Quality of Life and Technology Assessment (1989) / Chapter Skim
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6. Assessing Quality of Life: Measures and Utility
6. Assessing Quality of Life: Measures and Utility
Pages 65-115
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From page 65... ...
Those especially concerned about such matters may wish to go directly to the section entitled "Strategies Used to Assess Instruments," and then to the section entitled "l~e Sources of Descnp~ve ~fonnation for Quality-of-Iife Measures," which lists Awe key reference WOTICs that provide names, descnpua~s, and properties of a number of standard instruments. Readers may then skip to "Ten Review Fonns for Quality-of-Iife Measures," where sources are listed and rewew forms supplied for some instruments not described in standard works.
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From page 66... ...
, functional disability (Katz Activities of Daily Livings, heals status measures (RAND health status measures, Sickness Impact Profile) , and measures of life satisfaction and psychological weD-be~ng.
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From page 67... ...
For example, the Quality of Life Index developed by Spitzer et al.
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From page 68... ...
Although researchers and policymakers tend to malce much of He distinction between objective and subjective measures, bow are probably necessary when assessing quality of life, and bow require ~nves~gadons into Heir reliability and validity. It is pethaps supposing Hat He objective measures often are not as weU standardized as He subjective measures; objectivity does not automatically mean mat measures are reliable and valid.
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From page 69... ...
Lnvestigators' working win concepts and methods developed in economics, are desiring measures of the utilities of heady states, win me typical scores ranging from 0 for "Dead" to ~ for "Normal Heath." By multiplying the utility values by the number of years individuals live win a given health state, survival time can be expressed in Quality Adjusted Life Years (QUAY)
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From page 70... ...
Conversely, Chubon (1987) used the Life Situation Survey to compare the quality of life of patients in chronic care and rehabilitation programs wad Lose of healthy subjects.
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From page 71... ...
We used the Review Form to gamer bibliographic information, Be stated purpose of me measure, its underlying concept framework, and a descriptor of its content and fonnat. As part of this review, we have Died to use terms Cat are consistent wad Pose compiled in the Dictionary of Epidemiology Beast 1988)
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From page 72... ...
If me variables being considered are sufficiently objective to be evaluated by persons over man me patients, it is possible to compare raters' scores. For example, the Quality of Life Index is designed to be completed by the heady professions responsible for me care of We patient and significant others as well as by patients themselves.
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From page 73... ...
For example, the quality-of-life scores should differentiate patients dying of cancer, patients in intensive care, outpatients win chronic diseases, and hearty individuals, even Cough mere may be substantial overlaps in We distributions of scores. Concurrent criterion validity refers to me ability of a measure to differentiate between groups at We time the measure is applied.
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From page 74... ...
A REVIEW OF SELECTED MEASURES FOR ASSESSING QUALITY OF LIFE We reviewed 10 measures for rating quality of life using the Review Form for Quality-of-Life Measures. The section entitled "Ten Review Forms for Quality-of-Life Measures" presents the completed fonns, and Table 6-1 (see page 76, this volume)
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From page 75... ...
PadiDa ong~naBy developed her measure while working with cancer patients. She adapted the measure for use with colostomy patients, adding a number of disease-specific items.
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From page 76... ...
Dimensions Principal activity, Life quality Physical condition, activities of daily daily activities, living, heals, personal abrades social support, outlook on life Reliability Eternal consistency $*
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From page 77... ...
* Symptoms, sociability, daily living, satisfaction retirement, pe~e of mind, faidl, life goals, appearance, happiness, satisfaction *
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From page 78... ...
Scale Q~tionnawe First author Selby Priestman Levine Assessment Cancer-sp~ific Disease-speciB~c Cancer-,peafic Rater Patient, physician Patient Interviewer Subjects Cancer patients Patients (cancers Breast cancer of breast, long, patients bladder) Dimensions 12 categories of Symptoms, side Consequences SIP, clinical effects, anxiety, of hair loss, problems depression, emotionaldys personal function, physical relations, physical symptoms, trouble performance with treatment, fatigue, nausea, positive well-being Reliability Internal consistency *
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From page 79... ...
Priestman and Baum (1976) were among the first to use this technique for quality-of-life assessments of cancer patients.
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From page 80... ...
This method is referred to as a rating scale. The standard gamble technique was me original method for denying utility values.
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From page 81... ...
Churchill and his associates (1987) compared time trade-off utilities of end-stage renal disease patients with the ratings of physicians on Me Quality of Life Index and found them to be congruent That is, they demonstrated construct validity.
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From page 82... ...
