Fast Fact and Concept #52: Quality of Life

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Title: Fast Fact and Concept #52: Quality of Life

Author(s): Chang, Victor T; Weissman, David E

Quality of Life is a term commonly used by health professionals when trying to help patients and families make decisions concerning care near the end of life. Formal studies using quality of life instruments are increasingly common in clinical trials, typically used as an outcome measurement before and after treatment. Implicit is the notion that if quantity of the time left cannot be increased, then quality of life should be maximized. But what does Quality of Life (QOL) mean, and how should clinicians use this information in decision making?

There are two key concepts about Quality of Life: 1) it is multi-dimensional; and 2) it is most appropriately determined by the patient. Although family members, physicians and other health professionals can make significant observations about QOL, studies consistently document important variances between patient and surrogate defined QOL.

A quality of life assessment can be considered a review of systems of the patient's world. Multi-dimensionality can be assessed by asking questions in the following key domains: 1. Physical; 2. Functional; 3. Emotional; 4. Social; 5. Spiritual/Existential. The sum of these questions can be a "snapshot" of the patient's world and give the clinician an idea of what is important to a patient, and what goals of care may be meaningful. Although many QOL instruments (questionnaires) have been developed, a few basic open ended questions can be helpful in talking to patients:

(Functional) How has your disease interfered with your daily activities?
(Social) Have are you getting along with family and friends as a result of your illness?
(Emotional) Have you been feeling worried or sad about your illness?
(Physical) Have you been feeling sick or bedridden because of your illness?
(Physical) How much or which symptoms bother you the most?
(Spiritual) How have your religious beliefs been affected your illness by?
(Existential) Do you find yourself wondering what is the meaning of all this?

Patients almost always appreciate having the chance to discuss these issues with their doctor; for one thing, asking these questions tells the patient that the physician has an interest in their well being that goes beyond the actual disease. Physicians who have a better understanding of the totality of the disease experience for the patient, another way of reframing the meaning of QOL, will be better prepared to care for patients near the end of life.

Brunelli C, Constantini M, DiGiulio P, et al. Quality of life evaluation: when do terminal cancer patients and health-care providers agree? J Pain Sym Manage 1998; 15:151-158.
Detmar SB, Muller MJ, Wver LD, et al. The patient-physician relationship. Patient-physician communication during outpatient palliative treatment visits: an observational study. JAMA 2002; 285:1351-7.
Gudas SA and Burns LS. Quality of life in patients with cancer. Cancer Management 1998; March/April, 6-13.
Leplege A and Hunt S. The problem of quality of life in medicine. JAMA 1997; 278:47-50.

Copyright and Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing. Fast Fact and Concept #52 Chang VT and Weissman DE. Quality of Life. September, 2001. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.

Fast Facts and Concepts was originally developed as an end-of-life teaching tool by Eric Warm, MD, U. Cincinnati, Department of Medicine. See: Warm, E. Improving EOL care--internal medicine curriculum project. J Pall Med 1999; 2: 339-340.

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Creation Date: 10/2000

Format: Handouts

Purpose: Self-Study Guide, Teaching

Training: Fellows, 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice
Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
Non-Physician: Clergy/Chaplains, General Public, Graduate Students, Lawyers, Patients/Families, Nurses, Social Workers

ACGME Competencies: Medical Knowledge, Patient Care

Keyword(s): Decision making capacity/surrogates, Negotiating treatment goals, Quality of life

The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).