Showing papers in "Quality of Life Research in 1994"

Development of the Kidney Disease Quality of Life (KDQOL) Instrument

Abstract: This paper describes the Kidney Disease Quality of Life (KDQOLTM) Instrument (dialysis version), a self-report measure that includes a 36-item health survey as the generic core, supplemented with multi-item scales targeted at particular concerns of individuals with kidney disease and on dialysis (symptom/problems, effects of kidney disease on daily life, burden of kidney disease, cognitive function, work status, sexual function, quality of social interaction, sleep). Also included were multi-item measures of social support, dialysis staff encouragement and patient satisfaction, and a single-item overall rating of health. The KDQOLTM was administered to 165 individuals with kidney disease (52% female; 48% male; 47% White; 27% African-American; 11% Hispanic; 8% Asian; 4% Native American; and 3% other ethnicities), sampled from nine different outpatient dialysis centres located in Southern California, the Northwest, and the Midwest. The average age of the sample was 53 years (range from 22 to 87), and 10% were 75 years or older. Internal consistency reliability estimates for the 19 multi-item scales exceeded 0.75 for every measure except one. The mean scores for individuals in this sample on the 36-item health scales were lower than the general population by one-quarter (emotional well-being) to a full standard deviation (physical function, role limitations due to physical health, general health), but similar to scores for dialysis patients in other studies. Correlations of the KDQOLTM scales with number of hospital days in the last 6 months were statistically significant (p<0.05) for 14 of the 19 scales and number of medications currently being taken for nine of the scales. Results of this study provide support for the reliability and validity of the KDQOLTM.

Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group.

Abstract: Urinary incontinence (UI) is a relatively common condition in middle-aged and older women Traditional measures of symptoms do not adequately capture the impact that UI has on individuals' lives Further, severe morbidity and mortality are not associated with this condition Rather, Ul's impact is primarily on the health status and health-related quality of life (HRQOL) of women Generic measures of HRQOL inadequately address the impact of the condition on the day-to-day lives of women with UI The current paper presents data on two new condition-specific instruments designed to assess the HRQOL of UI in women: the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionaire (IIQ) Used in conjunction with one another, these two measures provide detailed information on how UI affects the lives of women The measures provide data on the more traditional view of HRQOL by assessing the impact of UI on various activities, roles and emotional states (IIQ), as well as data on the less traditional but critical issue of the degree to which symptoms associated with UI are troubling to women (UDI) Data on the reliability, validity and sensitivity to change of these measures demonstrate that they are psychometrically strong Further, they have been developed for simple, self-administration

Symptom prevalence, characteristics and distress in a cancer population

Abstract: Despite the importance of symptom control in the cancer population, few studies have systematically assessed the prevalence and characteristics of symptoms or the interactions between various symptom characteristics and other factors related to quality of life (QOL). As part of a validation study of a new symptom assessment instrument, inpatients and out-patients with prostate, colon, breast or ovarian cancer were evaluated using the Memorial Symptom Assessment Scale and other measures of psychological condition, performance status, symptom distress and overall quality of life. The mean age of the 243 avaluable patients was 55.5 years (range 23–86 years); over 60% were women and almost two-thirds had metastatic disease. The Karnofsky Performance Status (KPS) score was≤80 in 49.8% and 123 were inpatients at the time of assessment. Across tumour types, 40–80% experienced lack of energy, pain, feeling drowsy, dry mouth, insomnia, or symptoms indicative of psychological distress. Although symptom characteristics were variable, the proportion of patients who described a symptom as relatively intense or frequent always exceeded the proportion who reported it as highly distressing. The mean (±SD, range) number of symptoms per patient was 11.5±6.0 (0–25); inpatients had more symptoms than outpatients (13.5±5.4 vs. 9.7±6.0, p 80 (14.8±5.5 vs. 9.2±4.9, p<0.0001). The number of symptoms was highly associated with heightened psychological distress and poorer quality of life (for example, r=0.67 for the relationship with the Functional Living Index-Cancer, a QOL measure). These data clarify the prevalence and characteristics of cancer-related symptoms and suggest that the number of symptoms per patient may be a useful quality of life indicator.

Criterion validity and reliability of the SF-36 in a population sample.