We found no published reports Tat compare the utility values denved by me standard gamble, time trade-off, and rating scale mesons outlined by Torrance with me QWB utility values developed by me San Diego group. Several questions and criticisms have been directed toward the use of utility values and QALYs in quality-of-life assessments.
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From page 83... ...
The public has even more skepticism about multiplying He life expectancy times the utility values to obtain a "quality-adjusted life year." ~ summary, uglier assessments of quality of life can at best be descnbed as technology with promise and potential, but not as one accepted by the public. THREE SOURCES OF DESCRIPTIVE INFORMATION FOR QUALITY-OF-LIFE MEASURES The editors and He authors of this chapter refer readers to Tree books for reviews of more extensively studied and filmy established quality-oflife measures.
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From page 84... ...
Scales · A Rapid Disability Rating Scale The Functional Status Index The Pad ent Evaluation Conference System · The Functional Activities Questionnaire · The Lambeth Disability Screening Questionnaire · The Disability and Brnpair~nent Interview Schedule Psychological Indices . The Health Opinion Survey · The 22 Item Screening Score of Psychiatric Symptoms
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From page 85... ...
. · The Arthritis Impact Measurement Scare The Physical and Mental hopairment-of-Function Evaluation The Functions Assessment Inventory The Nottingham Health Profile The Sickness Impact Profile The Mul~dieve} Assessment Instrument The Older Americans Resources and Services (OARS)
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From page 86... ...
: Physical Heath Measures of Ability to Perfonn Activities of Daily Living (ADL) or Physical Functioning · PULSES Profile Index of ADL Kenney Self-Care Evaluation · Barthel Alex Rapid Disability Rating Scale (RDRS)
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From page 87... ...
Dementia Rating Scale (DRS) Extended Scale for Dementia Face-Hands Test Visual Counting Test Set Test Misplaced Objects Test Wechsler Adult Intelligence Scale (WAIS)
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From page 88... ...
OARS Social Resources Scale Social Dysfunction Rating Scale Social Behavior Assessment HRCA Reduced Actvides Inventory Activity Scale Unusual Day Future Activity Scores Measures of Subjective WeD-Being and Coping Cavan Attitude Inventory Kllmer Morale Scale Life Satisfaction Index OberIeder Attitude Scale Contentment Scale Tri-Scales
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From page 89... ...
Hat provides infom~adon on me reliability, validity, and sensitivity of various measures of heal status. TEN REVIEW FORMS FOR QUALITY-OF-LIFE MEASURES The review forms give, where available, the name of He measure, He auroras)
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From page 90... ...
I Review Form for Quality of Life Index and Quality of Life Uniscale Name of Measure: Quality of Life Index Spitter Quality of Life Un~sc~e~pit;zer Authors: Spitzer, W.O., Dobson, A.~., Hall, I., Chestennan, E., Levi, I., Shepherd, R., Bafflsta, R.N., and Catchiove, B.R.
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From page 91... ...
Validity: Content: Content validity was based on a review of the literature and on information supplied by content panels of patients with venous diseases, Heir relatives, healthy persons, physicians, other health professionals, arid clergy. Items were selected in a E-stage process; the final choices were based on methodological and content criteria Concurrent: In Australia, measures showed mean differences between 84 healthy individuals in Sydney, 101 healthy individuals in Hunter Valley, 108 chronically ill patients, 105 cancer patients' and 78 senously iD patients In hospital.
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From page 92... ...
Assessment of me quality of life of patients win advanced cancer. European Journal of Cancer and Clinical Oncology 19~:~161-1165, 1983.
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From page 93... ...
Purpose: The Life Situation Survey is a subjective Vestment that can be used in a variety of populations, including patients in chronic care and rehabilitation programs. Conceptual Framework: Chubon is critical of quality-of-life measures that are disease-specific or focus on functional limitations.
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From page 94... ...
WII HAMS AND S WOOD-DAUPHINFF TABLE 6-2 Sample Sizes, Means, and Seward Deviations for Me Life Situation Survey Medium End-Stage Back Spinal Mentally Security Renal Disease Problem Injury Retarded Feature Students Inmates Patients Patients Patients Individuals Sample size 50 44 27 22 16 30 Mean 107.3 743 83~2 81.1 87.9 102~3 Standard deviation 11.2 14.9 14.1 20.9 26A 13.8 Predictive: Mean scores and standard deviations forpre- and postu~atment groups for 37 of 55 persons who completed a 55-day program for chronic back pain were as follows: pre~eannent mean = 83 9?
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From page 95... ...
