Quality Of Life Assessment In Clinical Practice Research Articles

Clinical predictors of quality of life in a large sample of adult obsessive-compulsive disorder outpatients

BackgroundOCD causes impairment in different areas of the patients' quality of life (QoL), such as sociability, family relationships, and occupational performance. The literature has emphasized the relevance of assessing QoL as a critical outcome in mental health studies. AimsThe aim of this study was to investigate sociodemographic and clinical predictors of QoL, including treatment response, in a large sample of OCD subjects. Procedures575 adult OCD outpatients were interviewed as part of the Brazilian OCD Consortium (CTOC). A smaller number of subjects (N = 143) participated on a clinical trial conducted by one of the CTOC sites. ResultsOCD patients were more impaired in their QoL when compared to the Brazilian normative data. Obsessive-compulsive symptoms (OCS) severity had significant correlations with all Medical Outcome Short-Form questionnaire (SF-36) domains. Different OCS dimensions had specific correlations with each SF-36 domain. OCS, depression and anxiety severity significantly increased the impairment risk for the SF-36 domains. Suicidality increased the relative risks for impairment in the Role-Functioning and the Vitality domains by 51% and 17%, respectively. There was a significant improvement in some SF-36 dimensions after treatment. ConclusionsQoL domains are highly compromised in OCD patients. Each SF-36 domain had distinct associations with sociodemographic and clinical variables, including OCS dimensions, suicidality and treatment response. These findings emphasize the OCD heterogeneity and the need for including QoL assessment in clinical practice and research studies.

Does quality of life assessment in palliative care look like a complex screening program?

BackgroundPalliative Care (PC) is an approach that improves the Quality of Life (QoL). A number of QoL assessment tools have been developed and validated in PC. It is not clear how QoL should be measured in PC practice. A procedure of QoL assessment in clinical practice can be defined as a clinical intervention focused on QoL assessment. This is a typical complex intervention that should be appropriately developed and described in all its components and assessed for its effectiveness. The aim of this study is to define a framework to help researchers to develop and evaluate clinical interventions focused on QoL assessment in PC.MethodsA study group of experts in PC and in research methodology was set up to define a framework that would describe the principles of clinical interventions focused on QoL assessment in PC. The study group discussed the WHO Population Screening Principles as a possible useful framework. The new principles had to be developed taking into account the following criteria: 1) specific to PC practice; 2) address a single underlying characteristic; 3) anchored to relevant literature; 4) consistent with the WHO PC definition.With regard to contents and the format of the principles, discussions occurred among the study group members through a cognitive process.ResultsWe reviewed each of the WHO Population Screening Principles and adapted them to QoL assessment, taking into account the defined criteria. As a result, a new framework, the QoL Assessment Principles in Palliative Care was developed. It consisted of 4 sections, for a total of 11 principles.ConclusionsThe WHO Screening Principles framework was used to outline the eleven essential principles to be considered in developing and/or evaluating clinical interventions focused on QoL assessment in PC. The QoL Assessment Principles in Palliative Care identified could represent a methodological and ethical standard to be considered when developing and evaluating a clinical intervention focused on QoL assessment in PC.