Abstract: This study aimed to determine the criterion validity of the Short Form 36 health survey questionnaire (SF-36) in a large community sample, and to explore the instrument's internal consistency and validity in groups reporting different levels of ill-health A postal survey was undertaken using a questionnaire booklet, containing the SF-36 and a number of other items concerned with lifestyles and illness The questionnaire booklet was sent to 13,042 randomly selected subjects between the ages of 18-64 years, drawn from Family Health Services Authority (FHSA) computerized registers for Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire This paper is based upon the 9332 (72%) responses gained Scores for the functional status and well-being scales of the SF-36 were used as outcome measures The response rate for the questionnaire booklet was 72% Internal consistency of domains was found to be high, both for the sample as a whole, and when broken down by specific subgroups Criterion validity was assessed by comparing scores for the seven multi-item dimensions assessing functional status and well being with a single global health question The global question was the first item of the SF-36 and asks respondents to evaluate their health 'overall' Statistically significant trends were observed for decreasing SF-36 scores (ie, those indicating greater health problems) with worsening self-rated general health These results provide further psychometric evidence for the use of the SF-36 when used with groups reporting varying extents of ill-health

Psychometric properties and responsiveness of the EORTC Quality of Life Questionnaire (QLQ-C30) in patients with breast, ovarian and lung cancer

Abstract: The QLQ-C30, a health-related quality of life questionnaire developed for use in patients with cancer, has been previously validated in patients with lung cancer and head and neck cancer. In this study, further validation was carried out for 535 patients, including patients with breast cancer (n=143) and ovarian cancer (n=111) for whom there is no previously published validation, as well as patients with lung cancer (n=121). All patients were entered in one of two trials of anti-emetics to prevent chemotherapy-induced emesis. The QLQ-C30 was completed before chemotherapy and on day 8 after chemotherapy. The factor structure in patients with breast and ovarian cancer was similar to that previously described. Interdomain correlations, in the entire group, were strongest for the physical and role function domains and the fatigue, pain and global quality of life.domains before and after chemotherapy. In addition, after chemotherapy, social function was also strongly correlated with fatigue and global quality of life. These correlations were not always of equal strength in the breast, ovarian and lung groups, suggesting that there may be differences between these groups. The responsiveness of the QLQ-C30 in the presence of widely metastatic, as compared with locoregional, disease showed changes in the expected directions (i.e., diminished function in physical and social role functions and in global quality of life, with greater fatigue and pain in patients with metastatic disease). Eight days after chemotherapy, decreases were seen in physical, role and social functioning and in global quality of life, and there was greater fatigue, nausea and vomiting compared with before chemotherapy. Patients with breast cancer had better physical, role and social functioning, and less fatigue and pain than patients with ovarian cancer. This result is expected, since many of the patients with breast cancer had early stage disease, whereas those with ovarian cancer had advanced stage disease. Mean scores for patients with lung cancer were between the other two groups, in keeping with the mixture of early and advanced stage disease in these patients. There was a strong correlation between ECOG performance status scores and several domains of the QLQ-C30; these were all in the expected directions. The results of this study confirm those in earlier studies on patients with lung cancer, and provide new information on patients with breast and ovarian cancer. In addition, the QLQ-C30 is responsive to the effects of chemotherapy and of metastatic disease.

Quality of life in adult survivors of lung, colon and prostate cancer

Abstract: In a cross-sectional study design, a disease free sample of 57 lung, 117 colon, and 104 prostate cancer survivors who represented short, intermediate and long-term survivors completed a detailed assessment of quality of life (QOL) and rehabilitation needs using the CAncer Rehabilitation Evaluation System (CARES). Demographic and medical data, social support, and a global QOL rating were also assessed. Lung cancer patients showed no differences in QOL with respect to their period of survival. QOL improved for survivors of colon cancer as they lived for longer periods, but declined with time for survivors of prostate cancer. The best predictor of QOL for all groups was KPS, although other variables such as type of hospital, gender, and work status were predictive for survivors of colon cancer. For survivors of prostate cancer comorbidity with other medical illnesses, time since diagnosis and comorbidity due to psychiatric difficulties were predictive of QOL. All groups had significant rehabilitation problems in the domains of physical, psychosocial, sexual, medical interaction, and marital relationships. Lung cancer survivors had more problems than the other cancer survivors. We conclude that patients who survive cancer do not return to a state of normal health. They demonstrate a variety of difficulties with which they must cope as they continue to survive. Greater efforts need to be made early in diagnosis and treatment to understand rehabilitation problems and target interventions in the hope of reducing later sequelae.

