Quality of Life and Technology Assessment (1989) / Chapter Skim
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2. The Use of Quality-of-Life Measures in Technology Assessment
2. The Use of Quality-of-Life Measures in Technology Assessment
Pages 7-44
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From page 7... ...
Such issues include study design and me Innitations and advantages of specific measures, as wed as me kinds of information and insights Hey produce. Quality-of-life indicators have generally been applied to therapies for chronic conditions, for conditions where an increase in length of survive is unlikely, and for conditions wad negative consequences of care that may outweigh its benefits.
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From page 8... ...
Objective measures include clinical measures, such as survival or He presence of medical complications, as wed as over concrete data provided by sources over Han He patient. Over half of the studies identified by Hollandsworth used both objective and subjective criteria.
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From page 9... ...
The rise in me number of quality-of-life studies reported in the literature suggests that these measures are playing an increasingly important role in bow clinical teals and me evaluation of a variety of medical interventions for chronic diseases such as hypertension, coronary disease, renal disease, arthritis, and cancer. To assist me reader in locating matters of interest in me studies reviewed in this chapter, we have provided several aids.
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From page 10... ...
McCLEllAN, AND F AlOSTFr~FR TABLE 2-1 Technologies Exemplified and Instruments Con~ibuhng to the Assessment Study Technologies Assessed Number and Instruments Used Page Number 1 Antihypertensive medications General Well-Being Adjustment Scale Life Saiisfacion Index Physical Symptoms Distress Index Sleep Dysfunction Scale Positive Symptoms Index from the Bnef Symptom Inventory Wechsler Memory Scale Reitan Trail-Malcing Test Social Participation Index Sexual Symptoms Distress Index 2 Ar~iiis medications Health Assessment Questionnaire Keitel Assessment Quality of Well-Being Questionnaire Toronto Activities of Daily Living Questionnaire McGill Pain Quesiionn~re Pun Ladder Scale 10 cm Pain Line Arthritis Categoncal Scale Arthritis Ladder Scale Overall Health Ladder Scale, Current Overall Health Ladder Scale, 6-Day Mean RAND Current Heals Assessment Measure 10 cm Overall Health Scale, by Patient 10 cm Overall Health Scale, by Physician Patient Utility Measurement Set Standard Gamble Questionnaire Willingness-to-Pay Questionnaire National Institute of Mental Heals ~MH)
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From page 11... ...
Long-tenn dialysis and renal transplant Quality-of-life indices Physical activist indices Kupfer-Detre System Form 1 Kupfer-Detre System Fonn 2 Renal transplantation and dialysis Ka~nofi;ly Index Index of Psychological Affect Index of Overall Life Satisfaction Index of Well-Being Work status 11 Case management and usual and customary services for calorically mentally ill patients Social Unction Affect Balance Scale Self-Esteem Scale Cost-benefit analysis 12 Heals insurance payment mecharusms General Health Rating Index 26 28 30 32 34 36 39 41 ~NOTE: Page number refers to the page in this chapter where discussion of dais application begins.
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From page 12... ...
Similarly, assessments of altemadve surgical procedures for breast cancer require special emphasis on body image and sexual fimction. THE VALUE OF ASSESSING QUALITY OF LIFE AS AN OUTCOME Measures of quality of life promote an emphasis on issues of direct importance to patients that are only indirectly reflected in clinical measures and interpersonal communication.
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From page 13... ...
Work status depends on whether or not patients were employed at He time of Heir treatment, their age, how patients view Heir work both before and after treannent, the support after treatment, and me outcome of treannent. We are told by experts that some patients put off important operations because they fear being discharged from their posidons after treatment.
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From page 14... ...
McC:LEUAN, AND F MOSTF-r FOR don may be difficult, and no established measures are ava~lablee Herbert L
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From page 15... ...
This index assesses satisfaction in fourteen areas including marriage, finances, standard of living, housing, and degree of social participation. Physical Symptoms Distress Index.
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From page 16... ...
Padents Mated win methyldopa improved only in Me area of costive functioning, and they worsened in me areas of depression, work performance, sexual functioning, physical symptoms, and life sadsfaction. Patients Heated wad propr~olol reported improved cognitive functioning and social participation, but they reported more sexual dysfunction and physical symptoms.
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From page 17... ...
Assessment; Quality of Well-Being Questionnaire; Toronto Activities of Daily Living Questionnaire; McGill Pain Questionnaire; Pain Ladder Scale; loom Pain Line; Arthritis Categorical Scale; Arthritis Ladder Scale; Overall Heal Ladder Scale, Current; Overall Health Ladder Scale, 6-Day Mean; RAND Current Health Assessment Measure; 10-cm Overall Health Scale,
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From page 18... ...
McC~AN, AND F MOSTF-J-J OR by Patient; 10-cm Overall Health Scale, by Physician; Padent Utility Measurement Set; Standard Gamble Questionnaire; WiDingness-to-Pay Questionnaire; Nations Institute of Mend Health Depression Queshonn~re; RAND General Health Perceptions Questionnaire Description of Measures Health Assessment Questionnaire (HAQ)
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From page 19... ...
Overall Health Her Scale, 6-D Mean. This scale averages the responses to overall heady for each of the past six days.
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They note Cat within the functional composite, the Quality of WeD-Being Scale, the Keitel Assessment instrument, and the Health Assessment Questionnaire showed "comparable sensitivity to treatment
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From page 21... ...
Key Technology Assessed: Adiuvant chemotherapy Patient Group: Adult women Diagnosis Type: Breast carcinoma Measure Category: Psychological, physical, and social function Measures: Perceptions of Emotional Dismiss and Behavior Disruption
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From page 22... ...
assessed the effect of adjuv ant chemotherapy for stage IT breast carcinoma on me quality of life of postmastectomy patients. Methods The investigators selected 50 consecutive, postmastectomy patients, by order of their appointments, from among Hose patients actively participating In the University of Califom~a at Los Angeles (UCLA)
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From page 23... ...
