Quality Of Life

Question 1

List 3 commonly used measures of health.

Answer 1

• morbidity
• morality
• patient-based outcomes

Question 2

What are patient-based outcomes? How do they normally work?

Answer 2

Patient-based outcomes assess well-being from the patients point of view - they work by comparing scores before and after treatment over longer periods

Question 3

Why are patient-based outcomes being more predominantly used?

Answer 3

There has been an increase in conditions where the aim is managing, as opposed to curing, the condition

Question 4

Give 2 examples of a patient-based outcome.

Answer 4

• health-related quality of life (HRQoL)

- patient-reported outcome measure (PROM)

Question 5

Give 2 reasons why using PROMs may be beneficial.

Answer 5

• improve the clinical management of patients

- comparison of providers (hospitals)

Question 6

What 4 clinical procedures in the NhS are currently using PROMs?

Answer 6

• hip replacements
• knee replacements
• groin hernia
• varicose veins

Question 7

Define health-related quality of life.

Answer 7

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

Question 8

How may you measure the HRQoL using a PROM?

Answer 8

By using questionnaires known as instruments

Question 9

What is an instrument? Briefly describe 2 types.

Answer 9

An instrument is a type of questionnaire that can be used to makes health-related quality of life (HRQoL):

• generic instrument - can be used with any population
• specific instrument - evaluates a series of health dimensions for a specific condition or disease

Question 10

List 3 advantages and 3 disadvantages of generic instruments.

Answer 10

Advantages include:
- they can be used for a broad range of health problems
- they can be used if theres no existing disease-specific instrument
- they enable comparisons across treatment groups
Disadvantages include:
- they are inherently less detailed
- they may be too general and loss relevance to the condition
- they may be less sensitive to changes that result from an intervention

Question 11

What is the SF-36 an example of? How is it scored?

Answer 11

The SF-36 is an example of a generic instrument - questions to 8 dimensions are scored, and within each dimension are added together - a score from each dimension is then calculated

Question 12

List the 8 dimensions that compose an SF-36.

Answer 12

• physical functioning
• social functioning
• role functioning (physical)
• role functioning (emotional)
• bodily pain
• vitality
• general health
• mental health

Question 13

In an SF-36, are the separate dimensions added together to give an overall score? Why?

Answer 13

No - this can make interpretation difficult in some cases and makes generalisations of results (ignoring outliers)

Question 14

What is the EuroQol EQ-5D?

Answer 14

A generic instrument that generates a single index value for health status on which full health is assigned a value of 1 and death is assigned a value of 0

Question 15

Where is a EuroQol EQ-5D particularly useful?

Answer 15

It is particularly useful in economic evaluations

Question 16

What 5 dimensions does the EuroQl EQ-5D comprise? What 3 levels may these be rated?

Answer 16

• mobility
• self-care
• usual activities
• pain/discomfort
• anxiety/depression
• these are all rated as either no problem, moderate problem, or extreme problem

Question 17

What 3 types of specific instrument are there? Give an example of each.

Answer 17

• disease specific eg arthritis impact measurement scale
• site specific eg Oxford hip score
• dimension specific eg McGill pain questionnaire

Question 18

List 2 advantages and 2 disadvantages of specific instruments.

Answer 18

Advantages:
- very relevant content
- sensitive to change 
Disadvantages:
- comparison is limited
- may not detect unexpected effects

Question 19

What is a long term condition?

Answer 19

Manifestations that vary day-to-day and can be controlled, but not cured

Question 20

What does an ageing population mean I’m regards to the prevalence of long term conditions?

Answer 20

Long term conditions will increase with an ageing population

Question 21

What percentage of healthcare in England is directed towards caring for those with a long term condition?

Answer 21

70%

Question 22

Give an example of a long term condition, and briefly discuss its pathology and symptoms.

Answer 22

Rheumatoid arthritis, caused by an autoimmune attack at joints - symptoms include joint swelling, pain, fatigue and osteoporosis

Question 23

How is a sociological approach to long term conditions distinct?

Answer 23

It focuses on how long term condition impact on social interaction and performance, concerning the effects of long term conditions and the experiences of the patients, and is interested in now these patients manage their everyday lives

Question 24

What is an illness narrative?

Answer 24

A patients description of their own experiences suffering from a long term condition

Question 25

List the 5 sociological theories of long term conditions.

Answer 25

- illness work - every day life work - emotional work - biographical work - identity work

Question 26

In the illness work theory, why is optimum self management often difficult to achieve?

Answer 26

There are poor rates of adherence to the treatment, due to a reduced quality of life (side effects), and simply just a poor psychological wellbeing

Question 27

In everyday life work, what 2 forms of management are there, and what do they entail?

Answer 27

- coping - the cognitive processes involved in dealing with illness - strategy - actions and processes involved in managing the condition and its impact

Question 28

In everyday life work, what is normalisation?

Answer 28

Attempting to keep your pre-illness lifestyle and identity intact, or re-designing your new life as a 'normal' life

Question 29

What coping mechanism is often associated with emotional work?

Answer 29

Downplaying pain and symptoms, in an attempt to present a 'cheery self'

Question 30

How may social work have an impact of an individual's role in society?

Answer 30

They may now be extremely dependent on others, which may lead to feelings of uselessness - this is particularly damaging in younger individuals

Question 31

What does biographical work entail?

Answer 31

The 'loss of self' where the former self image seems to crumble away - it entails the interaction between the body and identity

Question 32

What type of grief can biographical work lead to?

Answer 32

Grief of their former self or life, with the idea they have lost what they once took for granted

Question 33

What is a huge issue in identity work?

Answer 33

The illness itself can become the defining aspect of identity of an individual, affecting how an individual sees themselves and how others see the sufferer of the condition

Question 34

What is considered a defining word of identity stigma? How is this defined?

Answer 34

Stigma - a negatively defined condition or behaviour conferring 'deviant' status

Question 35

What types of stigma exist?

Answer 35

- discreditable and discrediting stigma | - felt and enacting stigma

Question 36

What is the difference between a discreditable stigma and a discredited stigma?

Answer 36

- a discreditable stigma is one that involves no physical manifestations (eg some mental illnesses, HIV) - a discredited stigma is on that involves physical manifestations or knowledge of a previous stigma (eg physical abnormalities or past suicide attempts)

Question 37

What is the difference between an enacted stigma and a felt stigma?

Answer 37

- an enacted stigma is the real experience of prejudice and discrimination (stigma) as a consequence of a condition - a felt stigma is the fear of experiencing an enacted stigma, encompassing a feeling of shame