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Constructs

Construct Details

Construct Name:	Quality of Life
Definition of Construct:	Measures of quality of life using eight subscales: physical functioning, emotional functioning, social functioning, energy/fatigue, pain, general health perceptions, limitations due to physical health, and limitations due to emotional health as well as one item measuring a person’s perceived change in health compared to one year ago. Reliability and validity of the subscales have been established in studies of both general and patient populations (Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0. Health Economics, Vol. 2, No. 3, 1993, pp. 217-227).
Theoretical Foundation:
Synonyms for Construct:	functional health status
Similar Constructs:
Associated Constructs
Keywords:	EHR Candidate

No references found.

Measures

Datasets

Functional Assessment of Cancer Therapy-General (FACT-G)

RAND 36-Item Health Survey

The Functional Assessment of Cancer Therapy - Prostate Cancer (FACT-P)

The Expanded Prostate Cancer Index Composite (EPIC)

The Functional Assessment of Cancer Therapy - Breast Cancer (FACT-B)

SF-8 General Health Survey (short form) (EHR Campaign)

EQ-5D (EHR Campaign)

PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign)

Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign)

Cystic Fibrosis Questionnaire-Revised

SF-12 General Health Survey

Functional Assessment of Cancer Therapy - Bone Marrow Transplant (FACT-BMT) scale

Veterans RAND 12 Item Health Survey (VR-12)

Quality of Well-Being Scale-Self Administered (QWB-SA)

(Last Updated: 2/22/2011 12:29:00 PM by Dave Garner)

Comments (33 comments)