The women reported a decrease in bow general and wo~-related levels of activity as We most frequent and mated effect of adjuvant chemotherapy. Additionally, 45 percent of me women reported Tat Heir job status had been adversely affected since Hey had begun chemotherapy.
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From page 24... ...
Investigators stratified these patients by inshtution, clinical performance status, and previous treatment with adjuvant chemotherapy. The researchers based their comparisons of scores on quality-of-life measures on changes in the scores of each patient dunng treatment.
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Results demonstrate Rat intermittent therapy is inferior in palliative treatment for patients with advanced breast cancer in bow clinical and quality-of-life measures. This suggests Cat improved quality of life for patients with advanced breast
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From page 26... ...
Key Technology Assessed: Counseling for stage IV cancer Patient Group: Abut men with incurable cancer Diagnosis Type: Stage IV cancer Measure Category: Psychological function Measures: Cumulative Illness Rating Scale, Depression Factor of the Psychiatric Outpatient Mood Scale (POMSy, She~wood's Self-Esteem Scale, Can~il's Life Satisfaction Scale, Srole's Alienation Scale, Rotter's Locus of Con=l Scale, Rapid Disability Rating Scale Description of Measures Cumulative Illness Rating Scale. This scale assesses Me degree of ~mpairment to 13 body systems on f~ve-point scales.
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From page 27... ...
A physician completed me Cumulative Illness Rating Scale. The investigators compared groups for baseline differences and at foBow-up for survivors.
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From page 28... ...
Mat, ED F WOLFF I OR lime, both life satisfaction and self-esteem were sign~ficar~y increased for Me experimental patients.
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From page 29... ...
assessed quality~f-life differences in depression and body image between altemacive surgical and radiation therapies for patients with potentially curable breast cancer. Methods Me investigators studied 123 Montreal padents with potentially curable breast cancer, matched for venous socioeconomic variables, in the B-06 Nabonal Surgical Adjuv ant Breast Project.
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From page 30... ...
A comparison of the quality of life of cardiac transplant patients and coronary artery bypass graft patients before and After surgery. Quality of Life and Cardiovascular Care 1~7)
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From page 31... ...
There are 30 questions in all, most requiring a yes or no response. Purpose of the Study Wallwork and Caine compared the quality of life of cardiac transplant patients win those of coronary artery bypass graft (CABG)
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From page 32... ...
Although CABG patients reported a similarly high rate of improvement in this area, they demonstrated the greatest improvement in the area of employment; 70 percent of CABG patients compared with 56 percent of transplant patients resumed to work approximately one year af er surgery. The transplant patients' recovery rate, however, may be more striking considenng their preoperative level of impairment.
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From page 33... ...
Purpose of the Study Ott et al. determined the impact of Wee different cardiac rehabilitation programs on the quality of life of padents who suffered a myocardial infarction.
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From page 34... ...
Key Technologies Assessed: Long-tenn dialysis and renal transplantation Patient Group: Adults on long-tenn hemodialysis or transplant recipients Diagnosis Type: Renal failure
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From page 35... ...
The investigators selected this region because most padents with renal failure were able to receive treatment win a reasonably uniform level of management Results and Conclusions The investigators found that quality of life was lower for dialysis patients Can for transplant recipients. The dialysis patients were more likely to be unemployed, to be less physically active, to have less satisfac
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From page 36... ...
Measure Category: Physical, role and social function, and global weBbeing Measures: Ka~nofsky Lndex, Index of Psychological Affect, Index of Overall Life Satisfaction, Index of WeD-Being, work status Description of Measures Karnofsky Index. This is an objective measure of overall physical function.
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From page 37... ...
They found Mat transplant recipients had Me least functional impairment; those treated through in-center dialysis were most impaired. Almost 75 percent of transplant recipients were able to work, compared with 60 percent of those on home dialysis and much lower proportions of
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From page 38... ...
Subjective measures reveal Hat these padents may be experiencing levels of quality of life much closer to those of the general population Can objective measures might indicate. Although these results may demonstrate the "psychological adaptability" of ESRD patients, and possibly that of chronic disease patients more generally, they also raise policy questions concerning the appropriate standards for Reagent decisions.
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From page 39... ...
:674-678, 1987. Key Technology Assessed: Case management versus '`usual and customary" services for chronically mentally ill patients Patient Group: Mentally id adults Diagnosis Type: Mental illness Measure Category: Mental, role, and social function Measures: Social function, Affect Balance Scale, Self-Esteem Scale, Cost-Benefit Analysis Description of Measures Social function.
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From page 40... ...
Investigators found few significant differences in quality-of-life measures between He two groups. They concluded dlat tile expenmental case management approach appeared to increase costs substantially without demonstrating any important effect on He quality of life of mental patients.
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From page 41... ...
:1426-1434, 1983. Key Technology Assessed: Health insurance paymera mechanisms Patient Group: General adult population (under age 65)
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From page 42... ...
REFERENCES Bombardier, C., Ware, J., RusseD, I.J., Larson, M., Chalmers, A., and Read, J.~. Auranofin therapy and quality of life In patients win rheumatoid arthritis.
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From page 43... ...
A controlled randomized study of early cardiac rehabilitation: The Sickness Impact Profile as an assessmenttool. HeartandLungI2~2~:162-170,1983.
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From page 44... ...
Wallwor3`, I., and Caine, N A comparison of Me quality of life of cardiac transplant patients and coronary aneIy bypass graft padents before and aRer surgery.
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