Quality of life

Hermann P. G. Schneider,
Alastair H. MacLennan and David Feeny
 A definition of
health-related quality of life

HRQOL
• represents those parts of quality of life
that directly relate to an individual’s health

• includes the domains of physical,

psychological, social, spiritual, and
role functioning, as well as
general well-being
Spilker and Revicki , 1996
 Levels of quality of life

Overall
assessment
of well-being

Broad domains
Physical, Psychological,
Economic, Spiritual, Social

Components of each domain

In their totality, these three levels constitute

the scope of quality of life
Cramer & Spilker , 1998
 Rationale for using
health-related quality of life measures

• Goal of therapy is to make patients feel better

• Physiological measures may change
without people feeling better
• People may feel better without measurable change in
physiological function
• Trade-offs between treatment effects and side-effects
• The output of the health-care system is quality-adjusted
survival / health-related quality of life. Why not measure it?

Guyatt, Feeny, Patrick, 1993

Assessment of measures of HRQOL

• Acceptability
• Burden
• Reliability
• Validity
• Responsiveness
• Interpretability
• Usefulness
Feeny et al., 1999
 Most widely used measures within 3921 reports
No. of No. of
Instrument Instrument
records records
SF-36 408 WHOQOL 24
Sickness Impact Profile 111 Healthy Years Equivalent 24
Nottingham Health Profile 93 Beck Depression Inventory 23
EORTC QLQ-C30 82 Asthma Quality of Life Questionnaire 21
QALY 79 McGill Pain Questionnaire 19
EuroQOL 77 WOMAC 18
Health Assessment Questionnaire 62 Hospital Anxiety and Depression Scale 18
Arthritis Impact Measurement Scales 59 Duke Health Profile 17
Quality of Wellbeing Scale 53 SF-12 15
Psychological General Wellbeing
General Health Questionnaire 43 15
Scale
St George‘s Respiratory Disease
Health Utilities Index 41 15
Questionnaire
COOP Charts 33 MOS-HIV 14
Functional Assessment of Cancer 32 Rotterdam Symptom Check List 14

Garratt et al., 2002

 The EuroQOL Instrument
100
Best imaginable Mobility
health state • I have no problem in walking about
90 • I have some problems in walking about
• I am confined to bed
80 Self-care
• I have no problems with self-care
70 • I have some problems washing or dressing myself
• I am unable to wash or dress myself
60 Usual activities
• I have no problems with performing my usual activities
(e.g. work , study , housework , family or leisure activities)
50
• I have some problems with performing my usual activities
• I am unable to perform my usual activities
40 Pain / discomfort
• I have no pain or discomfort
30 • I have moderate pain or discomfort
• I have extreme pain or discomfort
20 Anxiety / depression
• I am not anxious or depressed
10 • I am moderately anxious or depressed
• I am extremely anxious or depressed
0 Worst imaginable
health state

Kind P, 1996
 Health-related quality of life
Issues in menopause and aging
• Importance of placebo effect in studies on symptoms
• Lack of standardization of reporting of symptoms
• Few studies consider HRQOL impact on partner
• Specific instruments for menopause and aging
• Generic instrument to capture chronic conditions and side-
effects
• Utility measures to reflect preferences of patients and
community
Feeny, 2006