SPECIAL ARTICLEApplying Quality-of-Life Data Formally and Systematically Into Clinical Practice
Section snippets
CLINICAL SCENARIO
Mrs James, a 62-year-old woman with a 5-year history of renal cell carcinoma treated with nephrectomy, presented for a second opinion regarding lung nodules. The nodules were first seen 3 months ago, at which time observation was chosen as the course of management. Her other medical history consisted of hereditary peripheral neuropathy and ataxia, hypothyroidism, osteoarthritis, and hypertension. Examining her history, the physician assumed that her quality of life (QOL) was likely impaired.
USING QOL DATA IN THE TREATMENT OF EACH PATIENT
Growing evidence suggests that optimizing processes and outcomes of care depends on implementing multicomponent interventions that change the prevailing system of care.3, 4, 5 The Institute of Medicine's report,6 Crossing the Quality Chasm, outlines 6 fundamental components of optimal care for illness: safe, timely, evidence based, efficient, equitable, and patient centered. The core of patient-centered care is the concept of self-management or patients' active and central role in managing
WHAT CLINICIANS NEED TO KNOW TO EFFECTIVELY USE QOL DATA
We begin by reviewing group-level data from published studies that have compared the QOL of one group of patients with those of another. The following section will then focus on individual-level data collected from patients at the time of their visit. For these 2 data sources, we address approaches to communicating QOL information to patients.
COMMUNICATION OF QOL DATA TO PATIENTS FOR THEIR USE
Informative communication approaches provide patients with data about the likelihood that a single aspect of QOL will improve with treatment, the meaningfulness of the QOL improvement in respect to the patient's ability to function, and the importance of the QOL change to the specific person.17 This information can be communicated as the number of symptom-free days, the percentage of persons experiencing improvements of a specified amount, and the time required to experience a minimally
INTEGRATING QOL ASSESSMENT INTO EACH PATIENT'S CARE
Thus far, we have discussed the importance of QOL concerns and the various types of data that are available to help patients make decisions about treatment or to proactively manage their disease such as cancer. This section summarizes studies that have evaluated the effect of QOL data collection on processes and outcome of care. These studies were identified as a result of a systematic search of the literature with MEDLINE, CINAHL, and PsychINFO. Additional references were identified through
IMPLEMENTATION INTO PRACTICE: EXAMPLES
Thus far, we have discussed the role of group-level vs individual-level data in the individual patient encounter, different administration modalities for collecting QOL data, and the effects of QOL data collection on processes and outcomes of care. In this section, we present an overview of several QOL instruments that have been used in individual patient encounters and for which group-level data are available. The instruments identified here reflect only a few of the many that are available in
HEALTH DECISION AIDS
Health decision aids facilitate shared and informed decision making by helping patients and clinicians make specific and deliberate health care choices (including the choice for the status quo).77, 78, 79, 80, 81 They do this in part by providing group-level data about the experiences of others in a similar situation. Decision aids are superior to usual care interventions in improving knowledge and realistic expectations of the benefits and harms of various health care options, reducing
FURTHER RESEARCH
In the previous sections we note the importance of QOL data for patient decision making. Several researchers have looked at the process of obtaining QOL information and providing that information to clinicians. We have documentation that computerized approaches are user friendly and are rated favorably by both clinicians and patients. The most frequently measured outcomes in QOL assessment studies were the frequency at which QOL problems were identified and whether communication was enhanced.
CONCLUSION
The routine assessment and use of QOL data in clinical settings are consistent with the Institute of Medicine's recommendation of ensuring patient-centered care for chronic illnesses. Patient-centered care can improve the interaction between patients and clinicians by placing the focus on shared decision making and patient self-management. We provided information on the types of QOL data (group vs individual level) available for aiding in shared decision making and improving patient
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