Individual quality of life in the healthy elderly

Abstract: Quality of life research with the elderly has usually focused on the impact of decline in function, and used a pre-determined model of quality of life in old age. The Schedule for the Evaluation of Individual Quality of Life (SEIQoL) allows individuals to nominate, weigh and assess those domains of greatest relevance to their quality of life. The SEIQoL was administered to 56 healthy elderly community residents at baseline and 12 months later. Quality of life levels were significantly higher at baseline (t = -2.04; p = 0.04) than that of a previously studied sample of healthy adults below 65 years of age, and did not change significantly over the study period. The domains nominated by both samples as relevant to their quality of life differed notably. Health status was not correlated with the perceived importance of health at baseline, and showed only a low correlation (r = 0.27) at 12 months. The weight placed on health did not increase over the study period despite a significant decline in health status. The value of allowing the individual to define personal quality of life values in a research context is explored.

The incidence of back pain and headache among Swedish school children

Abstract: Musculoskeletal pain is exceedingly common in young adults. With the aim of studying these symptoms in schoolchildren, a questionnaire survey was carried out among children 8, 11, 13 and 17 years old. The prevalence of back pain and headaches in 1,245 schoolchildren was studied. Twenty-nine per cent of the students reported back pain and 48% headache. In all age groups studied, both back pain and headaches were more common among girls than boys. Girls also reported more frequent symptoms than boys. In a longitudinal study 471 schoolchildren were asked a second time 2 years later. Nine per cent reported back pain and 30% headache in both surveys. Five per cent reported both back pain and headache on both occasions. Despite the reported symptoms most of the pupils did not report health problems. However, pupils with reported pain on both occasions may constitute a risk group for future chronic pain. There were statistically significant relationships between social, psychological and emotional factors and reported symptoms. No relationship between physical factors and reported symptoms were noted. The observed relationships are not proof of causal relations but did indicate areas of problems which make interventions targeting pupils at risk an appropriate measure.

The Karnofsky Performance Status Scale re-examined: a cross-validation with the EORTC-C30.

Abstract: A cross-validation of the Karnofsky Performance Status (KPS) and quality of life (QOL) as measured by item 30 of the quality of life questionnaire developed by the European Organization for Research and Treatment of Cancer Study Group (EORTC QLQ-C30) was conducted using ordered logit analysis and prospective data from a continuous sample of 139 lung cancer patients. The QOL is found to be a much broader concept than the KPS, since it likely captures not only physical functioning but also functioning in the non-physical dimensions of social, emotional, and possibly cognitive well-being as well as the level of distress in the physical dimensions of pain, breathing and fatigue. These results suggest that the palliative treatment of advanced cancer and the terminally ill should be guided by a broad concept of well-being that goes beyond one based only on physical functioning.

The Spanish version of the Nottingham Health Profile: a review of adaptation and instrument characteristics

Abstract: The increased interest in measuring health status implies a need for instruments that are appropriate and valid. Adaptation of existing instruments may be a cost-effective strategy. In this paper we describe the adaptation into Spanish of the Nottingham Health Profile (NHP), a self-administered perceived health questionnaire developed in the UK. The characteristics of the adapted questionnaire (validity, reliability, and sensitivity to change), as well as current and purposed applications, are discussed. Some of the principles that were applied in the described adaptation process may be useful for similar future research: involving the investigators that developed the original instrument; using a panel of lay individuals in the translation process; testing the characteristics of the adapted instrument by replicating previous studies with the original instrument, and organizing an international group for the development and use of the European versions of the NHP. Adaptation of health status measures is an opportunity for gaining comparability when measuring health, and for learning about cross-cultural differences in health-related quality of life.

Logic, truth and language in concepts of pain.

