Comments on “The quality of life: design and evaluation of a self-assessment instrument for use with cancer patients”

A study of quality of life in Internet health chat room users

Maintenance of quality of life (QoL) is central to healthcare and an increasingly important outcome of care provision reflecting enhanced awareness of the need to consider the effects of a disease or treatment on a patient's life. However, while its assessment has intuitive appeal it is predicated on the belief that QoL can be effectively defined, assessed and quantified. Achieving this is, however, difficult as individuals value different things and, it is claimed, often define QoL differently; there are no ‘generally agreed referents' and no ‘gold standard’ through which it can be measured. This may significantly affect the value and the uses to which such data can be put.

The study described here represents the first stage of a programme of work focusing upon defining QoL as it is currently perceived in the UK; it relied upon a qualitative, descriptive survey involving a sample of Internet health chat room users. It attempts to define QoL and to identify the factors contributing to life quality in these respondents. A subsidiary aim was to evaluate the use of email as a recruitment tool in such research.

A common definition was difficult to find but, in general terms, is taken to represent ‘what you think of your life’. Within this a range of factors are seen to contribute to individual perceptions and it was possible to identify those appearing to determine perceptions of QoL in this study population. Email was an effective route for recruiting subjects in this work.

Assessing the quality of life—reality or impossible dream?

Many now claim that maintaining or improving the quality of life is the essence of healthcare (i.e. care and/or treatment that improves the patients' quality of life). Interest in QL, however, stems from increasing recognition that individuals are an integrated whole rather than a series of disconnected parts or disease states. Though this represents a significant change from the past--when the emphasis lay solely on physical or medical condition--it is not, in itself, meaningful unless reliable and valid ways of evaluating the human aspects of the experience can be identified (i.e. quality of life). As quality of life (QL) is seen as a positive state, a desirable outcome of healthcare interventions, it has gained credence as an appropriate outcome measure and has intuitive appeal. Indeed, it is suggested that, because of its close relationship to mortality, self-perceived QL may be the most important outcome of both acute and, particularly, chronic disease. Lack of consensus about its meaning has, however, resulted in ambiguity and, therefore, difficulties in its measurement reflecting, in turn, the difficulty in identifying the components of this multifaceted concept. This paper explores these issues and questions whether we are, in fact, attempting to measure something that cannot truly be measured.