Quality of Life of Primary Open Angle Glaucoma Patients in Lagos, Nigeria

To evaluate the quality of life (QOL) of primary open angle glaucoma (POAG) patients attending a tertiary eye institution in Lagos, Nigeria and identify clinical and sociodemographic factors affecting it. A hospital-based cross-sectional analytical study design was used to compare 132 patients with varying degrees of severity of glaucoma (cases) with age-matched and sex-matched controls with essentially normal eyes and no family history of glaucoma. POAG patients had reduced QOL as defined by the 2 instruments used: the National Eye Institute Visual Function Questionnaire25 (NEIVFQ25) and the 15-item Glaucoma Quality of life Questionnaire (GQL-15). The mean QOL score obtained with the NEIVFQ25 for the cases was 85.2 (±16.07) and 96.7 (±2.34) for the controls. Using the GQL-15 scale, the mean QOL score for the cases was 24.07 (±12.4), whereas for the controls the score was 15.75 (±1.85). Early or mild glaucoma was associated with reduced QOL compared with the controls. Glaucoma patients had the greatest difficulty with glare and dark adaptation subscale of the GQL-15. Increasing severity of disease defined by increasing visual field deficit (mean deviation values) correlated significantly with worsening QOL [Spearman ρ (r) values ranging from 0.32 to 0.43]. Contrast sensitivity correlated moderately with QOL (r ranges from 0.43 to 0.47; P=0.001). Cup-to-disc ratios, visual acuity, and visual field indices (mean deviation) correlated with QOL scores of both tools with r values ranging from 0.28 to 0.49 for the GQL-15 and 0.38 to 0.54 for the NEIVFQ25. Age had a negative impact on QOL (r=-0.30 for the NEIVFQ25 and 0.30 for the GQL-15) and affected all the subscales of the GQL-15 and most subscales of the NEIVFQ25 except ocular pain (P=0.40), mental health (P=0.13), color vision (P=0.05), and role difficulty (P=0.11). Women generally had better vision-related QOL scores (P=0.001 for the NEIVFQ25 and 0.005 for the GQL-15). Higher educational status was associated with better QOL scores (P<0.05). Ethnicity, religion, marital status, and living situation had no significant effect on QOL scores. POAG reduces QOL even in the early stages of the disease, as there was a significant reduction in the QOL of patients with mild glaucoma compared with the controls. It showed a clear trend of worsening QOL scores with increasing severity of disease. The correlation observed between QOL scores and objective measures of visual function suggest that inclusion of QOL assessment in clinical practice could be highly informative and should be explored further.

Physicians' knowledge of health-related quality of life and perception of its importance in daily clinical practice

BackgroundHealth-related quality of life (QoL) has become a crucial outcome in medical care. However, few studies have assessed physician knowledge of QoL and rate of physicians adopting QoL measures in clinical practice. The present study aimed at assessing the level of knowledge of QoL and the perceived importance of incorporating QoL assessment in clinical practice among physicians of a tertiary level academic hospital in Rome, Italy.Materials and methodsA survey study performed through the distribution of a questionnaire assessing knowledge of QoL studies that used the SF-36 scale, participation in studies evaluating QoL as well as knowledge of journals publishing articles on QoL Physicians and residents at the hospital Policlinico Gemelli, Catholic University of Rome.ResultsThree-hundred nine physicians completed the questionnaire. Thirty-eight percent % reported knowing studies on QoL and using their results in clinical practice or for research purposes; 29% reported knowing the SF-36 questionnaire; 30% stated that at least one study assessing QoL had been conducted in their department. Fourty-six percent % stated that QoL must influence much or very much diagnostic choices and an even higher percentage reported that QoL must influence much or very much therapeutic and palliative strategies (70.8% and 91.3%, respectively). Reported barriers to the use of QoL measures in clinical practice were related to time constraints (8.7%) but also to doubts on methodological issues of QoL (30.7%). The large majority of physicians (94.3%) would have used more expensive drugs if these could improve QoL.ConclusionsThe present study shows that in a tertiary level academic italian hospital one third of the physicians, reported to know QoL measures and that more than 80% of them would like to use QoL in their daily clinical practice. Future studies are needed to identify the best strategies to implement the use of QoL measures in clinical practice.

Measurement Issues in Quality-of-Life Assessments

To describe issues to be considered when measuring the quality of life (QOL) of patients with cancer. Published articles and books, conference proceedings, and abstracts. A review of the existing literature reveals an emerging field of research and considerable discussion of measurement issues. Consensus is growing about measurement approaches to this subjective concept; however, agreement differs regarding specific aspects of measurement approaches and interpretation of data. The purpose of the QOL assessment and how the data will be analyzed are the main determinants of the choice of assessment and measurement approaches. Differences regarding how QOL is measured may be encountered based on a clinical or research purpose. QOL assessments may be used as part of data collection to address a specific research question or may be used to guide clinical practice. Research findings used to guide clinical practice should be evaluated for validity, reliability, and fit of the sample before being incorporated into clinical practice. QOL assessment in clinical practice may be used as an exploratory tool to identify potential problems or may be used to evaluate the effectiveness of a targeted intervention.

