How do you assess quality of life in patients?

From the Guidelines

Quality of life in patients should be assessed using a combination of standardized questionnaires, such as the EQ-5D, and clinical evaluation, incorporating patient-centered outcome measures like PROMs and PREMs, as recommended by the most recent study 1. To assess quality of life, a comprehensive approach is necessary, including:

• Standardized questionnaires, such as the EQ-5D, which measures health-related quality of life and provides a global life satisfaction measurement
• Clinical evaluation, including objective measures like physical symptoms, functional status, and laboratory values
• Subjective patient-reported outcomes, regarding physical, psychological, social, and spiritual wellbeing
• Direct patient interviews to understand personal goals and values
• Observation of daily activities and input from caregivers when appropriate The use of validated tools, such as the SF-36 or disease-specific instruments like the EORTC QLQ-C30, can provide valuable insights into the patient's quality of life 1. However, the most recent and highest quality study 1 suggests that incorporating patient-centered outcome measures, such as PROMs and PREMs, into routine clinical care is essential for a comprehensive assessment of quality of life. Regular reassessment is crucial, particularly after treatment changes or disease progression, to capture the patient's perspective on their health status and treatment effects, which may differ significantly from clinician assessments. By prioritizing patient-centered care and using standardized questionnaires, clinicians can provide more personalized care planning and identify areas where interventions might improve overall wellbeing beyond just treating the disease itself.

From the FDA Drug Label

The Daily Record of Severity of Problems (DRSP), a patient-rated instrument that mirrors the diagnostic criteria for PMDD as identified in the DSM-IV, and includes assessments for mood, physical symptoms, and other symptoms Other efficacy assessments included the Hamilton Depression Rating Scale (HAMD-17), and the Clinical Global Impression Severity of Illness (CGI-S) and Improvement (CGI-I) scores. The Liebowitz Social Anxiety Scale (LSAS), a 24-item clinician administered instrument that measures fear, anxiety and avoidance of social and performance situations, The Duke Brief Social Phobia Scale (BSPS), a multi-item clinician-rated instrument that measures fear, avoidance and physiologic response to social or performance situations, The Marks Fear Questionnaire Social Phobia Subscale (FQ-SPS), a 5-item patient-rated instrument that measures change in the severity of phobic avoidance and distress

To assess quality of life in patients, the following instruments can be used:

• Patient-rated instruments:
  • Daily Record of Severity of Problems (DRSP)
  • Marks Fear Questionnaire Social Phobia Subscale (FQ-SPS)
• Clinician-administered instruments:
  • Hamilton Depression Rating Scale (HAMD-17)
  • Liebowitz Social Anxiety Scale (LSAS)
  • Duke Brief Social Phobia Scale (BSPS)
• Clinical Global Impression scores:
  • Clinical Global Impression Severity of Illness (CGI-S)
  • Clinical Global Impression Improvement (CGI-I) 2

From the Research

Assessing Quality of Life

To assess quality of life in patients, several factors and instruments can be considered. The following points highlight key aspects of quality of life assessment:

• Multi-dimensional assessment: Quality of life is a multi-dimensional concept that encompasses physical, psychological, social, and environmental aspects 3. Assessing quality of life requires considering these various dimensions to get a comprehensive understanding of a patient's well-being.
• Instruments and questionnaires: Several instruments and questionnaires are available to assess quality of life, such as the WHOQOL-BREF, EQ-5D-5L, and PROMIS 3, 4. The choice of instrument depends on the specific aspects of quality of life being assessed and the population being studied.
• Patient-reported outcomes: Patient-reported outcome measures (PROMs) are essential in assessing quality of life, as they provide a patient's perspective on their health and well-being 4. PROMs can be used to evaluate the effectiveness of treatments and interventions.
• Physical activity and quality of life: Physical activity has been shown to improve quality of life and well-being in various populations, including adults and older adults 5. Assessing physical activity levels can be an important aspect of quality of life assessment.
• Frailty and quality of life: Frailty, a multi-dimensional concept that includes physical, psychological, and social aspects, can impact quality of life in older adults 6. Assessing frailty can help identify individuals at risk of poor quality of life and inform interventions to improve their well-being.

Key Considerations

When assessing quality of life, the following considerations are important:

• Definition and operationalization: Quality of life should be clearly defined and operationalized in the context of the assessment 4. This ensures that the concept is measured consistently and accurately.
• Cultural and socio-demographic factors: Quality of life assessments should take into account cultural and socio-demographic factors that can impact an individual's perception of their well-being 3, 6.
• Comprehensive assessment: A comprehensive assessment of quality of life should consider multiple dimensions, including physical, psychological, social, and environmental aspects 3, 6.