HS499 Bachelor’s Capstone

1. HS499 Bachelor’s Capstone Week 4 Seminar QOL Research

2. Seminar Questions Discuss your status report on your progress with your research project.  Include your impression of the availability of outside resources to include in your research.  Indicate which areas you think you may be in need of further assistance in developing your project. Discuss the articles assigned for Unit 4; select one and provide your interpretation of the research performed.  What methodology was used?  How was the data collected?  What were the findings? What were the implications of this research for future health care delivery?  Remember to include the source citations for outside resources used in forming your comments.

3. Article 1 • Abstract:

4. Article 1 • The authors note that “quality of life is an important end point in the care of patients with cancer” • System integration of QOL assessments in clinical settings lags behind importance • The task is to identify how QOL data can be integrated formally, systematically and efficiently into clinical practice to aid in patient care.

5. Article 1 • Further noted is the evidence suggesting the need to optimize processes and outcomes through implementation of multicomponent inverventions • Six components of optimal care of illness as indicated by the Institute of Medicine: • Safe • Timely • Evidence based • Efficient equitable • Patient centered

6. Article 1 • Article one stresses that the “core of patient centered care is the concept of self-management or patients’ active and central role in managing their illness”. • This is accomplished in two ways • Group Level Data: • Example: prophylactic mastectomy for women at high risk of breast cancer due to a strong family history • Example: conservative surgery instead of mastectomy

7. Article 1 • 2. Individual Data:

8. Article 1 • The authors indicate that “patient completion of QOL questionnaires before intervention is useful in providing a baseline in which the patient serves as his or her own control”. • Integrating these QOL assessments have short and long term outcomes • Examples: short term increased awareness for the patient, decrease time for clinician to determine patient concerns, and long term changes in QOL, patient reported outcomes, patient management and overall satisfaction with management of care.

9. Article 1 • The process of collecting QOL data is accomplished by: • Administration of paper and pencil questionnaires • Computer assisted touch screen self administration of questionnaires • Computerized interviews • Computerized data collection appears to be preferred as opposed to interviews.

10. Article 1 • Outcomes have been favorable by identifying QOL problems and enhancing communication between patients and their clinicians • Psychosocial outcomes have also been favorable for generalized distress, mental health, anxiety and stress or depression • The authors note that “few studies provided longitudinal data so that a person’s function from one time to another could be compared”.

11. Article 1 • Here are examples of the types of questionnaires that may be administered to patients for QOL

12. Article 1

13. Article 1

14. Article 1 • Several barriers are recognized and should be addressed in implementing QOL assessment in the clinical setting: • The belief that QOL is easily obtained by asking patients how they are doing • The possibility that clinicians could feel inadequate in their ability to address some of the issues identified by their patients • Concern that with the identification of additional needs comes the responsibility of addressing those needs. Article 1

15. Article 1 • Study conclusion:

16. Article 2 • HRQL: health related quality of life • Authors believe that this is an art and a science • These assessments have been successfully used to change and influence patient and physician communication • It is further demonstrated that this results in improved patient satisfaction

17. Article 2 • Authors indicate that clinical practice may be improved by • Aiding detection of physical or psychosocial problems that might be overlook • Monitoring disease and treatment • Allowing precisely timed alterations in therapeutic plans • Facilitating patient-physician communication • Improving the delivery of care

18. Article 2 • The authors identify the critical elements necessary for the success of HRQL assessments include: • Availability of acceptable set of measures from which to choose • Clinical relevance and ease of use • Buy in from clinic staff and patients for effective implementation

19. Article 2 • Authors further note that survey instruments must be reliable and valid • They define reliability as “an instrument’s dependability, expressed as the extent to which it either measures something accurately or produces the same score on repeated applications”. • “Validity refers to the extent to which an instrument measure what it proposes to measure”

20. Article 2

21. Article 2 • Figure 1 shows an organizing model with the hypothesis that the link between clinical and HRQL variables is stronger for self-reported disease symptoms than for more general health perceptions. • Table 2 shows data from selected studies of the reliability of common clinical and HRQL measurements • It provides a range of reliability estimates within each measurement category

22. Article 2

23. Article 2 • There are several examples of how HRQL data utilization is used as the primary source of decision making: • Pain management • Asthma • HIV • Gastrointestinal disorders • Rheumatoid Arthritis

24. Article 2 • Author’s conclusion