Abstract: Logic and language influence our ideas about the truth of pain, and can alter our understanding of it. Physicians should not tell their patients that there is nothing wrong with them if all their test results are negative, as this denies their patients' experiences of pain. Popular methods of conceptualizing pain may be erroneous. Diagrams of pain or disability are misleading and unhelpful—it is not usually possible to distinguish their components in practice. Giving patients a high or low score for pain behaviour, depression or for health locus of control can influence our views on aetiology in a seriously misleading way. Anyway, aetiological attributions are not always possible from analyses of the experience of pain. The problems of logic and language inherent in assigning pain to emotional causes, in using behavioural approaches, and in defining idiopathic pain and somatization are discussed. The IASP definition of pain is important and useful, provided that it is used appropriately. The recommended version is now ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.’

Approaches to the analysis of quality of life data: experiences gained from a medical research council lung cancer working party palliative chemotherapy trial.

Abstract: Standardization in the choice of quality of life (QOL) instruments and their application in randomised clinical trials have been advocated and generally accepted However, there is now an urgent need to address the problems relating to the analysis and presentation of the data thus generated There are intrinsic difficulties associated with QOL data, namely its multidimensional nature, attrition and missing data, and there is no consensus as to how these problems should be dealt with This paper therefore considers there problems using interim data from a large Medical Research Council randomised trial in patients with small cell lung cancer and a poor prognosis, in which attrition and compliance are major concerns Three possible approaches to the analysis of these data, which use different subsets of patients, are examined in detail The strengths and weaknesses of these three methods are discussed, and examples of their use in the literature are given and compared with other reported approaches The need for a standard definition of compliance is also emphasised, and a method of presentation suggested The best current advice is that QOL data should be analysed in a number of different ways, and conclusions reached only when consistency is seen

Measuring quality of life in hospice patients using a newly developed Hospice Quality of Life Index.

Abstract: The purpose of this study was to evaluate the validity and reliability of the newly developed Hospice Quality of Life Index (HQLI). Sixty-eight patient/caregiver dyads from one hospice were asked to fill out the HQLI on admission and after 3 weeks of hospice care. Hospice experts evaluated the items on the tool to assess content validity. The content validity index (0.83) and the alpha coefficients (r = 0.87 and 0.83) supported the validity and reliability of the HQLI. Item analysis revealed items with which patients were most satisfied and aspects of quality of life that were considered to be most important.

The epidemiology of chronic pain in a Swedish rural area.

Abstract: In order to establish basic epidemiological data on chronic pain (duration > 3 months) in a rural population, a survey of pain symptoms was conducted by means of a postal questionnaire. The questionnaire was sent to a random sample (from the population register) of 15% of the population aged 25–74 (n=1806) in two Swedish primary health care districts. The response rate was 90%. In a follow-up study individuals selected among the responders (neck-shoulder pain, widespread pain and controls without pain; n=213) were examined and interviewed. They were requestioned about pain symptoms 24 months after the initial survey.

The reproducibility of the Childhood Asthma Questionnaires: measures of quality of life for children with asthma aged 4-16 years.

Abstract: This paper reports the internal consistency and reproducibility of the Childhood Asthma Questionnaires, measures of quality of life and symptom distress in paediatric asthma. A total of 535 children aged 4–16 years completed age appropriate forms of the questionnaire, over 1-or 3-week intervals. Pearson correlation coefficients between 0.63 and 0.84 for subscales of the questionnaires indicated good test-retest reliability while intraclass correlation coefficients in a very similar range showed that scores also remained at the same level on the two occasions. Comparisons between children with asthma and healthy non-asthmatics indicate that these are likely to be true estimates of stability. Internal consistency varied widely but was higher for older children and longer subscales. Implications of the findings for the use of the questionnaires in the evaluation of new asthma treatments are discussed.

Rapid translation of quality of life measures for international clinical trials: avoiding errors in the minimalist approach.

Abstract: There is a growing demand for tools to assess outcomes multinationally for use in international clinical trials. This has been accompanied by the need to produce valid and reliable questionnaires in a multiplicity of languages within a short time frame. We present an eight-step protocol for rapidly translating a quality of life (QOL) questionnaire into multiple languages, and demonstrate the protocol's utility and effectiveness by evaluating the translations for reliability and validity. The rapid translation protocol represents a minimalist approach to QOL questionnaire translation. Although this minimalist approach is not considered a recommended methodology, it may represent a feasible mechanism for questionnaire translation under certain circumstances. Most of the steps were completed in the USA, including a translation and back-translation by bilingual translators who were native speakers in the target-language, a test-retest of the translated instrument on five bilingual respondents to establish language and cultural equivalence and review of the translation by an editorial review board. The translated instrument was performance tested in the target language country on a pilot population of patients to determine its reliability and validity. Based on the findings, the instrument was further refined for use in the clinical trial.

