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OCR for page 116
7
Applications of Quality-of-
Life Measures and Areas for
Cooperative Research
Jennifer Falotico-Taylor and
Frederick MosteDer
Severe developments contribute to the emergence of Me field of qual-
ity of life: me increased prevalence of chronic disease, We proliferation of
health technologies, cost-contairunent concerns, and the cunent emphasis
on social factors in heals assessments.
Numerous quality-of-life instruments can evaluate heath technologies
in response to these concems. Genenc measures contain a minimum set
of health concepts, usually measuring physical, psychological, social, and
role functioning and general well-being. Specific measures target treat-
ments, diseases, or populations.
Each measure has its own research advantages. For example, standard-
ized, generic measures facilitate comparisons between various sick and
well groups, younger and older age groups, and groups win different
diseases; disease-specific measures are more sensitive to specific clinical
interventions. Many researchers supplement accepted generic measures
win specific measures that seem appropriate for a particular group, dis-
ease, or treatment
Researchers emphasize Me importance of focusing on these existing
generic and specific measures and establishing more firmly their reliabil-
i~ and validity, rather Man increasing the variety of measures. Clinicians
Acknowledgment: The issues and ideas presented in this chapter are drawn in large part from the
summary statements of Frederick bIosteller, John E. Ware, Jr., and Sol Levine (~osteller et al 1989)
presented at the Henry J. Kaiser Family Foundation Conference on Advances in Health Status As-
sessment, Menlo Park, ~~tifoniia, July 13-15, 1988.
~6
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APPLICATIONS AND AREAS FOR COOPERATIVE RESEARCH
117
need these data for special populations such as handicapped groups,
ethnic groups, Me elderly, and well populations.
By being able to interpret these measures in a broader variety of
populations, researchers can refine Weir work and strengthen Weir con-
elusions. The ~ntemational community is already active ~ this area. Dr.
Neil Aaronson of the Netherlands Cancer Institute has been ~nves~gadng
He applications of quality~f-life measurement in oncology clinical Vials.
He has also been working with the World Heath Organazadon (WHO)
CoBaborat~ng Center and is establishing a databank on He measurement
of quality of life in coccal teals.
Researchers agree Hat for He quality-of-life field to continue to de-
velop, it must be applied to daily clinics practice. Clinicians, In parUcu-
lar physicians, win carry most of the burden of using these measures.
Clinicians are the key to He future of quality-of-life measurement in
assessing health care because Hey form the frord line. Researchers must
cianfy the relationship between clinical and general heath measures as a
way for clinicians to appraise and appreciate what quality-of-life scores or
changes In scores mean In Heir clinical practice. By translating these
quality-of-life scores into concrete gains or losses, He clinician can con-
vert a score on a quality-of-life measure or a change in status to an
indication for the next step in treatment or ~ greater insight about the
health of a particular patient.
Short, easy to administer, and widely adaptable quality-of-life meas-
ures have He greatest chance of being used in a variety of clinical and
practice rouhnes. Researchers caution that although short-fonn measures
may be more practical, they may not achieve the level of reliability and
validity of lengthier forms. To convince others that undertaking the
expense and time necessary to gamer data on the various treatments and
procedures is worthwhile, researchers need to demonstrate Hat use of
these measures does improve He padents' outcomes.
Phamlaceubcal companies have alIeady funded some quality-of-life
research as part of their product development; in the long term, quality-of-
life concerns may become part of He marketing strategy for these fiens.
The interest these funding sources create in quality~f-life measures can
increase Heir use by providing a reimbursement system that would en-
courage cI~rucians to administer these measures.
Several researchers have emphasized the importance of good methodo-
logical work. Toward this end, many investigators principally interested
in measuring health outcomes have joined forces with researchers study-
ing methodological issues. These cooperative, "piggybacked'9 studies
OCR for page 118
118
J. FALOTICO-TAYl~OR AND F. MOSTF, FOR
capitalize on existing research opportunities by combining outcome and
methodological research. Methodology investigators can provide techni-
cal assistance to those measuring heady outcomes and may share costs if
me additional methodological work is expensive. Sponsors of bow types
of research win receive more information and thus a greater return on
Weir research ~nve;stment.
Ultimately, quality-of-life research offers padents a greater voice and
an opportunity to make more informed choices about their heath care.
For example, John Wennberg and his colleagues gave preoperative prostat-
ectomy patients We chance to hear from others who had undergone this
operation and who related, on film, their pre- md postoperative experi-
ences. This approach gives the preoperative padent a better understand-
ing of the consequences of this decision In quality-of-life terms. Cal
clans adso benefit because Weir patients have a more realistic view of what
a specific trea~anent win and win not remedy. Me joird effort of clin~-
cians, health care researchers, a~nin~strators, and funding sources can
strengthen technology assessments to improve the perceived as wed as
Me physiological impact of interventions on patients.
REFERENCE
Mosteller, F., Ware, I.E., Ir., and Levine, S. Finale Panel: Comments on
Me conference on advances in health status assessment. Medical Care
27:S282-S294, March Supplement, 1989.
Representative terms from entire chapter:
generic measures
