Quality of life: an overview of the concept and measures


This paper summarizes the concepts and measures of quality of life. Although numerous attempts have been made to conceptualize and operationalize quality of life, there has been no universally accepted standard for the study design, data collection and data analysis of studies that use quality of life as an outcome measure. Quality of life has been defined either as a measure of happiness and satisfaction with life, or goal achievement, or social utility. However, most studies conceptualize and measure quality of life as a composite that consists of several domains. There are two approaches to the measurement of quality of life, namely, the psychometric approach and the utility approach. A quality of life measure can be either generic or diseasespecific. High reliability and validity are important criteria for a credible quality of life instrument. Published clinical studies which use quality of life as an outcome measure have to be assessed on the basis of the appropriateness of the study design, the validity of study results and the applicability of the quality of life measure to the specific patient group.

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  1. 1

    Fries JF, Spitz PW. The hierarchy of patient outcomes. In: Spilker B, editor. Quality of life assessments in clinical trials. New York: Raven Press, 1990:25–35.

    Google Scholar 

  2. 2

    Stewart AL. The medical outcomes study framework of health indicators. In: Stewart AL, Ware JE Jr, editors. Measuring functioning and well-being. Durham: Duke University Press, 1992:12–24.

    Google Scholar 

  3. 3

    Patrick DL, Erickson P. Assessing health-related quality of life for clinical decision-making. In: Walker SR, Rosser RM, editors. Quality of life assessment. Key issues in the 1990s. London: Kluwer Academic Publishers, 1993:11–64.

    Google Scholar 

  4. 4

    Campbell A, Converse PE, Rodgers WL. The quality of American life: perceptions, evaluations and satisfaction. New York: Russel Sage Foundation, 1976.

    Google Scholar 

  5. 5

    Wenger NK, Mattson ME, Furberg CD, Elinson J. Assessment of quality of life in clinical trials of cardiovascular therapies. Am J Cardiol 1984;54:908–13.

    PubMed  Google Scholar 

  6. 6

    DimenÄs ES, Dahlöf CG, Sverker CJ, Jern SC, Wiklund IK. Defining quality of life in medicine. Scand J Prim Health Care Suppl 1990;1:7–10.

    PubMed  Google Scholar 

  7. 7

    Kleinpell RM. Concept analysis of quality of life. Dimens Crit Care Nurs 1991;10(4):223–9.

    PubMed  Google Scholar 

  8. 8

    Hörnquist JO. The concept of quality of life. Scand J Soc Med 1982;10:57–61.

    PubMed  Google Scholar 

  9. 9

    Oleson M. Subjectively perceived quality of life. Image. J Nurs Scholar 1990;22(3):187–90.

    Google Scholar 

  10. 10

    Dalkey NC. Studies in quality of life: Delphi and decision making. Lexington: Lexington Books, 1972.

    Google Scholar 

  11. 11

    Dalkey N, Rourke D. The quality of life concept. Washington: Environmental Protection Agency, 1973.

    Google Scholar 

  12. 12

    McCall S. Quality of life. Soc Indicators Res 1975;2:229–48.

    Google Scholar 

  13. 13

    Vetter NJ, Jones DA, Victor CR. The quality of life of the over 70's in the community. Health Visitor 1981;61:10–13.

    Google Scholar 

  14. 14

    Jonsen AR, Seigler M, Winslade WJ. Quality of life. In: Jonsen AR, Siegler M, Winslade WJ, editors. Clinical ethics. New York: MacMillan, 1986:101–27.

    Google Scholar 

  15. 15

    Baltrusch HJ, Waltz EM. Theoretical framework for developing measures of quality of life and morale. In: Aaronson NK, Beckmann J, editors. The quality of life of cancer patients. New York: Raven Press, 1987:25–35.

    Google Scholar 

  16. 16

    Ferrans CE. Development of a quality of life index for cancer patients. Oncol Nurs Forum 1990;17 Suppl:15–21.

    PubMed  Google Scholar 

  17. 17

    Miller JF. Coping with chronic illness: Overcoming powerlessness. Philadelphia: Lippincott, 1983.

    Google Scholar 

  18. 18

    Gerson EM. On ‘Quality of life’. Am Soc Rev 1976;41:793–806.

    Google Scholar 

  19. 19

    Engquist CL. Can quality of life be evaluated? Hospitals 1979;16:97–100.

    Google Scholar 

  20. 20

    Calman KC. Definitions and dimensions of quality of life. In: Aaronson NK, Beckmann J, editors. The quality of life of cancer patients. New York: Raven Press, 1989:1–9.

    Google Scholar 

  21. 21

    Sartorius N. Cross-cultural comparisons of data about quality of life: a sample of issues. In: Aaronson NK, Beckmann J, editors. The quality of life of cancer patients. New York: Raven Press, 1989:19–24.

    Google Scholar 

  22. 22

    Edlund M, Tancredi L. Quality of life: an ideological critique. Perspect Biol Med 1985;28:591–607.

    PubMed  Google Scholar 

  23. 23

    Avron J. Benefit and cost analysis in geriatric care. N Engl J Med 1984;310:1294–301.

    PubMed  Google Scholar 

  24. 24

    Shaw A. Quality of life revisited. Hastings Central Rep 1988;2:10–12.

