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July 2, 1997, Vol 278, No. 1 >
ARTICLE | July 2, 1997

The Problem of Quality of Life in Medicine FREE

Alain Leplège, MD, PhD; Sonia Hunt, PhD
[+] Author Affiliations

Reprints: Alain Leplège, MD, PhD, INSERM Unité 292, Hôpital de Bicêtre, 82 rue du Général Leclerc, 94276 Le Kremlin-Bicêtre, Cedex, France (e-mail: leplege@vjf.inserm.fr).


JAMA. 1997;278(1):47-50. doi:10.1001/jama.1997.03550010061041
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References

The use of the term "quality of life" to encompass the values and perceptions of patients has created doubt, confusion, and misunderstanding among practitioners, researchers, policymakers, and patients. The principal reason for this state of affairs is that a clear conceptual basis for quality-of-life measures is lacking. In this article, the current rationale for quality-of-life measurement in the health field is examined, and the drawbacks of the various models being used are outlined. Our suggestion is that quality of life as an outcome could be explored more clearly (ie, defined) if quality of life were replaced with a more easily handled notion such as that of "subjective health status." However, the idea that the patient's perspective is as valid as that of the clinician when it comes to evaluating outcomes has a great deal of legitimacy and should certainly not be abandoned.

REFERENCES

1 +
Walsh RM, Aranha GV, Freeark RJ.  Mortality and quality of life after total abdominal colectomy . Arch Surg . 1990;;125:1564-1566.
2 +
Hunt SM, McKenna SP.  The measurement of quality of life of people with epilepsy . In: Hopkins A, Shorvon S, Cascino G, eds. Epilepsy . 2nd ed. London, United Kingdom: Chapman & Hall; 1995;.
3 +
Testa MA, Anderson RB, Nackley JF, Hollenberg NK, for the Quality of Life Hypertension Group.  Quality of life and anti-hypertensive therapy in men . N Engl J Med . 1993;;328:907-913.
4 +
Hunt SM, McEwen J, McKenna SP.  Measuring health status . J R Coll Gen Pract . 1985;;35:185-188.
5 +
Bergner M, Bobbitt R, Pollard W, et al.  The sickness impact profile . Med Care . 1976;;19:787-805.
6 +
Mahoney F, Barthel D.  Functional evaluation: the Barthel Index . Md Med J . 1965;;14:61-65.
7 +
Lough ME, Lindsey AM, Shinn AJ, Stotts NA.  Life satisfaction following heart transplantation . J Heart Transplant . 1985;;4:446-449.
8 +
Elinson J, Siegmann AE. Socio-medical Health Indicators . Farmingdale, NY: Baywood Publishing Co Inc; 1976;.
9 +
Hunt SM.  Cross-cultural comparability of quality of life measures . In: Guggenmoos-Holzmann I, Bloomfield K, Brenner H, Flick U, eds. Quality of Life and Health . Berlin, Germany: Blackwell Wissenschafts-Verlag; 1995;:1.
10 +
World Health Organization Working Group.  The WHO quality of life assessment instrument . In: Orley J, Kuyken W, eds. Quality of Life Assessment in Health Care Settings . Heidelberg, Germany: Springer-Verlag; 1994;.
11 +
Leplège A, Verdier A.  The adaptation of health status measures: methodological aspects of the translation procedure . In: Shumaker S, Berzon R, eds. International Use and Performance of Health Related Quality of Life Instruments . Oxford, United Kingdom:Rapid Communication of Oxford; 1995;:93-101.
12 +
Warwick D, Osherson S. Comparative Research Methods . Englewood Cliffs, NJ: Prentice-Hall International Inc; 1973;.
13 +
Hunt SM, Wiklund I.  Cross cultural variation in the weighting of health statements: a comparison of English and Swedish valuation . Health Policy . 1987;; 8:227.
14 +
Hunt SM.  Cross cultural issue in the use of sociomedical indicators . Health Policy . 1986;;6:149-158.
15 +
