Session 2 - Quality of Life, Long Term Conditions and Mental Health

Question 1

List some reasons as to why we measure health.

Answer 1

• To be able to assess need for healthcare
• To target resources to this need
• To assess the effectiveness of health interventions
• To evaluate the quality of health sevices
• To monitor the progress of patients.

Question 2

What are 3 commonly used measures of health?

Answer 2

1. Mortality
2. Morbidity
3. Patient-based outcomes

Question 3

What is meant by ‘Patient Based Outcomes’?

Why are they used?

Answer 3

• The attempt to assess well-being from the patient’s point of view. Methods include PROMs (measures scores before and after treatment) and HRQoL.
• Useful in a healthcare system where there is an increase in conditions that require managing rather than curing.
• Advantageous in that they focus on the patient’s concerns (akin to a consumer)

Question 4

How might Patient Based Outcomes be used?

Answer 4

• Clinically
• To assess benefits against costs
• To measure the health status of populations
• To compare interventions in a clinical trial
• To measure overall service quality.

Question 5

What have PROMs been introduced?

Answer 5

• To improve the clinical management of patients (informed, shared decision making).
• To enable a comparison of hospitals

Question 6

What procedures to PROMs currently cover?

Answer 6

1. Hip replacements.
2. Knee replacements.
3. Groin hernia.
4. Varicose Vein.

Question 7

Outline some of the challenges with PROMs.

Answer 7

• Trying to minimise the time and cost of collection, anaylsis and presentation of data.
• Achieving high rates of patient participation.
• Avoiding misuse of PROMs.

Question 8

Define Health Related Quality of Life.

Answer 8

Quality of life in clinical medicine represents the functional effect of an illness and its consequent therapy upon a patient, as perceived by the patient.

Question 9

What are some of the dimensions to HRQoL?

Answer 9

• Physical function (mobility, dexterity, range of movement, ADLs)
• Symptoms (pain, nausea, appetite, energy, vitality)
• Psychological well-being
• Social well-being (intimate relations, social contact)
• Cognitive functioning (concentration, memory)
• Personal constructs (satisfaction with appearance)
• Satisfaction with care

Question 10

What criteria (2) should using a PROM to measure HRQoL meet?

Answer 10

Reliability - is it accurante over time and internally consistent?

Validity - does it measure what it is meant to measure?

Question 11

What are GENERIC instruments in the context of HRQoL, and what are the advantages of these?

Answer 11

• Cover perceptions of overall health and can be used with any population.
• EXAMPLE = SF-36
• Wide-ranging
• Enable comparision across treatment groups
• Can be used to assess the health of populations
• Useful if there is no disease-specific tool.

Question 12

What are some disadvantages of GENERIC instruments?

Answer 12

• Less detailed (because they are general)
• Potentially not relevant enough
• Less sensitive to changes that occur
• Less acceptable to patients on occasion.

Question 13

Outline the 8 categories of the SF-36.

Answer 13

1. Physical functioning
2. Social functioning
3. Role functioning (physical)
4. Role functioning (emotional)
5. Bodily pain
6. Vitality
7. General health
8. Mental health

Question 14

What is the EuroQoL EQ-5D?

Answer 14

Tool which generates a single index value for health status whereby full health = 1 and death = 0.

It has 5 dimension - mobility, self-care, ADLs, pain/discomfort & anxiety/depression.

These each have 3 levels - no problems, some problems and extreme problems

Question 15

Outline the advantages and disadvantages of SPECIFIC instruments.

Answer 15

ADVANTAGES:

• Relevant content
• Sensitive to change
• Acceptable to patients.

DISADVANTAGES:

• Limited comparison
• Disease specific
• May not detect unexpected effects

Question 16

Outline some key considerations when selecting an instrument for the purposes of HRQoL.

Answer 16

• Is the instrument reliable and valid?
• Has it been used successfully on previous occasions?
• Is it suitable for this area?
• Does it accurately reflect patients’ concerns and is it acceptable to them?
• It is sensitive to change?
• Is it easy to use and analyse?

Question 17

Why might psychological problems in patients with long term conditions not be recognised?

Answer 17

• Symptoms may be missed i.e. attributed to the illness or treatment, or experienced outside of the consultation.
• Patients may not disclose their symptoms - wishing to avoid stigma, feeling judged, or being seen as failing to cope.
• HCPs may avoid asking - capacity/time constraints, reluctance to label people.

Question 18

What is COPING?

Answer 18

The sum of cognitive and behavioural efforts, which are constantly changing, that aim to handle particular demands, whether internal or external, that are viewed as taxing or demanding.

Question 19

How does the transactional model work?

Answer 19

Question 20

What are two functions/approaches to coping?

Answer 20

1. EMOTION FOCUSSED COPING i.e. change the emotion
   * - Behavioural approaches that involve doing something.*
   * - Cognitive approaches that involve changing how you think about the situation.*

2. PROBLEM FOCUSSED COPING i.e. change the problem or resources.

• • Reduce the demands of a stressful situation.*
• • Expand your resources to deal with it.*

Question 21

In what ways can coping be aided?

Answer 21

1. Social Support - increase/mobilise a patients’ social support.
2. Increase Personal Control - pain management, CBT, involve patients in care planning & facilitate cognitive control.
3. Prepare patients for stressful events (by reducing ambiguity and uncertainty)