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Quality-of-life scales ignore patients.

A woman in her early seventies suffers a mild heart attack. After a brief hospital stay, she goes home. Her new medication makes her feel better physically, but it seems to make her hair thin. Also, she feels mildly depressed.

Despite her important complaints, she might score high on one of the many tools designed to measure quality of life, suggest physicians Thomas M. Gill and Alvan R. Feinstein of Yale University School of Medicine.

To assess how the medical literature measures quality of life, Gill and Feinstein reviewed 75 articles that used one or more quality-of-life questionnaires, they report in the Aug. 24/31 Journal of the American Medical Association.

In only nine studies did the researchers allow patients to comment on how they felt instead of just answering the questions posed. In only six studies were patients asked to rate the importance of the issues raised. For example, researchers tended to ask patients what symptoms they had and not how much those symptoms bothered them.

Investigators defined the term "quality of life" in only 11 articles, although "little agreement has been attained on what it means," Gill and Feinstein note.

In only about one-third of the studies did the authors say why they chose the quality-of-life measurements they used. Such explanations are useful because they help "reassure readers about the instruments' suitability for the intended task," Gill and Feinstein argue.

No article distinguished overall quality of life - which includes, for example, how a patient is getting along with his family as well as how he feels mentally and physically - from health-related quality of life, the Yale team reports.

"The need to incorporate patients' values and preferences is what distinguishes quality of life from all other measures of health," Gill and Feinstein conclude.
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Title Annotation:quality-of-life measures often exclude patients' opinions
Publication:Science News
Article Type:Brief Article
Date:Aug 27, 1994
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