The probability of recovery and return to work from work disability as a function of time.

Abstract: This paper describes a prospective longitudinal cohort study of musculoskeletal soft tissue pain impairment following a work related injury. It focuses on specific, univariate prognostic factors indicated in previous research studies that might affect the likelihood that injured workers will return to work or remain on work disability at any point in time. These factors include gender, age, return to work attempts and site of injury. Life table analysis was used to model the probability of work disability. The results showed that different disability and return to work patterns emerged for males and females. Males were more likely to return to work; however, females had a higher probability than males of remaining at work once they returned to work. Older workers had the highest probability of being off work any given number of days after injury; were less likely to return to work, and if they did, had a higher probability of becoming disabled again. Efforts to return early to work contributed to a decrease in overall work disability. Workers with low back injuries had a greater likelihood of recurrence compared to injuries at other body sites.

Spectrum of quality of life impairment in hypothyroidism.

Abstract: The aim of this study is to evaluate the frequency and relative importance of different aspects of health related quality of life (HRQOL) impairment in patients with hypothyroidism. A survey of 200 patients with treated hypothyroidism was undertaken. Patients were identified and questionnaires distributed through family physicians, endocrinologists, and regional branches of the Thyroid Foundation of Canada. Frequency of importance of patients' symptoms attributed to hypothyroidism and resolved or improved with treatment were measured. Establishing the wide variety of patient-specific complaints associated with hypothyroidism provides guidance for clinicians dealing with hypothyroid patients, and investigators interested in HRQOL impairment in these patients.

The economic impact of musculoskeletal disorders.

Abstract: Musculoskeletal disorders have a major impact on society in terms of morbidity, long-term disability and economics As populations increase and age, payment for medical care and indirect costs from loss of earnings will increase Both rheumatoid arthritis and low back pain have a great economic impact on society, and the costs of these are escalating problems Statistics are analysed from various studies in the United States and Canada, and these highlight the need for more rational and effective health care management strategies

Domains, constructs and the development of the breathing problems questionnaire

Abstract: Health-related quality of life (QoL) questionnaires are commonly developed as content valid instruments with conventionally defined domain subscales. We contrasted content valid domain subscales with construct valid construct subscales and developed a 13-domain QoL questionnaire, the Breathing Problems Questionnaire (BPQ), for patients with chronic bronchitis. In a series of studies, we examined the constructs relevant to COPD patients' experience of health. First, we provided psychometric evidence that items in the BPQ form two distinct groups: functional problems and negative evaluations. Second, we showed that problems were significantly more correlated with morbidity whereas negative evaluations were significantly more correlated with neuroticism. Third, we showed that negative evaluations correlated with neuroticism whereas positive evaluations (measured by the Satisfaction with Illness Scale) correlated with extraversion. Patients are more likely to make positive evaluations of their illness when they recognize that they are seriously ill. Most of the BPQ domains are subcategories of the construct of problems: both domains and construct classifications provide useful information.

Symbiotic relationships of quality of life, health services research and other health research

Abstract: Clinical biomedical research, the traditional research orientation of quality of life (QOL) researchers, is chiefly concerned with disease processes and assessing the impact of therapeutic interventions on improving health status and QOL outcomes. This paper suggests, however, that the biomedical paradigm limits utility of QOL research findings in terms of its ability to shape health policy and improve health-related QOL in populations at risk. This paper proposes that health services research (HSR) and other health research paradigms can be used to assess QOL from multiple perspectives. HSR and QOL research can be mutually beneficial. The models for understanding health services utilized in HSR may assist in defining major determinants of QOL and the interaction of QOL with its environment. Conversely, QOL measures may be used to establish the relevance of HSR to people's well-being. The paper first defines the domain of HSR and the domain of quality of life. In order to understand their relationship, we consider what a model or paradigm for each might be, and how they would overlap. Finally, a merging of conceptual frameworks is proposed, linking QOL research to HSR and other health research. Ultimately, expanding the QOL paradigm beyond the biomedical model will promote two objectives. First, it will permit research findings to contribute more fully to shaping national health policy by considering the broader community and the delivery system factors which influence QOL. Second, researchers will be more aware of a broader range of factors affecting patients and will incorporate this in their research.

