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What should your 'quality of life' score be?
October 01, 2002In a controversial article in the October Journal of the Royal Society of Medicine, Dr Michael Koller and Dr Wilfried Lorenz publish their new 'quality of life profile' which they argue can be used alongside other medical tests.
It's not how ill you are, it's how you feel about it
Traditionally, doctors focus on the clinical aspects of a patient's response to treatment. Koller and Lorenz, at the Philipps-University Marburg in Germany, conducted a series of studies which indicate that the psychosocial response is just as important. Their work suggests that the problems a patient has with disease symptoms are closely linked to their 'quality of life' rating, based on basic psychological characteristics such as ability to cope and optimistic expectations. Patients with these characteristics are less likely to have symptom distress - no matter how severe the illness is judged to be by traditional medical criteria.
The authors warn: "in order to fully understand a patient's situation, two sides of the coin have to be taken into consideration: the classical medical aspects such as physical complications, as well as the patient's self-reported quality of life."
Case studies
In two case studies, Koller and Lorenz investigated how patients' quality of life is separate from how ill they actually are. Patient B, with a 50% chance of survival and severe medical symptoms after an operation for colorectal cancer, came out with a higher global quality of life score than patient A, who had a 90% chance of survival and fewer unpleasant symptoms. Why? Patient B's wider network of family and friends may have helped. Patient A did not mention family or friends, and found parts of the treatment process a big psychological shock, which could have slowed recovery.
What is a 'good' quality of life score?
The authors adapted the European Organisation for Research on Treatment of Cancer (EORTC) standard questionnaire and coverted patients' answers into a visual profile which "can be read like an electrocardiogram or any other functional test". Koller and Lorenz chose 60-80 out of 100 as a realistic score to aim for, and suggest that if a patient falls below 50, doctors should expect to intervene just as they would expect to if the patient's blood pressure dropped too low.
Raising patients' quality of life scores
Doctors can affect a patient's quality of life score with different treatment approaches, including pain relief, psychotherapy, better nutrition and social rehabilitation. After their research, Koller and Lorenz restructured the follow-up care for cancer patients in their region, and worked to increase doctors' acceptance of quality of life as a diagnostic tool. They have now introduced guidelines that include quality of life as an "essential endpoint for care".
Royal Society of Medicine
In two case studies, Koller and Lorenz investigated how patients' quality of life is separate from how ill they actually are. Patient B, with a 50% chance of survival and severe medical symptoms after an operation for colorectal cancer, came out with a higher global quality of life score than patient A, who had a 90% chance of survival and fewer unpleasant symptoms. Why? Patient B's wider network of family and friends may have helped. Patient A did not mention family or friends, and found parts of the treatment process a big psychological shock, which could have slowed recovery.
What is a 'good' quality of life score?
The authors adapted the European Organisation for Research on Treatment of Cancer (EORTC) standard questionnaire and coverted patients' answers into a visual profile which "can be read like an electrocardiogram or any other functional test". Koller and Lorenz chose 60-80 out of 100 as a realistic score to aim for, and suggest that if a patient falls below 50, doctors should expect to intervene just as they would expect to if the patient's blood pressure dropped too low.
Raising patients' quality of life scores
Doctors can affect a patient's quality of life score with different treatment approaches, including pain relief, psychotherapy, better nutrition and social rehabilitation. After their research, Koller and Lorenz restructured the follow-up care for cancer patients in their region, and worked to increase doctors' acceptance of quality of life as a diagnostic tool. They have now introduced guidelines that include quality of life as an "essential endpoint for care".
Royal Society of Medicine
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