    Google Scholar 

  25. 25

    McCormick R. To save or let die. JAMA 1974;229:172–6.

    PubMed  Google Scholar 

  26. 26

    Schipper H, Levitt M. Measuring quality of life: risks and benefits. Cancer Treat Rep 1985;69:1115–23.

    PubMed  Google Scholar 

  27. 27

    Aaronson NK. Methodological issues in psychosocial oncology with special reference to clinical trials. In: Ventafridda V, Van Dam FSAM, Yancik R, Tamburini M, editors. Assessment of quality of life and cancer treatment. Amsterdam: Elsevier, 1986:29–42.

    Google Scholar 

  28. 28

    Rothman ML, Revicki DA. Issues in the measurement of health status in asthma research. Med Care 1993;31 Suppl 3:MS82–96.

    PubMed  Google Scholar 

  29. 29

    Revecki DA. Relationship between health utility and psychometric health status measures. Med Cara 1992;30 Suppl 5:MS274–82.

    Google Scholar 

  30. 30

    Fletcher AE, Bulpitt CJ. Measurement of quality of life in clinical trials of therapy. Cardiology 1988;75 Suppl 1:41–52.

    PubMed  Google Scholar 

  31. 31

    Testa MA, Anderson RB, Nackley JF, Hollenber NK, and the Quality of Life Hypertension Study Group. Quality of life and antihypertensive therapy in men. A comparison of captopril and enalapril. N Engl J Med 1993;328:907–13.

    PubMed  Google Scholar 

  32. 32

    Gabriel SE, Campion ME, O'Fallon WM. A cost-utility analysis of misoprostol prophylaxis for rheumatoid arthritis patients receiving nonsteroidal antiinflammatory drugs. Arthritis Rheum 1994;37:333–41.

    PubMed  Google Scholar 

  33. 33

    Nord E. Methods for quality adjustment of life years. Soc Sci Med 1992;4:559–60.

    Google Scholar 

  34. 34

    Torrence GW. Utility approach to measuring health-related quality of life. J Chron Dis 1987;40:593–600.

    PubMed  Google Scholar 

  35. 35

    Mulley A. Assessing patient's utilities: can the ends justify the means? Med Care 1989;27 Suppl:S269–79.

    PubMed  Google Scholar 

  36. 36

    Spector PE. Summated rating scale construction: an introduction. Sage University Paper Series on Quantitative Applications in Social Sciences, 07-082. Newbury Park: Sage, 1992.

    Google Scholar 

  37. 37

    Ware JE, Sherbourne CD. The MOS 36-item short form health survey (SF-36): conceptual framework and item selection. Med Care 1992;30(6):473–83.

    PubMed  Google Scholar 

  38. 38

    Bergner M, Bobbitt RA, Carter WB, Gilson BS. The sickness impact profile: development and final revision of a health status measure. Med Care 1981;19:787–806.

    PubMed  Google Scholar 

  39. 39

    Hunt SM, McKenna SP, McEwen J, Williams J, Papp E. The Nottingham health profile: subjective health status and medical consultations. Soc Sci Med 1981;15A:221–9.

    Google Scholar 

  40. 40

    Morrow GR, Chiarello RJ, Derogatis LR. A new scale for assessing patients' psychosocial adjustment to medical illness. Psychol Med 1978, 8:605–10.

    PubMed  Google Scholar 

  41. 41

    Marks GB, Dunn SM, Woolcock AJ. A scale for measurement of quality of life in adults with asthma. J Clin Epidemiol 1992;45(5):461–72.

    PubMed  Google Scholar 

  42. 42

    DimenÄs E. The SSA-profile, an instrument for assessment of subjective symptoms among hypertensives. Scand J Prim Health Care 1990;Suppl 1:27–30.

    Google Scholar 

  43. 43

    Dahlöf C. Minor Symptom Evaluation (MSE) profile — a questionnaire for assessment of subjective CNS-related symptoms. Scand J Prim Health Care 1990;Suppl 1:19–25.

    Google Scholar 

  44. 44

    Karnofsky D, Burchenal J. The clinical evaluation of chemotherapeutic agents in cancer. In: Macleod CM, editor. Evaluation of chemotherapeutic agents. New York: Columbia, 1949.

  45. 45

    Grant M, Padilla GV, Ferrell BR, Rhiner M. Assessment of quality of life with a single instrument. Semin Oncol Nurs 1990;6(4):260–70.

    PubMed  Google Scholar 

  46. 46

    Lynn MR. Determination and quantification of content validity. Nurs Res 1986;35:382–5.

    PubMed  Google Scholar 

  47. 47

    Erickson P, Taeuber RC, Scott J. Operational aspects of quality-of-life assessment. Choosing the right instrument. PharmacoEconomics 1995;7(1):39–48.

    PubMed  Google Scholar 

  48. 48

    Kong SX. Quality of life: Concepts and measures. InPharma 1992;852:14–6.

    Google Scholar 

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Correspondence to Seema Dedhiya or Sheldon Xiaodong Kong.

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Dedhiya, S., Kong, S.X. Quality of life: an overview of the concept and measures. Pharm World Sci 17, 141–148 (1995). https://doi.org/10.1007/BF01879707

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  • Clinical trials
  • Concept formation
  • Measures
  • Methods
  • Operationalization
  • Quality of life
  • Rating scales