Surgical research reviewUsing quality-of-life measurements in clinical practice
Section snippets
Assimilating quality-of-life information into clinical practice
Information from quality of life research can be applied at the macro, meso, or micro levels. The macro level of decision-making affects large communities of people, such as a governmental jurisdiction. The meso level affects a targeted group of patients. The micro level deals with the individual patient with the purpose of effecting a health benefit for that patient.6 It is at this level, that of the individual patient, on which this review will focus its attention.
Most surgeons will receive
Using quality-of-life data in clinical decision-making
When surgeons would initially use quality-of-life information is in making a treatment choice for a particular patient. Essentially this is taking meso-level data and applying it to the micro level. As with any application of clinical research to the individual patient, the first question to ask is, “Is my patient in the same group of patients in which the intervention worked?” For example, a quality of life study of the effects of doxorubicin-based chemotherapy after operations for breast
Patient counseling
Information from quality of life outcomes is valuable in patient counseling. Patients will ask frequently questions such as, “How much better is this operation going to make me?” and “How will this operation affect my life?” Knowledge of quality-of-life data will aid the surgeon in answering these questions.
Take the example of gastroesophageal reflux disease. There are many studies published using a variety of instruments.33 A surgeon who wishes to use such information in counseling would have
Caveats and difficulties
There are several caveats and difficulties in the use of quality-of-life measures in clinical practice5, 36 which can be divided generally into instrument-related, clinician-related, health care delivery system–related, and patient-related. With respect to instruments, the problem centers on which instruments to use and when. There is no universal instrument that is valid, reliable, appropriate for the disease or its treatment, and assesses all of the aspects of quality of life important to the
Conclusions
Although applying quality-of-life measures to everyday clinical practice poses challenges, there are clear advantages to the physician and to the patient. The most important of these is in treatment choice, when treatments are primarily for symptom relief or if treatments may have noticeable side effects. Clinical decision-making can be enhanced using such measures as predictive or prognostic tools and in monitoring patient response to treatment or disease recurrence. Communication with
References (36)
Assessing quality of life in clinical research: from where have we come and where are we going?
J Clin Epidemiol
(1999)- et al.
Measuring treatment impact: a review of patient-reported outcomes and other efficacy endpoints in approved product labels
Controlled Clin Trials
(2004) The quality of quality of life studies in general surgical journals
J Am Coll Surg
(2001)- et al.
The standard of reporting of health-related quality of life in clinical cancer trials
J Clin Epidemiol
(2000) Evaluating the outcome of treatment: shouldn’t we be asking patients if they are better?
J Clin Epidemiol
(2000)Using quality-of-life instruments to assess surgical outcomes
Surgery
(1999)The effect of chronic pain syndromes and psychoemotional disorders on symptomatic and quality of life outcomes of antireflux surgery
J Gastrointest Surg
(2003)- et al.
The use of patient reported outcomes measures in routine clinical practice: lack of impact or lack of theory?
Soc Sci Med
(2005) - et al.
Assessment of quality-of-life outcomes
N Engl J Med
(1996) - et al.
Quality of life measurements: origin and pathogenesis
Yale J Biol Med
(2002)
Taking stock of health-related quality-of-life measurement in oncology practice in the United States
J Natl Cancer Inst Monogr
A taxonomy of the uses of health-related quality-of-life instruments in cancer care and the clinical meaningfulness of the results
Med Care
Measuring health-related quality of life
Ann Intern Med
Quality of life: assessment, analysis and interpretation
Generic and disease-specific measures in assessing health status and quality of life
Med Care
Users’ guides to the medical literatureXII. How to use articles about health-related quality of life
JAMA
Assessing health status and quality-of-life instruments: attributes and review criteria
Qual Life Res
SF-36 health survey: manual and interpretation guide
Cited by (17)
Improving modern cancer care through information technology
2011, American Journal of Preventive MedicineCitation Excerpt :Patients' symptom reports also have been correlated with adverse outcomes, including functional and emotional disability and rehospitalization.67 Despite decades of research on cancer HRQOL in clinical trials, research on its application in clinical practice is a newer development.68,69 A recent symposium described promising use of HRQOL instruments in clinical practice, especially for their ability to screen for functional problems, improve clinician–patient interactions, and address quality of care from the patient perspective.70
The tangible consequences and intangible implications of laparoscopic cholecystectomy-associated bile duct injuries
2020, South African Journal of SurgeryPatient-Centered Outcomes in Surgical Research and Practice
2017, Journal of Gastrointestinal SurgeryQuality-of-life assessment in children with fecal incontinence
2015, Diseases of the Colon and RectumQuality of Life in Bile Duct Injury: 1-, 5-, and 10-year Outcomes After Surgical Repair
2014, Journal of Gastrointestinal SurgeryValidation of the SF-36 as a measure of postoperative recovery after colorectal surgery
2014, Surgical Endoscopy