Surgical Research Review

Using quality-of-life instruments to assess surgical outcomesast;,**

Purposes of quality-of-life instruments

Quality-of-life instruments have a number of applications. Fitzpatrick et al³ have identified 6 categories of applications for quality-of-life instruments.

• 1.

  Screening and monitoring for psychosocial problems in individual patient care—directed primarily to patients with chronic disease to measure progress or to identify psychosocial stressors that may require intervention.

• 2.

  Population surveys of perceived health problems—use of the instrument as a survey to help health care policy makers in

Essential characteristics of a quality-of-life instrument

Quality-of-life instruments have 5 essential characteristics that determine their “quality.”3, 7

• 1.

  Reliability: the instrument must produce the same result on repeated examinations.

• 2.

  Validity: the instrument needs to measure what it was intended to measure.

• 3.

  Sensitivity to change (also referred to as responsiveness): the instrument must be able to detect and measure changes in quality of life over time or after an intervention.

• 4.

  Appropriateness: the instrument must be appropriate for the health problem

Types of quality-of-life instruments

There are 3 basic types of quality-of-life instruments: generic, disease specific, and symptom severity. The Table provides examples of each.

Choosing an instrument

No one quality-of-life instrument fits all situations. The choice of the instrument cannot be separated from the goals of the investigator or clinician. However, some rules of thumb can be helpful in making the choice.¹¹

In all situations the instrument chosen must be reliable and valid. It must be reliable in the sense that the instrument must produce the same results on repeated examinations under the same conditions, a concept that must be tested for specifically by the developers of the