Quality of life in cancer patients

Cancer and cancer therapies, including chemotherapy, radiotherapy, and surgery, all have a significant impact on the quality of life (QOL) of a patient. Poor QOL can jeopardize completion of the cancer treatment regimen since it may influence the patient's willingness to continue with cancer therapy. Whether treatment is intended as palliative or curative, it is important to design treatments where there is an acceptable tradeoff between probability of cure and QOL, or between survival time and QOL. These considerations are becoming increasingly important since newer potent therapeutic therapies have not only improved cure rates for many types of cancer, but have also greatly prolonged survival times for incurable cancers. For these reasons, QOL measurements have become increasingly important when determining efficacy of treatments in clinical trials. This conference was organized to review and discuss the issues relating to QOL in cancer patients. There can be a variety of causes of QOL deficits in cancer patients, including pain, depression, anaemia, and fatigue. The increased use of adjuvant chemotherapy and radiotherapy and their associated side effects (i.e. nausea and vomiting) have caused increased concern regarding QOL. Moreover, the longer survival times of patients with incurable cancers have increased the need to improve the palliative care they receive. The establishment of standardized QOL assessment tools will facilitate the use of QOL as an efficacy measure. In addition, the increased use of QOL measures addresses the growing awareness that it is important to treat the whole patient, not just the disease. The need for accurate instruments to measure QOL had led to the development of the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire and the Functional Assessment of Chronic Illness Therapy (FACIT) QOL measurement system. The conference, entitled 'Quality of Life in Cancer Patients', included a thorough discussion of the factors that need to be considered for proper implementation of the QOL questionnaires and interpretation of the data. These factors included language issues, cross-cultural sensitivity of the questionnaire, and the degree of disease severity. Methods on assuring validity and reliability of the questionnaire were also discussed. The discussion then moved on to potential barriers to effective utilization of QOL assessments. Despite the advances made in QOL instrument development, many clinicians are not comfortable with the use of these tools. Fundamental misunderstandings regarding the use of these instruments include improper administration, analysis and interpretation of the data. Appropriate strategies to overcome these barriers were then discussed. The conference also included an overview of the recent progress in improving QOL in cancer patients. Areas such as depression, pain, fatigue and nausea were discussed. Special attention was paid to anaemia and fatigue as well as pain. Fatigue is a common symptom of cancer patients and is quite often the result of anaemia. Several large studies assessing the QOL benefits of epoetin alfa treatment in anaemic cancer patients were reviewed. Despite the development of guidelines for pain treatment in cancer patients, pain is still undertreated in an alarmingly high percentage of patients. Barriers to effective pain management were reviewed with a discussion on ways to overcome them. In summary, the following articles will highlight the importance of QOL assessment in both clinical trials and practice when treating cancer patients. It will also provide helpful information on the development and use of questionnaires, as well as methods to analyse and achieve proper interpretation of the collected QOL data. Clinicians may also find useful information on overcoming the obstacles to effective use of QOL assessment in clinical practice, particularly for the management of anaemia and pain.

Measurement of quality of life in bone marrow transplantation survivors.

This study was designed to assess the reliability and validity of a Quality of Life (QOL) instrument on a sample of 179 allogeneic Bone Marrow Transplant (BMT) survivors. The QOL-BMT tool was developed specifically for this population and was based on the investigators' prior research and a conceptual model of Quality of Life. Patients who were at least 100 days post BMT completed the 30 item visual analogue questionnaire. The instrument measured physical symptoms (e.g., weight loss, frequent colds, skin changes, cataracts, sexual problems), psychological symptoms (e.g., worry about recurrence, adjustment to illness), social concerns (e.g., relationship adjustment, return to work), and spiritual well-being (e.g., sense of control, future goals). Psychometric analysis of the instrument included measures of reliability and validity. The study findings demonstrate the unique aspects of QOL dimensions in BMT survivors and the value of QOL assessment in clinical practice and research.

Overview of health-related quality-of-life measures

Quality of life (QOL) as a measurable health-care outcome is discussed, and an overview of the field of QOL assessment is provided. QOL assessments can be used to evaluate drugs in clinical trials, to evaluate provider performance, and to monitor the progress of patients receiving drug therapy. QOL information is most useful in evaluating drug therapy when the primary purpose of a drug is palliative rather than curative, when a drug is somewhat effective but also fairly toxic, when lifelong therapy is administered to prevent complications of a relatively asymptomatic disease, and when there are several equally effective therapies for a specific condition but the adverse-effect profiles differ. Contemporary QOL questionnaires are completed by patients, and they most commonly include dimensions of physical function, mental or cognitive function, emotional or psychological function, social and role function, disease symptoms, and perceptions of well-being. The keys to successful QOL assessment in clinical practice will be selection of instruments that are practical to administer and are capable of detecting small changes in health, selective application of those instruments to patient populations most likely to benefit from this more intensive form of monitoring, and efficient use of data management systems. The consumer of QOL literature must assess the validity of QOL data obtained in a given study and their applicability to his or her practice setting.