U3 health psych - quality of life

• Basic dimensions of quality of life

  • Psychological (mood, emotional distress, coping with illness)
  • Social (relationships, social and leisure activities)
  • Occupational (paid and unpaid work)
  • Physical (mobility, pain, sleep, appetite)
• Health-related quality of life includes only those factors that are part of an individual's health, such as physical, mental, social, and functional aspects of subjective health/well-being
• What is health-related quality of life used for?

  Measure of global self-assessment of health, indicator in diagnostics, success parameter in rehabilitation
• (Health-related) quality of life represents a subjective measure of health and is an important criterion for assessing the course and success of treatments in rehabilitation
• To calculate QALYs:

  1. Remaining Years of Life (x-axis)

  2. Quality of Life in these remaining years (y-axis)

  3. QALY = Lifespan x Quality of Life
• What are some "subjective" health measures?

  • Asking individuals how they feel
  • quality of life
  • health-related quality of life
• What dimensions does the SF-36 Scale used to measure quality of life capture?

  1. Physical functioning (e.g. problems with climbing stairs)
  2. Physical role functioning (problems with household & daily activities)
  3. Bodily pain
  4. General health perception
  5. Social functioning (e.g. mobility issues making social meetings difficult)
  6. Vitality (e.g. becoming sluggish)
  7. Mental well-being
  8. Emotional role functioning
• What are some problems about current Quality of Life measures?

  General measures (e.g. SF-36) can be too broad (providing a vague, unfocused definition of quality of life) or too specific and focused (which could leave out potentially important aspects for some individuals)

  while individual QoF measures have participants assess their health based on self-defined dimensions, which has become increasingly complex as the idea of health becomes more multi-dimensional.
• What are some advantages and disadvantages of measuring QoF?

  Advantages:

  • Health-related QoF represents a subjective measure of health
  • And is an important criteria for assessing the course & success of rehabilitation treatment

  Challenges

  • Definition can be too broad, lacking consensus
  • Wide range of measurement methods lacks comparability and offers different interpretation of results
• What does 1 QALY represent?

  1 year of life in perfect health
• How to determine (gained) QALYs?

  • Potential longer lifespan calculable based on study results that evaluate medical treatment
  • 3 Methods for quality of life (bit more complex)

  1. Time-trade off (e.g. how many years of my life would i give up to live without these health restrictions)
  2. Standard-Lottery ("what probability of death would I accept for a complete cure?")
  3. Rating Scales (subjective assessment of QoF given a health condition)
• What are QALYs used for?

  Not for the individual decision of whether a patient should receive treatment, but rather for policy level; e.g. which treatment should be approved for Condition A?
• If QoF value is between 0 (worst possible) and 1 (best possible QoF) and Lifetime value is in years, QALY = QoF (0-1) * remaining Lifetime, how much QALYs would Patient X gain through the new therapy in the following example?

  A patient lives with standard therapy for another 2 years with a quality of life of 0.3. New therapy would result in an expected lifespan of 4 years with a QoF of 0.5.

  Standard therapy yields 2* 0.3 = 0.6 QALYs, while new therapy yields 4*0.5=2 QALYs. The patient would thus gain 2-0.6=1.4QALYs from the new therapy.

  
• What are the benefits of using QALYs?

  Resource allocation; QALYs do not include costs themselves but can be used for financial efficiency calculations (controversial) (e.g. cost of intervention/QALYs= how much does an additional unit of QALY cost through intervention?, compared to either another or no intervention)
• What are some methodical critiques of using QALYs?

  Methodical critiques:

  • Validity of the objective valuation of QoF (some health conditions could be considered worse than death, should they have negative value of QoF?)
  • Should we consider diminishing marginal utility? (Should gain of 0.1 in QALY be equal in those who are otherwise healthy and in those who are severely ill?)
  • Accuracy in assessing "disease burden" in illnesses one doesn't personally experience
• What are some potential ethical critiques against using QALY?

  • Potential for discrimination against individuals with chronic illness/disability by comparing "intervention utility" between conditions
  • Discrimination against older folks (who naturally would have fewer additional years of life expected than those who are younger)
  • General critiques of utilitarianism
• multimorbidity is the presence of 2 or more chronic diseases, often seen in older folk. a common consequence of multi-morbidity is a reduced quality of life
• From Makovski et al. (2019)'s meta-analysis of multimorbidity and quality of life, we can see:

  • There is a negative correlation between multimorbidity and quality of life.
  • Correlations between the 2 factors are comparable across different measures.
  • Correlation between physical health and QoF appears > than between mental health and QoF.
  • Increasing illnesses are more strongly associated with a deteriorated QoF in women than in men. (SF)
  • Higher age is associated with less severe decline in QoF with increasing illnesses. (EQ-5D)