EHR Campaign Evaluation, 4/11/2011 2:26:20 PM By Karen Basen-Engquist, The University of Texas MD Anderson Cancer Center Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 4 EQ-5D (EHR Campaign) = 3 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 5 SF-8 General Health Survey (short form) (EHR Campaign) = 5 Recommendations
From Kazis Lewis, Boston University, 4/11/2011 1:33:54 PM By Maureen Boyle, NIH, OBSSR The VR-12 is in the public domain and available with scoring algorithms. It is a short assessment (10 items) and highly recommended for use, as it has been adopted by CMS for evaluation of the Medicare advantage Program as the principal outcome. It is also part of the QI program in the VA as it is included in their annual surveys. The assessment has been developed as a utility measure with 6 items (VR-6D) for purposes of cost-effectiveness studies.
EHR Campaign Evaluation, 4/10/2011 7:34:00 PM By Laura Hayman, UMass Boston College of Nursing & Health Sciences Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 3 EQ-5D (EHR Campaign) = 2 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 5 SF-8 General Health Survey (short form) (EHR Campaign) = 4 Recommendations
EHR Campaign Evaluation, 4/9/2011 6:11:28 PM By Diane King, Kaiser Permanente Colorado, Institute for Health Research Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 3 EQ-5D (EHR Campaign) = 3 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 2 SF-8 General Health Survey (short form) (EHR Campaign) = 3 Recommendations What about the CDC's Healthy Days measure.... was surprised not to see that one. I like the questions on the EQ-5D, but if everyone answers positively, that's an issue. Having to pay a fee is also an issue, as a barrier for some providers.
EHR Campaign Evaluation, 4/8/2011 6:01:47 PM By Abdel Fahmy, Access Community Health Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 4 EQ-5D (EHR Campaign) = 4 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 4 SF-8 General Health Survey (short form) (EHR Campaign) = 5 Recommendations
EHR Campaign Evaluation, 4/8/2011 3:07:25 PM By Thomas Land, Mass Dept of Pub Health Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 1 EQ-5D (EHR Campaign) = 2 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 3 SF-8 General Health Survey (short form) (EHR Campaign) = 2 Recommendations
Quality of life is not the same construct as functional health status, 4/8/2011 2:13:58 PM By Clare Bradley, Psychology Department, Royal Holloway, University of London and Health Psychology Research Ltd, RHUL. The four measures proposed as 'quality of life' measures are actually measures of health status. It is highly misleading to regard 'functional health status' as a synonym for 'quality of life' as is suggested on this website. My research team and I have designed individualised quality of life measures for many long term conditions, including the ADDQoL for diabetes, MacDQoL for macular disease and RDQoL for chronic renal disease (see www.healthpsychologyresearch.com for more information about these) but we haven't yet designed one for cancer. We define quality of life as 'how good or bad you feel your life to be' while health status is 'how good or bad you feel your health to be'. If a person is very seriously ill, measures of the two concepts may be highly correlated. However with long term conditions it is important to distinguish between the two concepts with care for reasons that I have discussed in The Lancet commentary below. Bradley C (2001) Importance of differentiating health status from quality of life. The Lancet, 357, 7-8. http://www.ncbi.nlm.nih.gov/pubmed/11197385?ordinalpos=97&itool;=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
EHR Campaign Evaluation, 4/8/2011 11:30:48 AM By richard street, Texas A&M; University Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 3 EQ-5D (EHR Campaign) = 4 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 5 SF-8 General Health Survey (short form) (EHR Campaign) = 4 Recommendations
EHR Campaign Evaluation, 4/4/2011 6:00:28 PM By Anna Adachi-Mejia, Dartmouth Medical School Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 5 EQ-5D (EHR Campaign) = 3 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 4 SF-8 General Health Survey (short form) (EHR Campaign) = 3 Recommendations I like all of the suggested questions but the issue of licensing is a big limitation.
Comments of the National Association of Social Workers, 4/4/2011 4:44:32 PM By stacy collins, National Association of Social Workers SF-8 is the most useful tool for several reasons: • Specific time frame—within past 14 days • Most psychosocial content • Open-ended questions with clear response choices EQ-5D is ranked second. The format is too closed and it’s limited in its psychosocial content. It also has limited usefulness because it only measures quality of life for the day it’s completed, which can lead to skewed results. PROMIS_Q is the least useful, focusing only on physical well-being with no psychosocial content or time frame, though the open-ended questions and response formats are useful. Psychosocial domains are missing from all three scales, such as social support, emotional intimacy, sexual relationships, financial concerns, and the home environment.
