Quality of life often depends on health and health care. However, health care practitioners, especially when establishing therapeutic objectives, may underemphasize its importance to patients.
Health-Related Quality of Life
How health affects quality of life is variable and subjective. Health-related quality of life has multiple dimensions, including the following:
Some of the factors that influence health-related quality of life (eg, institutionalization, reduced life expectancy, cognitive impairment, disability, chronic pain, social isolation, functional status) may be obvious to health care practitioners. Practitioners may need to ask about others, especially social determinants of health (ie, the social, economic, and political conditions that people experience from birth to death and the systems put in place to prevent illness and treat it when it occurs). Other important factors include the nature and quality of close relationships, cultural influences, religion, personal values, and previous experiences with health care. However, how factors affect quality of life cannot necessarily be predicted, and some factors that cannot be anticipated may have effects.
Also, perspectives on quality of life can change. For example, after a stroke that caused severe disability, patients may choose treatment (eg, life-saving surgery) to sustain a quality of life that they would have considered poor or even unacceptable before the stroke.
Barriers to assessment:
Assessing patients' perspectives on quality of life may be difficult for the following reasons:
Quality of life is best assessed by a direct interview with patients. During assessment, practitioners should be careful not to reveal their own biases. Determining a patient's preferences is usually possible; even patients with mild dementia or cognitive impairment can make their preferences known when practitioners use simple explanations and questions. Having family members present when discussing preferences of a patient with cognitive impairment is recommended.
Instruments that measure health-related quality of life can be useful in research studies for assessing group trends but tend not to be useful clinically for assessing individual patients.
Last full review/revision June 2013 by Richard W. Besdine, MD
Content last modified August 2013