Abstract
A remarkable surge in efforts to assess the quality of life of patients has occurred in recent years in medical research. Philosophical discussions of these developments have focused, on the one hand, on epistemological reservations about the plausibility of measuring quality of life and, on the other hand, on moral and ethical qualms about the meaning of life conveyed in such assessments. Whilst providing an important note of caution, such critiques fail to recognise two basic principles of quality of life in medical research. Firstly it is intended to provide understanding about groups and categories of patients rather than individuals. Secondly the purpose of such research is to produce generalisations about the relative costs and benefits of specific health care interventions rather than absolute judgements regarding the quality of life of patients per se. Selecting a good quality of life measure for a clinical trial requires balancing criteria such as validity with practical feasibility. Such measures will play an increasingly central role in providing research evidence to improve health care.
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REFERENCES
Barry, M., Cherkin, D., Chang, Y., Fowler, F., Skates, S., A Randomised Trial of a Multimedia Shared Decision-making Program for Men Facing a Treatment Decision for Benign Prostatic Hyperplasia Disease, Management and Clinical Outcomes 1 (1997) pp. 5–14.
Black, N., Why we need Observational Studies to evaluate the Effectiveness of Health Care, Br Med J 312 (1996) pp. 1215–1218.
Bleehen, N., Girling, D., Machin, D., Stephens, R., A Randomised Trial of Three or Six Courses of Etoposide Cyclophosphamide Methotrexate and Vincristine or Six Courses of Etoposide and Ifosfamide in Small Lung Cancer (SCLC). II Quality of Life, Br J Cancer 68 (1993) pp. 1157–1566.
Bowling, A., Measuring Health: A Review of Quality of Life Measurement Scales. Milton Keynes: Open University Press, 1991.
Carr-Hill, R., Assumptions of the QALY Procedure, Soc Sci Med 29 (1989) pp. 469–477.
Cox, D., Fitzpatrick, R., Fletcher, A., Gore, S., Spiegelhalter, D., Jones, D., Quality of Life Assessment: Can we keep it simple? J Roy Stat Soc 155 (1992) pp. 353–393.
Croog, S., Levine, S., Testa, M., Brown, B., Bulpitt, C., Jenkins, C., et al., The Effects of Antihypertensive Therapy on the Quality of Life, N Engl J Med 314 (1986) pp. 1657–1663.
Deyo, R., The Quality of Life, Research, and Care, Ann Intern Med 114 (1991) pp. 695–697.
Fayers, P., Hand, D., Factor Analysis, Causal Indicators and Quality of Life, Qual Life Res 6 (1997) pp. 139–150.
Fitzpatrick, R., Alternative Approaches to the Assessment of Health-Related Quality of Life, in A. Offer (ed.), In Pursuit of the Quality of Life. Oxford: Oxford University Press, 1996a, pp. 140–162.
Fitzpatrick, R., Patient-Centred Approaches to the Evaluation of Health Care, in K. Fulford, S. Ersser, T. Hope (eds.), Essential Practice in Patient-Centred Care. Oxford: Blackwell Science, 1996b, pp. 229–240.
Fitzpatrick, R., Ziebland, S., Jenkinson, C., Mowat, A., Mowat, A., The Importance of Sensitivity to Change as a Criterion for Selection of Health Status Measures, Qual Health Care 1 (1992) pp. 89–93.
Gill, T., Feinstein, A., A Critical Appraisal of the Quality of Quality of Life Measurements, JAMA 272 (1994) pp. 619–626.
Gerard, K., Mooney, G., QALY League Tables: Handle with Care, Health Economics 2 (1993, pp. 59–64.
Guyatt, G., Cook, D., Health Status, Quality of Life, and the Individual, JAMA 272 (1994) pp. 630–631.
Helewa, A., Bombardier, C., Goldsmith, C., Menchions, B., Smythe, H., Cost-effectiveness of Inpatient and Intensive Outpatient Therapy for Patients with Arthritis - a Randomised Controlled Trial, Arth Rheum 32 (1989) pp. 1505–1514.
Hopwood, P., Stephens, R., Machin, D., Approaches to the Analysis of Quality of Life Data: Experiences gained from a Medical Research Council Lung Cancer Working Party Palliative Chemotherapy Trial, Qual Life Res 3 (1994) pp. 339–352.
Jones, P., Measurement of Health-related Quality of Life in Asthma and Chronic Obstructive Airways Disease, in S. Walker, R. Rosser (eds.), Quality of Life Assessment: Key Issues in the 1990s. Dordrecht: Kluwer, 1993, pp. 301–320.
Juniper, E., Guyatt, G., Wilan, A., Griffith, L., Determining a Minimal Important Change in a Disease-Specific Quality of Life Questionnaire, J Clin Epidem 47 (1994) pp. 81–87.
Kazis, L., Callahan, L., Meenan, R., Pincus, T., Health Status Reports in the Care of Patients with Rheumatoid Arthritis, J Clin Epidem 43 (1990) pp. 1243–1253.
Mulkay, M., Ashmore, M., Pinch, T., Measuring the Quality of Life: A Sociaological Invention concerning the Application of Economics to Health Care, Sociology 21 (1987) pp. 541–564.
Nordenfelt, L., Introduction, in L. Nordenfelt (ed.), Concepts and Measurement of Quality of Life in Health Care. Dordrecht: Kluwer, 1994, pp. 1–15.
Rorabeck, C., Bourne, R., Laupacis, A., Feeny, D., Wong, C., Tugwell, P., et al., A Double-Blind Study of 250 Cases Comparing Cemented with Cementless Total Hip Arthroplasty.Cost-effectiveness and its Impact on Health-related Quality of Life, Clin Orthop 210 (1994) pp. 156–164.
Schumacher, M., Olschewski, M., Schulgen, G., Assessment of Quality of Life in Clinical Trials, Stat Med 10 (1991) pp. 1915–1930.
Spilker, B., (ed.), Quality of Life and Pharmacoeconomics in Clinical Trials. Philadelphia: Lippencott-Raven, 1996.
Streiner, D., Norman, G., Health Measurement Scales: A Practical Guide to their Development and Use. Oxford: Oxford University Press, 1995.
Stucki, G., Daltroy, L., Katz J., Johannesson, M., Liang, M., Interpretation of Change Scores in Ordinal Scales and Health Status Measures: The Whole may not Equal the Sum of the Parts, J Clin Epidem 49 (1996) pp. 711–717.
Testa, M., Simonson, D., Assessment of Quality of Life Outcomes, New Engl J Med 334 (1996) pp. 835–840.
Tugwell, P., Bombardier, C., Buchanan, W., Goldsmith, C., Grace, E., Bennett, K., et al., Methotrexate in Rheumatoid Arthritis. Impact on Quality of Life Assessed by Traditional Standard-Item and Individualized Patient Preference Health Status Questionnaires, Arch Intern Med 150 (1990) pp. 59–62.
VanderBurg, M., Measuring the Quality of Life of Patients with Angina, in S. Walker, R. Rosser (eds.), Quality of Life Assessment: Key Issues in the 1990s. Dordrecht: Kluwer, 1993, pp. 333–342.
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Fitzpatrick, R. Principles and Problems in the Assessment of Quality of Life in Health Care. Ethical Theory and Moral Practice 2, 37–46 (1999). https://doi.org/10.1023/A:1026466916100
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DOI: https://doi.org/10.1023/A:1026466916100