EHR Campaign Evaluation, 4/4/2011 4:33:15 PM By Nancy Avis, Wake Forest University School of Medicine Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 1 EQ-5D (EHR Campaign) = 2 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 3 SF-8 General Health Survey (short form) (EHR Campaign) = 4 Recommendations I clicked on save before having a chance to provide comments. The BRFSS - I think it is hard for people to think in terms of number of days. I also don't like the term "not good." Question 2.3 does not distinguish between physical and mental health. EQ-5D - heavily focused on physical aspects of QOL. PROMIS - wish there was something on mental health. SF-8 - this is the broadest in terms of QOL. Biggest negative is that it requires a license. Does PROMIS have any way to add more mental health? If not, I think the SF-8 is the broadest in terms of measuring QOL.
EHR Campaign Evaluation, 4/4/2011 4:13:34 PM By Nancy Avis, Wake Forest University School of Medicine Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 1 EQ-5D (EHR Campaign) = 3 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 3 SF-8 General Health Survey (short form) (EHR Campaign) = 4 Recommendations
EHR Campaign Evaluation, 4/4/2011 3:29:04 PM By Jessica Kasirsky, NextGen Healthcare Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 4 EQ-5D (EHR Campaign) = 4 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 3 SF-8 General Health Survey (short form) (EHR Campaign) = 4 Recommendations The General Health Survey short form and EQ-5D require a license. This should be taken into consideration when choosing the survey tool.
EHR Campaign Evaluation, 4/4/2011 1:34:25 PM By Doug Fernald, University of Colorado Department of Family Medicine Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 4 EQ-5D (EHR Campaign) = 2 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 2 SF-8 General Health Survey (short form) (EHR Campaign) = 3 Recommendations If we're thinking about whole person care, a global assessment of HRQoL seems appropriate to include. It may show improvements in a person's perception of health even if other indicators (e.g., BMI,physical acitivity, diet) have not yet shown improvements even though the patient is working on ipmrovement. BRFSS has been used widely in a variety of settings, studies, illnesses, and interventions (same as CDC Healthy Days). We know a lot about it. SF-8 is a good option , but too long.
EHR Campaign Evaluation, 4/3/2011 11:27:17 AM By Thomas Kottke, Medical Director for Evidence-Based Health, HealthPartners Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 2 EQ-5D (EHR Campaign) = 2 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 2 SF-8 General Health Survey (short form) (EHR Campaign) = 2 Recommendations We are going to need to add up the total number of questions that we think the EHR ought to contain. I think that the proposed number will be shocking to the work group and even more shocking to the people and patients that we expect to actually collect or divulge the data. In regards to quality of life, I would like to propose the Satisfaction with Life Scale. Diener, E., Emmons, R., Larsen, J., & Griffin, S. (1985). The Satisfaction With Life Scale. J Personality Assessment, 49(1), 71-75. The following is from the web site: http://www.tbims.org/combi/swls/swlsrat.html Below are five statements with which you may agree or disagree. Using the 1-7 scale below, indicate your agreement with each item by placing the appropriate number on the line preceding that item. Please be open and honest in your responding. The 7-point scale is as follows: 1 = strongly disagree 2 = disagree 3 = slightly disagree 4 = neither agree nor disagree 5 = slightly agree 6 = agree 7 = strongly agree __ 1. In most ways my life is close to my ideal. __ 2. The conditions of my life are excellent. __ 3. I am satisfied with my life. __ 4. So far I have gotten the important things I want in life. __ 5. If I could live my life over, I would change almost nothing. The SWLS is in the public domain. Permission is not needed to use it. One of our central goals ought to be to operationalize the WHO definition of health: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." (http://www.who.int/about/definition/en/print.html) and we need to focus on behaviors that are important and modifiable and conditions that are treatable. The four most important behaviors are nutrition (fruits and vegetables), physical activity, tobacco use and hazardous use of alcohol. A fifth behavior we ought to be considering is healthy thinking. While the prevalence of depression may be as high as 8%, the prevalence of unhappiness due to negative thinking and lack of expressed appreciation is probably much higher. Seligman has demonstrated in an RCT that instructing people to note positive events in their lives every day and use their signature strengths in a new way is associated with fewer reports of depressive symptoms and more reports of happiness. Seligman, ME, Steen, TA, Park, N, Peterson, C, 2005. Positive psychology progress: empirical validation of interventions. Am Psychol. 60,