Measuring change over time: a comparison of results from a global single item of health status and the multi-dimensional SF-36 health status survey questionnaire in patients presenting with menorrhagia.

Abstract: This paper compares the sensitivity to change of a multi-item, multi-dimensional health status measure with a single global health status question, in the assessment of treatment for menorrhagia. A cohort study of patients recruited by general practitioners, was carried out, with a follow up at eighteen months. Questionnaires were administered postally at baseline and follow up. General practices in Berkshire, Buckinghamshire, Northamptonshire and Oxford-shire supplied three hundred and nine women who reported heavy menstrual bleeding, and received either drug treatment alone or both drug and surgical treatment (endometrial resection or hysterectomy) during the eighteen months between the two admini-strations of the questionnaires. A single global question was given to patients asking them to rate their overall health status as ‘excellent’, ‘very good’, ‘good’, ‘fair’ or ‘poor’. The eight dimensions of the SF-36 health survey questionnaire were also given to patients to complete. The dimensions of the SF-36 indicated only small levels of improvement for patients who received drug treatment. However, on many dimensions of the SF-36, a moderate to large improvement was detected for the surgical group. However, small changes were reported in overall health status, as indicated by the single global question, for both groups. Single item measures of health status may not provide a sufficiently accurate indication of health status to be appropriate for use in longitudinal studies.

Research on health-related quality of life: dissemination into practical applications

Abstract: Stategles and processes for the effective dissemination and diffusion of research findings on healthrelated quallty of life (HQL) into practical applications were explored at a workshop held in Montreal in April, 1994. A conceptual model for dissemination and diffusion of evidence about HQL was used to identify five different target groups: HQL assessors, policy makers, planners of clinical trials, developers of clinical practice guidelines, and those at the level of patient-practitioner clinical decision making. A framework designed to facilitate the translation of fundamental research knowledge into effective action was then used as a starting point for discussions about priorities for research on HQL. The most important problem identified at the workshop was how best to strike an appropriate balance between priorities deemed to be important to those directly involved in HQL research, and priorities deemed to be important to potential users of the results of HQL research?

The time trade-off technique: how do the valuations of breast cancer patients compare to those of other groups?

Abstract: The time trade-off method was incorporated into a study of valuation of health states following treatment for breast cancer. A major aim of the work was to determine whether different groups give different valuations. The time trade-off technique was simple and quick to administer, acceptable to subjects, and produced different values in different groups. Age and sex of valuers had some influence: the most striking differences were found between women who had experlenced breast cancer and those who had not. The time trade-off method has considerable potential in health state valuation. The choice of valuers needs to be further explored.

Prepubertal children with short stature have a different perception of their well-being and stature than their parents

Abstract: The well-being of children with short stature has commonly been assessed by questioning the children's parents and teachers. Few studies have included questionnaires completed by the children themselves. The aim of this study to compare how short children and their parent perceive the height and well-being of the child. A total of 80 prepubertal children who were investigated for short stature at the Children's Hospital, Goteborg, Sweden were included in the study. The Silhouette Apperception Technique (SAT) was used to estimate the perception by the child and his/her parents of the child's present stature, as well as their expectations of the child's final stature. The mean ratings of the parents' and children's perception of the child's present stature indicate that both children and parents tend to overestimate it. The mean rating of the children's expectations of final height suggests that the children have high and unrealistic expectations of achieving a tall stature. A visual analogue (VA) scale was used to assess aspects of well-being. Although the children in this study did not seem to have a negative perception of their own well-being, their parents rated the children's well-being lower. The correlation between the ratings of parents and children were comparatively low on both the SAT and the VA scale, indicating that conclusions about how children perceive their height and well-being cannot be based solely on the opinions of proxy respondents such as parents.