Internal consistency: Item analysis of We 14-item index across four samples yielded an alpha of 0.88. Scalability: Ten-cendmeter visual analogue scales are used.
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From page 96... ...
Purpose: This ~ns~ument is used to assess Me quality of life of colostomy patients. Conceptual Framework: The QLl for patients win cancer (PadiBa et al., 1983)
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From page 97... ...
5. Review Form for Quality of Life Index Name of Measure: Quality of Life Apex Authors: Ferrans, C.E., and Powers, M.~.
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From page 98... ...
Validity: Content: Items were based on a literature review of Me dimensions of quality of life as wed as on padent reports of how dialysis affected Me quality of their lives. Concurrent: The scores on me Quality of Life Index were correlated against an overall satisfaction win life measure (Campbell, 1976~.
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From page 99... ...
(Gr~eco and Long 1984~. Sets of physicians or mental health professionals assessed 75 cancer patients.
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From page 100... ...
KPS scores by physicians were correlated with ~ ~ variables assessing the type and severity of problems experienced by cancer patients. The correlations were significant but tended to be low (~0.51)
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From page 101... ...
Primary Reference: Measuring He quality of life of cancer padents: The Functional Living Index—Cancer: Development and validation loumad of Clinical Oncology 2~5~:472483, 1984. Purpose: The Functional Living Index—Cancer COLIC)
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From page 102... ...
were correlated with the Katz Activities of Daily Living instrument, Goldberger's General Heady Queshonna~re win four subscales, the Beck Depression Inventory, Ka~nofsky Index, Speilberger State Treatment Anxiety Inventory, and Meizack Pain Inventory. AU instruments were tested in Winnipeg and Edmonton, except for Me Melzack Pain Inventory, which was tested only in Edmonton.
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From page 103... ...
Ganz, P.A., Hasked, C.M., Figlin, R.A., La Soto, N., and Siau, I Estimating the quality of life in a clinical trial of patients win metastatic lung cancer using He Kamofsky performance status and He Functional Living~dex~ancer.
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From page 104... ...
Internal consistency: Using me scores from 96 breast cancer patients, investigators reported an alpha of 0.71. Interrater: Self-assessments by 31 patients and ratings by physicians were correlated.
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From page 105... ...
References and Applications: Bed, D.R., Tannock, I.F., and Boyd, N.F. Quadity of life measurement in breast cancer patients.
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From page 106... ...
Reliability: Stability: Twenty-nine breast cancer patients completed forms with 10 items. These fonns were completed again 24 hours later at home.
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From page 107... ...
Linear Analogue Self Assessment MASAI in He evaluation of aspects of me quality of life of cancer patients receiving therapy. European Joumal of Cancer and Clinical Oncology 19~:1633-1637, 1983.
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From page 108... ...
:1-7, 1988. A linear analogue scale consisting of 10 items, including feeling of well-being, mood, level of physical activity, pain, nausea, appetite, ability to perform work, social activities, level of anxiety, and whether treatment is helping, was a~nin~stered to 98 cancer patients over 293 office visits and 137 family practice padents over 137 visits.
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From page 109... ...
Conceptual Framework: The investigators reviewed We available measures of quality of life for cancer patients' but these did not focus on me specific problems of women wad advanced breast cancer faced wad receiving adjuvant therapy. Their god was ~ develop a measure specific to me type of patient and me type of therapy.
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From page 110... ...
A nursep~nterviewer administered me BCQ, He RAND Physical Health and Mental Heady Status queshonnatures, and the Spitzer Quality of Life Index. The physician completed the Kamofsky Index.
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From page 111... ...
Coates, A., Gebski, V., Bishop, Id., Jeal, PA., Woods, R.L"., Snyder, R., Tattersall, M.H., Byme, M., HaIvey, V., and Gill, G., for He Australian-New Zealand Breast Cancer Tnals Group, Clinical Oncology Society of Australia Improving the quality of life during chemo~erapy for advanced breast cancer. A comparison of intermittent md
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From page 112... ...
Scale for the assessment of quality of life for metastatic lung cancer patients. American loum~ of Clinical Oncology 2~6~:630-633, 1988.
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From page 113... ...
Morris, J.N., Suissa, S., Sherwood, S., Wright S.M., and Greer, D Least days: A study of me quality of life of terminally ill cancer patients.
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From page 114... ...
Measuling the quality of life of cancer patients: The Functional Living Index Cancer: Development and validation. Journal of Clinical Oncology 2~5~:472483, 1984.
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From page 115... ...
Evaluation of patients win advanced cancer using the Kamof~y perfonnance status. Cancer45~:222~2224, 1980.
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