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Patient’s evaluation of quality of life
Provides understanding of impact of illness from patient’s viewpoint– Different from health status or physical functioning– Quality of life can be good even with physical disability– More than health problems, loss of abilities, or
functional deficits
Incorporation of patient’s values sets QOL assessment apart from measures of health status
Patient’s evaluation of quality of life
Important tool for understanding individual differences in response to illness– Individual responses in adapting to cancer and
treatment– Re-evaluation of life in context of life-threatening
disease
Ultimate purpose for QOL assessment Enhanced well-being – Particularly in palliative care and at end of life
(interventions aimed at providing comfort and emotional support)
– Maximize QOL
Ferrans Model of QOL (1985 & 1990) Scope of the Concept
Social and Economic Domain
Psychological/Spiritual Domain
Quality of Life
Health andFunctioning Domain
Family Domain
Ferrans & Powers Quality of Life Index
Part 1: SATISFACTION with various aspects of life
Part 2: IMPORTANCE of those same aspects of life
• Scores reflect satisfaction with the aspects of life that are valued by the individual.
• Five Scores– Overall QOL
– Health and functioning
– Psychological/spiritual
– Social and economic
– Family
Ferrans & Powers Quality of Life Index
Published first in 1985 (200+ published studies) International research (30+ countries)
– Americas: USA, Canada, Mexico, Brazil, Chile
– Europe: Denmark, France, Great Britain, Hungarian, Italy, Lithuania, Norway, Poland, Portugal, Romania, Russia, Spain, Sweden
– Middle East: Israel, Jordan, Turkey
– Africa: South Africa
– Asia: India, China, Korea, Japan, Thailand, Taiwan
– Australia and New Zealand U.S. cross-cultural research
– African Americans– Mexican Americans– Korean Americans
21 Languages
Arabic Chinese Danish English French Hebrew Hungarian Italian Japanese Korean Lithuanian
Norwegian Polish Portuguese Romanian Russian Spanish Swedish Tamil Thai Turkish
Ferrans & Powers Quality of Life Index --Prognostic value in 251 breast cancer patients (p = .0006)
Survival Functions
Overall survival from the date first seen at MRMC
6050403020100-10
Cum
Sur
viva
l
1.2
1.0
.8
.6
.4
.2
0.0
NTILES of HEALTHFU
2
2-censored
1
1-censored
Quality of Life of African American Cancer SurvivorsNIH R01 CA89418 (CALGB 119901)
Survivors: 500 African American cancer survivors – Breast, prostate, colon– Currently free of cancer
Controls: 500 African American non-cancer controls– Selected via random digit dialing from the areas in
which the cancer survivors reside.
– Matched (as a group) to the survivor group on age, gender, health insurance status, and education level
16 Participating CALGB Institutions
Heme/Onc Associates of Central NY
Northern Indiana Ohio State University University of Chicago University of Illinois at
Chicago Wake Forest Walter Reed Washington University –
St. Louis Hartford Hospital
Jersey Shore Medical Center
Navy Medical Center – San Diego
Queens Hospital Medical Center
Roswell Park Cancer Center
Sibley Memorial Hospital Wayne Memorial
Hospital - SCCC Jesse Brown VA Medical
Center
Explaining the Variance in Quality of Life
Urban Life Stress
Depression
Social Support
Physical Function
Comorbidities
Work Problems
Trust in MD
Spirituality
Age
Cancer Survivor
Interaction
26%
22%19%
9%
8%
5%5%
3%2% .4% .2%
Model explained 66% of variance in QOL