Is this the most important measure of health?

Naveed Saleh, MD, MS | November 18, 2021

Have you ever stopped to think about what health means to those around you? Historically, health in the United States has been characterized by morbidity and mortality. Health, however, is so much more than that and encompasses physical, psychological, and social factors.

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Young masked doctor talking to patient

Health-related quality of life is an important health metric, but how does it apply in the clinic?

As a physician, you are familiar with the metric health-related quality of life (HRQoL). This measure has grown to include any aspects of health that directly impact physical or mental health. With respect to individuals, the CDC describes HRQoL as composed of energy levels, affect, functional status, social support, and more. More generally, they define it as perceived physical/mental health during a duration of time.

But, definitions are all well and good. Clinicians are likely interested in how HRQoL directly impacts (chronic) disease states and how it can be used to improve patient quality of life. Here’s a closer look.

Why is HRQoL important?

On one hand, HRQoL has implications for preventive health and public health and can span the divide between specialties, as well as social services, mental health services, and medical services. It can help with the allocation of resources, identification of preventable disease, legislation, policy, and more. 

On an individual level, however, HRQoL is associated with chronic diseases, such as diabetes and hypertension, as well as associated risk factors.

In a systematic review published in the BMC that included studies in English and other languages, researchers found that quality-of-life scores in the physical and mental domains were decreased in those with diabetes, obesity, cancer, neurological disease, and more. Higher HRQoL scores were linked to no disease and increased exercise.

The authors cited a study demonstrating that physical health and HRQoL related more strongly with the presence of long-term mental health problems, thus “highlighting the importance of addressing these problems, which are often overlooked in patients seeking treatment for physical disorders. According to the authors, integrated approaches to the diagnosis and treatment of long-term health conditions are necessary.”

The authors also highlighted the insidious nature and relentless advance of chronic disease, which results in various personal detriments such as lowered productivity, missed work, lost wages, and disability. 

How is HRQoL assessed?

The formal assessment of HRQoL can be challenging; there exist various quality-of-life scales and choosing one can be hard. More generally, HRQoL questionnaires can be global or symptom-centered.

Standard HRQoL questionnaires cover physical, psychological, social, and financial indicators of well-being. Commonly used general questionnaires are the World Health Organization Quality of Life Assessment (WHOQOL) and the Medical Outcomes Study 36-Item Short Form (SF-36). Of note, the CDC has a four-item HRQoL questionnaire called the Healthy Days core questions (CDC HRQOL– 4), which has been used with the National Health and Nutrition Examination Survey (NHANES), the Medicare Health Outcome Survey (HOS), and more.

An example of a disease- or symptom-specific questionnaire is the European Organisation for the Research and Treatment of Cancer (EORTC) QLQ-C30. It covers scales of function, symptoms, and quality of life.

Making HRQoL actionable in the clinic

Now that the importance of HRQoL is clear, it’s useful to flesh out how results from such questionnaires can be used to facilitate patient healthcare. 

In an article published in The ASCO Post, clinicians suggested that quality-of-life assessments can be used to gauge treatment tolerance. They can also be used to direct interventions that can improve quality of life and disease symptoms. For instance, with cancer care, older patients tend to value quality of life more than quantity, and this can direct treatment reductions and other decisions.

Bottom line

HRQoL is a measure of high importance in the care of patients. It can boost patient satisfaction, promote patient-centric care, and direct treatment plans. Incorporating HRQoL assessments into routine care can be a boon to your patient’s well-being, as well as your practice of exemplary and robust care.

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