosn are seen as value for money depending on how they affect QOL and duration of life for a particular cost
- QALY: Quality adjusted life years --> combines effect of an intervention on qulaity of life and duration of life.
QOL measurements instruments
1. generic QOL
2. disease specific QOL
3. dimension specific QOL
4. Individualised QOL
5. Utility
Disease specific or population specific measures
- for example the EORTC QLQ-C30 measures diarrhea, nausea and vomiting, cognitive problems, hair loss, relevant for cancer patients
Thee intstruments are developed to be sensitive to change in aspects of life believed to be most affected by the condition concerned and its treatments.
- research challenge is that it is more difficult to determine howo a diseased group differs from the general population.
- Thus, many studies combine genereic and disease specific QOL
EuroQOL (EQ-5D)
- Weighting of difficulty is based on weighting calculated from a validation population (and not the individual!)
* a healthy person is asked to assign a weight, based on the idea that she/he may have about experiencing the disease (much criticism!)
* valuations do represent public's rating and how much interventions may cost
QOL assessment in routine clinical practice
- increasing attention to its use in daily clinical care
- patients complete questionnaire before meeting doctor (at home or in waiting room)
- improves patient-doctor communication
- unfortunately no evidence that it improves QOL
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