At BioMatrix, we are committed to improving quality of life for patients and producing positive outcomes along the healthcare continuum. This article discusses how quality of life (QOL) is defined in healthcare, how it’s measured, and why it’s important to monitor.
How is quality of life (QOL) defined and influenced?
In 1948, the Constitution of the World Health Organization defined health as “a state of complete physical, mental and social well-being.” This was a departure from the tendency to see health only in terms of the presence or absence of disease.1 Today, QOL in healthcare is still defined and broken down by three domains, or ‘perceptions of health’.2
Physical functioning: symptoms resulting either from the disease itself or from treatment and the ability to perform a range of daily activities
Psychological functioning: ranges from severe psychological distress to a positive sense of well-being and may also encompass cognitive functioning
Social functioning: quantitative and qualitative aspects of social relationships and interactions and societal integration
Within these three domains/perceptions of health, QOL is influenced and determined by many factors. Over the past few decades, medical outcomes researchers and medical sociologists have categorized QOL determinants as:3
1. Health-related
2. Sociological and economical
Each of these domains can be measured both objectively and subjectively.
Health-related ParametersWhen defining and measuring QOL, health-related parameters need to be both provider and patient reported. While the objective health status of symptoms is recorded by a physician, this fails to describe the patient’s tolerance and discomfort for these symptoms. Two people with the same health status may have very different expectations regarding health and the ability to cope. These differing expectations can greatly affect a person's perception of health and satisfaction with life.2
Patient reported parameters are important because patients have the best perspective on the impact of their treatment. They experience first-hand the physical and financial burdens of treatment that may also affect their adherence to treatment and other provider recommendations.3
Sociological and Economical ParametersOverall QOL may be strongly influenced by factors that are unseemingly related to health, such as economic status, employment status, and family situation.3 Again, there is both an objective and subjective component. For example, financial burden may decrease a patient’s adherence rate, objectively making treatment less successful while a stressful family situation may subjectively and negatively alter a patient’s perception of their treatment outcome.
How is quality of life (QOL) measured?
Though QOL should include both measurements of objective and subjective (perceived) components (symptom, condition, or social role), the subjective (perception) of improvement by the patient and a greater sense of well-being due to an improved self-image may actually be the most relevant therapeutic benefit.2
The EQ-5D-5L Questionnaire is an instrument that measures these components and weighs them accordingly. It’s a preference-based descriptive system with one question presented for five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. It also includes a Visual Analog Scale (VAS), where perceived health status can be reported with a grade ranging from 0 (the worst possible health status) to 100 (the best possible health status).4 EQ-5D can be used anywhere a general measure of health status is useful such as clinical trials, population health surveys, or routine outcome measurements.5 Guides on how to fill out and report results for EQ-5D can be found here.
Why is QOL important to measure and monitor?
Understanding patient QOL supports a more well-rounded, higher quality of clinical care to patients. QOL data has helped further clinical care studies, clinical trials, and cost-effectiveness studies in these four areas:3
Assessments of treatment outcomes and to qualify survival—both between provider and patient, and for FDA drug approvals
Assessments of late problems—i.e. mere survival gain to survival gain accompanied by a health-related QOL comparable to that of the survivor’s peers
Mortality Predictions—i.e. ample evidence now indicates that health-related QOL measurements independently predict survival
Transfer of Patient Information—i.e. through QOL surveys given to patients while waiting for their doctor visit, doctors can gain a greater amount of data on their patient
QOL assessments can also help inform treatment plans by answering questions such as:2
What will the effect of a treatment plan be regarding day-to-day quality of life and long-term complications?
Are relatively small gains in survival for a patient with a limited life expectancy worth the reductions in their QOL due to aggressive long-term therapy?
Do cost-containment programs for employers, such as high-deductible insurance plans and shifting more costs to employees, actually increase employer costs due to decreased functioning and productivity of employees?
Why is QOL important to measure and monitor specifically in Specialty Pharmacy?
Specialty pharmacies, like BioMatrix, have the opportunity to improve future QOL outcome metrics, thus enhancing and improving the patient experience. By quantifying QOL, specialty pharmacies can:
Allow individual patients to collaborate in their own assessment and, ultimately, decision-making in the healthcare they receive
Help minimize costs associated with the treatment of costly severe chronic disease
Determine the impact of health care when a cure may not be possible
Specialty pharmacies can use QOL data to collaborate with providers which helps:
Minimize the risk of patients incurring harm
Increase the probability of providing treatments that may improve symptoms associated with chronic incurable diseases
Minimize the cost impact of treatments to patients, providers and institutions (i.e., insurers, state, and federal government)
At BioMatrix, we use the EQ-5D-5L questionnaire to measure and help improve QOL and help empower patients to live each day to its fullest potential. We set the standard for exceptional care maximizing the health and satisfaction for each patient served. Learn more.
In summary, quality of life (QOL) in healthcare is weighed heavily by patient perception of both their objective and subjective well-being. While it’s measured and monitored through complex questionnaires and reporting, understanding QOL is incredibly beneficial in supporting a more well-rounded, higher quality of clinical care to patients.
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References
Croat Med J. (2006). The Meanings of Health and its Promotion. NCBI, U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080455/
Testa MA M.P.H. Ph.D., Simonson DC M.D. (1996). Assessment of Quality-of-Life Outcomes. The New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJM199603283341306
Schwartz CE, Sprangers MAG. (2003). An introduction to quality of life assessment in oncology: The value of measuring patient-reported outcomes. The American Journal of Managed Care. https://www.researchgate.net/profile/Carolyn-Schwartz/publication/10963675_An_introduction_to_quality_of_life_assessment_in_oncology_The_value_of_measuring_patient-reported_outcomes/links/02bfe50ef12daed3d2000000/An-introduction-to-quality-of-life-assessment-in-oncology-The-value-of-measuring-patient-reported-outcomes.pdf
Balestroni G, Bertolotti G. (2012). [EuroQol-5D (EQ-5D): an instrument for measuring quality of life]. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/23614330/
EQ-5D. How Can EQ-5D be Used. https://euroqol.org/eq-5d-instruments/how-can-eq-5d-be-used/