EHR Campaign Evaluation, 4/1/2011 5:55:21 PM By Hardeep Singh, Houston VA and Baylor College of Medicine Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 2 EQ-5D (EHR Campaign) = 1 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 2 SF-8 General Health Survey (short form) (EHR Campaign) = 1 Recommendations This construct raises several questions that should be discussed. For example, we should clarify the precise rationale of collecting QOL measures; is it research, or is it to impact patient care or both? What will be done with the data collected? Is this something that PCPs will find useful and if so how. Currently, the purpose of this construct is not clear. Moreover, who will collect all this data (most certainly I hope its not the PCP)? If at all, the discussion should revolve around surveys with the least items and that dont need a license.
EHR Campaign Evaluation, 4/1/2011 1:33:57 PM By richard street, Texas A&M; University Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 3 EQ-5D (EHR Campaign) = 4 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 4 SF-8 General Health Survey (short form) (EHR Campaign) = 3 Recommendations
EHR Campaign Evaluation, 3/31/2011 1:12:11 PM By Robert Kaplan, NIH/OBSSR Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 2 EQ-5D (EHR Campaign) = 2 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 5 SF-8 General Health Survey (short form) (EHR Campaign) = 4 Recommendations
Disease Specific Quality of Life Measures, 3/30/2011 12:36:58 PM By Kenneth HOlroyd, Ohio University It is doubtful that disease specific Quality of LIfe measures would be used in primary care except by health psychologists the Headache Disability Inventory and the Migtraine Specific Quality of Life Scale are both available for use. Ken
EHR Campaign Evaluation, 3/28/2011 6:10:08 PM By seana zagar, OCHIN Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 5 EQ-5D (EHR Campaign) = 3 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 2 SF-8 General Health Survey (short form) (EHR Campaign) = 3 Recommendations The PROMIS GPH doesn't separate MH from PH so I question its utility for collecting psychosocial info. The SF-8 is long but perhaps it could be a secondary tool for the 1 question brief screening. Agree with others regarding costs - should look for a tool that does not force additional spending to maintain compliance.
Use of measures that do not include a license or additional fee, 3/28/2011 9:32:22 AM By Linda Burhansstipanov, Native American Cancer Research Corporation Reviewing the recommendations again and think it is inappropriate to include measures that require an additional fee or license to use. Perhaps PROMIS or BRFSS QOL measures because they do NOT require such a fee. Systems such as Indian Health Service RPMS and Tribal programs are so under-funded, yet are doing their best to address EHR. Requiring additional fees makes it less likely that our EHR are comparable to those used by most other healthcare systems.
QOL measures , 3/27/2011 8:35:30 AM By Linda Burhansstipanov, Native American Cancer Research Corporation Use of "Excellent /Very good /Good /Fair/Poor" may be common, but doubt that it is actually very helpful. We found using the City of Hope QOL measures with some additional phrases were of more value. These included phrases such as Overall, do you currently feel you are physically able to do everything that you want to do on a DAILY basis? ? I am NEVER ABLE to physically do everything I want to do ? I am NOT ABLE to physically do MOST Things that I want to do ? I am ABLE to physically do MOST things that I want to do ? I am ABLE to physically do EVERYTHING that I want to do ? I do not know or not sure ? I do not want to answer this question We have similar items for spiritual health, mental-emotional health, and social health. I think seeing that the patient is able to do (physically, spiritually, mentally-emotionally or socially) most things they want to do DAILY is more helpful than if the patient rates him/herself as "good" or "fair"
EHR Campaign Evaluation, 3/26/2011 8:10:36 PM By Lisa Klesges, University of Memphis Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 4 EQ-5D (EHR Campaign) = 2 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 5 SF-8 General Health Survey (short form) (EHR Campaign) = 4 Recommendations
Social Support, life satis, and spiritual experiences, 3/26/2011 1:45:53 PM By Jennifer Hodgson, East Carolina University Multidimensional Scale of Perceived Social Support (MSPSS) Satisfaction with Life Scale (SWLS) Daily Spiritual Experience Scale (DSES)
EHR Campaign Evaluation, 3/21/2011 10:07:23 PM By Aanand Naik, Houston VAMC and Baylor College of Medicine Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life (EHR Campaign) = 3 EQ-5D (EHR Campaign) = 3 PROMIS Global Physical Health (GPH) Short Survey (EHR Campaign) = 5 SF-8 General Health Survey (short form) (EHR Campaign) = 5 Recommendations
