Quality of Life and Health Care Services

Health Care Services and Quality of Life

Quality of Life in Health Care,Approaches to Quality of Life,Measurement of Quality of Life,Quality of Life as a Research Variable,Quality of Life In Different Research Methods,Dynamic Nature of Quality of Life Measure and Challenges.

Quality of Life in Health Care

    Quality of life (QOL) is a multifaceted construct without a single definition. QOL is used by many disciplines concerned with conditions of human life, including social, environmental, political, economic, and health (Anderson, KL, & Burckhardt, 1999). 

    Nursing and health care researchers are interested in determining how disease or injury, or the treatment of disease or injury, affects QOL. Health promotion researchers may use QOL measures to ascertain the effectiveness of measures taken to enhance or improve, physical, social, or spiritual health.

Approaches to Quality of Life

    Despite a lack of consensus on what quality of life is, three broad approaches for defining QOL have been suggested (Haas, 1999; Carr , Gibson, & Robinson, 2001; Dijkers , 2003). 

    One category characterizes QOL as evaluations or reactions such as well-being, happiness, satisfaction, morale, or positive and negative affect. Another category describes QOL in terms of normality, meeting societal standards, and status or achievements. Ability to function and fulfill basic needs are examples of this QOL domain. 

    A third approach suggests QOL is a matter of perception regarding the differences between expectations, what is valued or considered important in life, and current life experiences. Many QOL instruments are multi-dimensional, combining the conceptual dimensions of evaluation, normality, and/or perception. The importance of quality-of-life research is evident through federal funding of health research. 

    One of the five future research priorities identified in September 2003 by the National Institute of Nursing Research includes quality-of-life research in chronic illness. The Centers for Disease Control also has a division for health-related quality of life that provides measures and data for tracking various aspects of population health.     

    The prevalence of QOL as a variable in nursing studies is demonstrated through a CINAHL search, using the phrase “quality of life” and limited to research and nursing journals. The search yielded 1,744 articles published between 1982 and November 2003, with 824 or 47% entered since the year 2000.

Measurement of Quality of Life

    QOL measurements are classified into five types (Garratt, Schmidt, Mackintosh, & Fitzpatrick , 2002). Generic measures, such as the Medical Outcomes Study SF-36, can be used with any patient population, or any disease or health condition. 

    Disease or population specific instruments have been found to be more sensitive to changes in QOL since these tools are designed to measure more specifically how a disease or illness affects life dimensions. The European Organization for Research into the Treatment of Cancer quality-of-life questionnaire (EORTC QLQ-C30) is an example of a population specific tool. 

    Dimension specific measurements focus on specific aspects of health, such as well-being or depression. Utility measures, exemplified by the Health Utilities Index, are beneficial in evaluating economic aspects of health treatments and require respondents to choose between alternative health states, with economic or other costs associated with the choices. 

    Individualized QOL tools, such as the Patient Generated Index or the Schedule for the Evaluation of Individual Quality of Life, ask respondents to identify and weigh what they deem important in their lives. 

    The individualized approach is considered by some to be the most appropriate way to measure quality of life, because the research participants are the only ones who can say what matters most in their lives (Joyce, Hickey, McGee, & O'Boyle, 2003; Macduff, 2000).

Quality of Life as a Research Variable

    Because QOL is defined in a variety of ways, many methods and tools are available. to measure QOL as a research variable. The MAPI Research Institute (Lyon, France) offers a free catalog describing over 1,000 QOL instruments and provides access to these instruments for a subscription fee. 

    Considerations for selecting or developing a QOL instrument include: deciding who is evaluating QOL, what aspects or dimensions of QOL are to be evaluated, whether the measurement needs to be able to detect changes over time, and how the information gained from the measurement will be used. 

    The research participant's age, communication ability, severity of illness, and cognitive ability will determine whether QOL is scored by an outside observer or proxy, such as a parent, spouse, or health care provider (Addington-Hall & Kalra, 2001). 

    The Scientific Advisory Committee of the Medical Outcomes Trust (2002) suggests the following criteria for evaluating QOL instruments: the conceptual and measurement model underlying the instrument, psychometric properties of reliability and validity, sensitivity or responsiveness to change over time, case of interpreting and understanding scores, respondent or administrative burden, alternative modes of administration, and cultural and language adaptations of the instrument for use in other populations.

Quality of Life In Different Research Methods

    Whether a study is cross-sectional or longitudinal will also influence the instrument choice. Tools used in longitudinal studies need to be sensitive to change, without floor or ceiling effects associated with items in the tool (Hyland, 2003). 

    Hyland also suggests that tools in longitudinal studies be relatively short, have multiple response items such as Likert scales, and include items that describe problems common and relevant to the population being studied. QOL questionnaires used in cross-sectional studies need to be able to discriminate among respondents who will have varying differences in QOL (Hyland). 

    QOL tools for cross-sectional studies may have more items with two or three response choices, may include items that have floor. and ceiling effects, and may not be relevant to all respondents.

    Because of the variety of definitions and tools, QOL may be difficult to compare across studies (Garratt et al., 2002). Thorough knowledge of conceptual and psychometric aspects of a QOL measure is essential for selecting the right tool for a research study. 

    Using the same instrument as other researchers may not be appropriate if the instrument does not adequately capture the researcher's conceptualization of quality of life, or if the tool is not sensitive to change over time and the study is a longitudinal design. Thus, definitional and measurement issues may hamper building a body of knowledge about quality of life.

Dynamic Nature of Quality of Life Measure and Challenges

    The dynamic nature of life also presents challenges for measuring QOL ( Carr et al., 2001). People adapt to illness and their expectations about interventions may change over time, so what effects QOL at one time may not at another. 

    Priorities in life also change, so what a person considers important at one time may be less important at another. Aggregation of QOL data within a population may be difficult because people's expectations regarding the effects of a disease or intervention may differ. 

    Despite these difficulties in measuring QOL, it is an important concept for nursing, and will continue to be an outcome variable in nursing studies.