Quality of life (healthcare)
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Quality of life (QOL) is used in healthcare to refer to an individual's emotional, social and physical wellbeing, including their ability to function in the ordinary tasks of living. It is a term used most frequently in the context of medicine and healthcare, where the impact of a disease may reduce "Health-related Quality of Life"
Understanding quality of life is recognized as increasingly important in healthcare, where the relationship between cost and value raises complex problems. For instance, health providers must make economic decisions about access to expensive drugs that may prolong life by a few months, and weight these against alternative uses such as preventative medicine or a surgical bed. Monetary measures alone do not readily apply. In the case of chronic and/or terminal illness where there is no effective treatment or cure, there may be an emphasis on improving HRQoL through interventions such as symptom management, adaptive technology, and palliative care. There is a growing field of research concerned with developing, evaluating and applying quality of life measures within health related research (e.g. within randomized controlled trials), especially Health Services Research. Well-executed HRQoL research informs those tasked with health rationing, is involved in the decision-making process of bodies such as the Food and Drug Administration or National Institute for Clinical Excellence, and may be used as an endpoint in clinical trials of experimental therapies.
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Initial QoL measures referred to simple assessments of physical abilities by an external rater (e.g.: patient is able to get up, eat and drink, take care of personal hygiene without any help by others), or even to a single measurement (e.g. the angle to which a limb could be flexed).
The current concept of HRQoL acknowledges that subjects put their actual situation in relation to their individual expectation. The latter can vary over time, and react to external influences like long-time disease, family support etc. Patients' and e.g. physicians' rating of the same objective situation have been found to differ significantly. Consequently, HRQoL is nowadays usually assessed using patient questionnaires. These are often multidimensional and cover physical, social, emotional, cognitive, work- or role-related, and possibly spiritual aspects as well as a wide variety of disease related symptoms, therapy induced side-effects, and even the financial impact of medical conditions.
Hundreds of validated QoL questionnaires have been developed: Generic instruments (e.g. SF-36, Short-Form with 36 questions) as well as disease specific instruments (e.g. the LC-13 Lung Cancer module from the EORTC Quality of Life questionnaire library, or the HADS Hospital Anxiety and Depression Scale). Like other psychometric assessment tools, QoL questionnaires should meet certain quality criteria, most importantly with regard to their reliability and validity.
"Improved Quality of Life" is also often advertised for marketing purposes. This is not limited to the medical field; but here, the growing impact of chronic conditions that cannot ultimately be healed, but merely controlled or made bearable, adds to the relevance of the topic.
Frequently used HRQoL measures
- Short-Form Health Survey One example of a widely-used questionnaire assessing physical, social, and mental HRQoL, used in clinical trials.
- Manchester Short Assessment of Quality of Life 16-item questionnaire for use in psychiatric populations.
- EQ-5D a simple quality of life questionnaire.
The quality of life ethic refers to an ethical principle which uses assessments of the quality of life that a person can experience or hope to experience as a foundation for making decisions about the continuation or termination of life. It is often used in contrast to or in opposition to the sanctity of life ethic.
See also
References
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- ProQolid (Patient-Reported Outcome & Quality of Life Instruments Database)
- Mapi Research Trust ("Non-profit organization advancing the art & the use of scientific approaches to Patient-Reported Outcome (PRO) measures")
- Quality-of-Life-Recorder (Project to bring QoL measurement to routine practice. Platform & library of electronic questionnaires, Shareware/Freeware)
- The International Society for Quality of Life