Choices in oncology: factors that influence patients' treatment preference

Abstract: Medical treatment of cancer often entails a trade-off between outcomes of two different attributes: quality of life (QOL) and length of life (LL). This process of weighing advantages and disadvantages seems to be influenced by different factors. The main purposes of this study were (a) to investigate the relative importance of different factors on the trade-off and (b) to explore the relationship between these importance ratings and personal characteristics. We asked 199 patients with cancer to indicate to what degree they consider a number of factors to be of importance if they had to choose between two treatment modallties that differ in their expected outcomes concerning QOL and LL. The seven factors were their age at the time of decision, having a partner, having children, inability to work due to side-effects of the treatment, the nature of the side-effects, disease-related life expectancy and baseline QOL. The results indicate that six of the seven factors were of considerable to great importance when a treatment choice had to be made. The negative effects of treatment on the ability to work did not seem to be a very important consideration. Patient age and education were positively associated with importance ratings.

The Nottingham Health Profile as a measure of quality of life in zoster patients: convergent and discriminant validity.

Abstract: The main symptoms of zoster, a disease caused by the reactivation of the varicella zoster virus (that causes chicken-pox) are: rash, associated with pain, burning, or itching, and pain that outlasts the rash sometimes by months or years. The uncomfortable and long-lasting symptoms of herpes zoster are likely to compromise the patient's quality of life. However, the impact of zoster on health-related quality of life has not previously been measured directly. Recent papers have demonstrated the ability of generic measures to discriminate among patients with different clinical symptoms. In this paper, we demonstrate the convergent validity for zoster of a generic measure, the Nottingham Health Profile (NHP), by measuring its correlation with rash progression, pain levels, and pain medications. The discriminant validity of the NHP was demonstrated by its ability to distinguish between different levels of pain severity. The NHP dimensions most highly correlated with the pain measures, were pain (0.42–0.50), energy (0.34–0.38) and sleep (0.32–0.38). The NHP scores in all six dimensions show large differences at different levels of pain severity that are statistically significant. These results demonstrate the NHP's validity as a measure of health-related quality of life in zoster patients.

Colorectal cancer screening and quality of life.

Abstract: To evaluate the quality of life of patients following surgery for colorectal cancer, and to compare the quality of life between patients whose cancer was detected as a result of faecal occult blood screening with that of patients whose cancer presented symptomatically, an analysis was conducted within the context of the randomized controlled trial of colorectal cancer screening, University Hospital, Nottingham, UK A total of 418 survivors of the trial's test and control groups and 33 randomly selected cancer patients completed quality of life questionnaires (Nottingham Health Profile and Health Measurement Questionnaire) The mode of entry to diagnosis and treatment (screening vs non-screening) appeared to exert no major impact on post-intervention quality of life The stage of cancer progression was not closely related to outcome life quality A quality of life coefficient for surviving patients based on the Rosser classification was estimated to lie within the range 0948-0981 This figure accords well with the estimates of other studies of interventions in populations of similar age Overall, there are no grounds for believing that faecal occult blood screening for colorectal cancer per se significantly influences patients' post-intervention quality of life

Quality of life of cancer patients with different prognoses

Abstract: This study examines differences and similarities in the quality of life of 253 cancer patients with good, medium and poor prognoses. Our main hypothesis was that patients with a good prognosis will experience a higher quality of life than patients with a medium or poor prognosis. A multivariate analysis of covariance of eight quality of life scales was performed with prognosis as a factor and with age, sex, and the duration of the illness as covariates. Significant main effects of prognosis were found for the general QOL-scale and for physical aspects of quality of life. There were, however, only marginal and non-significant effects of prognosis groups on social and psychological functioning. A final multivariate analysis confirms earlier findings that performance status shows a weak but significant relationship with the psychological functioning. Thus, the physical condition of the patient at the time of measurement seems to have some influence on the psychological functioning, whereas the severity of the disease as inducated by the classification into prognosis groups does not. These results question the general attitude that seriously ill cancer patients have reduced social and psychological well-being. An alternative interpretation is that the scales used to measure psychological aspects of quality of life are inadequately sensitive.

Chronic pain—the end of the welfare state?

Abstract: The problem of low back pain has reached epidemic proportions in the industrialized nations. The predicament of back pain is common, 30–40% of our populations from 10–65 years old report such trouble to occur on a monthly basis. In 1–8% this results in work-disabling back pain. Only in very few of these patients can physicians diagnose a definite pathoanatomical cause for the pain. It can be deduced that psychosocial factors, including insurance benefits are of importance for this variation. Sweden, with 100% sickness benefits, has the highest disability rate.