Assessing the use of health-related quality of life measures in the routine clinical care of lung-transplant patients
This randomized controlled clinical trial examined the usefulness of including an assessment of health-related quality of life (HRQL) in the routine clinical care of lung-transplant patients. We hypothesized that the inclusion of HRQL in routine clinical care would improve patient–clinician communication, affect clinical management, and improve patients’ HRQL.
At the outpatient clinic, University of Alberta Hospital, patients were randomly assigned to intervention (completion of Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) on touch-screen computer with feedback to clinicians) and control group (completion of HUI2 and HUI3 on touch-screen computer without feedback). Feedback involved a graphical representation included in patients’ chart. All clinical encounters were audio-taped. Changes in clinical management (medication changes, number of referrals and test ordered) were summed to produce an overall management composite. At the end of every visit, patients completed the EQ-5D.
Two hundred and thirteen patients were randomized (108 to intervention and 105 to control groups). There were statistically significant differences between the groups in mean number of issues discussed per encounter (P = 0.003; Cohen’s d = 0.03) and mean management composite score (P = 0.001; Cohen’s d = 0.41). EQ-5D index was not statistically significant different between the groups (P = 0.48).
We detected very small effects on patient–clinician communication and small effects on patient management, without detecting improvement in patient outcome.
KeywordsQuality of life Health-related quality of life Communication Clinical management
The authors thank the patients and the staff in the lung-transplant program at the University of Alberta Hospital for their support in this project. The authors also acknowledge the constructive comments provided by two anonymous reviewers and by the editor, Ron D. Hays. The authors are grateful to the Institute of Health Economics (IHE), Edmonton, for providing the funding for the study. IHE has neither reviewed nor approved of the manuscript. The research was also supported by an unrestricted educational grant from Roche. Roche has neither reviewed nor approved of the manuscript.
Conflict of interest
It should be noted that David Feeny has a proprietary interest in Health Utilities Incorporated, Dundas, Ontario, Canada. HUInc. distributes copyrighted Health Utilities Index (HUI) materials and provides methodological advice on the use of HUI.
- 7.Rosenbloom, S. K., Victorson, D. E., Hanh, E. A., Peterman, A. H., & Cella, D. (2007). Assessment is not enough: A randomized controlled trial of the effects of HRQL assessment on quality of life and satisfaction in oncology clinical practice. Psychooncology, 16, 1069–1079.CrossRefPubMedGoogle Scholar
- 8.Gutteling, J. J., Darlington, A. S., Janssen, H. L., Duivenvoorden, H. J., Busschbach, J. J., & de Man, R. A. (2008). Effectiveness of health-related quality of life measurement in clinical practice: A prospective, randomized controlled trial in patients with chronic liver disease and their physicians. Quality Life Research, 17, 195–205.CrossRefGoogle Scholar
- 11.Santana M. J. Feeny D. (2007). The framework. International Society for Quality of Life Research Meeting Abstracts. www.isoqol.org/Budapest2007/mtgabstracts.
- 19.Godin, G., & Shephard, R. J. (1985). A simple method to assess exercise behaviour in the community. Canadian Journal of Applied Sport Sciences, 10(3), 141–146.Google Scholar
- 20.Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey, CAHPS. Available from: https://www.cahps.ahrq.gov/ . Accessed 8 Jan 2005.
- 21.Kind, P. (1996). The Euroqol instrument: An index of health-related quality of life. In Bert Spilker (Ed.), Quality of life and pharmacoeconomics in clinical trials (2nd ed., pp. 191–201). Philadelphia: Lippincott-Raven Press. Chap. 22.Google Scholar
- 25.Feng, Y., Bernier, J., McIntosh, C., Orpana, H. (2009). Validation of disability categories derived from Health Utilities Index Mark 3 scores. Component of Statistics Canada Catalogue no. 82-003-X. Health Reports.Google Scholar
- 27.Santana, M. J., & Feeny, D. (2006). Reliability of a patient-clinician communication evaluation form. Patient reported outcome newsletter, 36, 37–38.Google Scholar
- 30.Cohen, J. (1988). Statistical power analysis for the behavioural sciences (2nd ed.). Hillsdale, NJ: Laurence Erlbaum.Google Scholar
- 31.SPSS version 15.00. SPSS Inc. Chicago, IL. www.spss.com.
- 32.Nicklasson M. & Bergman B. (2008). The impact of quality of life assessment on psychosocial attention and satisfaction with care in patients with chest malignancies: A randomized study. International Society for Quality of Life Research Meeting Abstracts, www.isoqol.org/2008/mtgabstracts, Quality of Life Research, A-16, Abstract #1628.
- 33.Santana M. J., Feeny D. (2007). Patient and provider perceptions about the inclusion of health-related quality of life (HRQL) measures in routine clinical care. International Society for Quality of Life Research Meeting Abstracts, www.isoqol.org/2007/mtgabstracts, Quality Life Research, A-65, Abstract #1270.