EQ-VAS, 3/17/2011 11:35:32 AM By William Riley, NHLBI Given the need for brevity and the limited actionability of HRQL relative to more specific constructs, the committee may want to consider a single item like the overall quality of life item from the PROMIS global health items or the EQ-VAS item.
EHR Campaign Evaluation, 3/16/2011 12:20:28 PM By Maureen Boyle, NIH, OBSSR Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life = 4 EQ-5D = 2 PROMIS Global Physical Health (GPH) Short Survey = 5 SF-8 General Health Survey (short form) = 3 Recommendations I think that for the average adult, without a chronic condition, a one-2 question screener such as that described in the comment below, or the first 2 questions of the PROMIS scale. If the responses indicate a problem the SF-8 or 12 could be administered as a follow up.
Stephen Taplin MD, MPH, 3/15/2011 12:42:07 PM By Stephen Taplin, NCI The 4 value general question is commonly used (Would you say that in general your health is: Excellent /Very good /Good /Fair/Poor ). IF the PROMIS measure gets better informaiton on functional status then it might also be a considertion, though going to a 4 item question creates problems .
EHR Campaign Evaluation, 3/14/2011 8:25:54 PM By karen emmons, dfci/hsph Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life = 3 EQ-5D = 3 PROMIS Global Physical Health (GPH) Short Survey = 5 SF-8 General Health Survey (short form) = 4 Recommendations
EHR Campaign Evaluation, 3/11/2011 9:40:46 AM By Sandra Mitchell, National Cancer Institute Measure Ratings Behavioral Risk Factor Surveillance System- Quality of Life = 3 EQ-5D = 3 PROMIS Global Physical Health (GPH) Short Survey = 5 SF-8 General Health Survey (short form) = 5 Recommendations
Quality of Life, 3/6/2011 10:16:17 AM By Sandra Mitchell, National Cancer Institute CDC uses a set of questions called the "Healthy Days Measures." These questions include the following: Would you say that in general your health is: Excellent /Very good /Good /Fair/Poor Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation? These items have had fairly extensive testing relative to reliability and validity, and have had some use across cultural and language groups both in the US and Internationally.
health status, 3/2/2011 5:49:46 PM By Elizabeth Bayliss, KPCO Depending on decisions regarding the SF 12 or 36, it would still be worth including the well-validated single question about health status.
Health Policy Committee Statement, 2/22/2011 9:36:10 PM By Maureen Boyle, NIH, OBSSR The quality of life (QOL) measures workgroup considered several instruments as a brief screening tool for primary care. The primary considerations for this group included (1) strong reliability and validity data, (2) practicality for use in primary care, (3) ability to translate to a summary utility score for comparison with other instruments. We are recommending the following three surveys for consideration: 1- General Health survey short form SF-8 (Ware et al, 2001). The SF-8 is a widely used and well validated instrument that is a strong fit for the criteria listed above. While this is an 8 item questionnaire it typically takes only 1-2 minutes to complete. Using methods developed by Brazier, these scores can be converted to utility weighted measures. One caveat to this survey is that it requires a license to use and associated costs could hinder widespread usage. 2- The PROMIS Global Physical Health (GPH) Short Survey (Hays et al, 2009). The GPH is a short 4 question survey on overall physical health, physical function, pain, and fatigue. This scale has reliability ratings that are comparable to the SF-8 and SF-12 surveys. 3- EQ-5D- This instrument is widely used utility based measure. One caveat is the strong ceiling effects with over 70% of participants receiving a perfect score using this scale. In addition, this measure also requires a license to use. 4- The QOL measures from the Behavioral Risk Factor Surveillance System Questionnaire (BRFSS, Zullig and Hendryz, 2010). The BRFSS QOL measures consist of 3 questions that may be more practical for use in primary care. This questionnaire could serve as a short screen to identify QOL issues which would trigger the administration of a longer, more widely used survey. (http://www.cdc.gov/brfss/) We also evaluated the following surveys which were ultimately not included in our recommendations due to the listed issues: 1- The Health Utilities Index (HUI) 15Q (Feeny et al, 1995; Horsman et al, 2003). The HUI was not included due to its length and the associated licensing fees which could hinder widespread use. 2- The Quality of wellbeing Scale (Kaplan et al, 1979)- This scale includes 58 questions which is significantly too long for use as a primary care screen. 1- Ware J et al. Boston: QualyMetric; 2001. 2- Hays RD et al. Qual Life Res (2009) 18: 873-880. 3- Zullig KJ and Hendryx M. Public Health Reports 125 (4):548 -55, 2010. 4- Horsman J et al. Health and Quality of Life Outcomes 2003, 1:54. 5- Feeny D et al. Pharmacoeconomics. 1995 Jun;7(6):490-502. 6- Hurst NP et al. Br J Rheumatol 1994, 33:655-62. 7- Kaplan RM et al. Med Care 1979; 17: 501-525. QOL measures workgroup: Drs. Robert Kaplan and Maureen Boyle