Hodge J.  The quality of life: a contrast between utilitarian and existential approaches . In: Baldwin S, Godfrey C, Protter C, eds. Quality of Life: Perspectives and Policies . London, United Kingdom: Routledge; 1990;.
16 +
Bury M.  The sociology of chronic illness . Sociol Health Illness . 1991;;13:451-468.
17 +
Weinstein MC, Stason WB.  Foundation of cost-effectiveness analysis for health and medical practices . N Engl J Med . 1977;;296:716-721.
18 +
Smith GT.  The economics of hypertension and stroke . Am Heart J . 1990;;119( (suppl 3) ):725-728.
19 +
Drummond M, Torrance G, Mason J.  Cost effectiveness league tables: more harm than good? Soc Sci Med . 1993;;37:33-40.
20 +
Carr-Hill RA, Morris J.  Current practice in obtaining the 'Q' in QALYs . BMJ . 1991;;303:699-701.
21 +
Savage LJ. The Foundations of Statistics . 2nd rev ed. New Haven, Conn: Yale University Press; 1972;.
22 +
Kahneman D, Slovic P, Tversky A, eds. Judgment Under Uncertainty: Heuristics and Biases . New York, NY: Cambridge University Press; 1982;.
23 +
Pearlman RA, Jonsen A.  The use of quality of life considerations in medical-decision making . Ann Intern Med . 1985;;97:420-425.
24 +
Jachuck SJ, Brierley H, Jachuck S, Willcox PM.  The effect of hypotensive drugs on the quality of life . J R Coll Gen Pract . 1982;;32:103-105.
25 +
Hall R, Horrocks JC, Clamp SE, De Dombal FT.  Observer variation in assessment of results of surgery for peptic ulceration . BMJ . 1976;;1:814-816.
26 +
Thomas MR, Lyttle D.  Patient expectations about success of treatment and reported relief from low back pain . J Psychosom Res . 1980;;24:297-301.
27 +
Sugarbaker PH, Barofsky I, Rosenberg SA, Gianda FJ.  Quality of life assessment of patients in extremity sarcoma clinical trials . Surgery . 1982;;91:17-23.
28 +
Finlayson T, McEwen J. Coronary Heart Disease and Pattern of Living . London, United Kingdom: Croom Helm; 1977;.
29 +
Mossey JM, Shapiro E.  Self-rated health: a predictor of mortality among the elderly . Am J Public Health . 1982;;72:800-808.
30 +
Scambler G, Hopkins A.  Generating a model of epileptic stigma . Soc Sci Med . 1990;;30:1187-1194.
31 +
Anderson R, Aaronson NK, Leplège A, Wilkin D.  Review of the International Assessment of Health Related Quality of Life . In: Spilker B, ed. Quality of Life and Pharmacoeconomics in Clinical Trials . New York, NY: Raven Press; 1995;.
32 +
Sartre JP. L'existentialisme est un humanisme . Paris, France: Nagel; 1946;.
33 +
Adorno TW. Cited by: Hodge J.  The quality of life: a contrast between utilitarian and existential approaches . In: Baldwin S, Godfrey C, Protter C, eds. Quality of Life: Perspectives and Policies . London, United Kingdom: Routledge; 1990;.
34 +
Lerner M.  Conceptualization of health and social well-being . Health Serv Res . 1973;;8:6-12.
35 +
Drummond N. The Quality of Life of Patients With Asthma. Aberdeen, Scotland: University of Aberdeen; 1997. Thesis.
36 +
Leplège A.  Mesurer la quelité de vie . L'enseignement Philosophique . 1996;;46:23-37.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Walsh RM, Aranha GV, Freeark RJ.  Mortality and quality of life after total abdominal colectomy . Arch Surg . 1990;;125:1564-1566.
2 +
Hunt SM, McKenna SP.  The measurement of quality of life of people with epilepsy . In: Hopkins A, Shorvon S, Cascino G, eds. Epilepsy . 2nd ed. London, United Kingdom: Chapman & Hall; 1995;.
3 +
Testa MA, Anderson RB, Nackley JF, Hollenberg NK, for the Quality of Life Hypertension Group.  Quality of life and anti-hypertensive therapy in men . N Engl J Med . 1993;;328:907-913.
4 +
Hunt SM, McEwen J, McKenna SP.  Measuring health status . J R Coll Gen Pract . 1985;;35:185-188.
5 +
Bergner M, Bobbitt R, Pollard W, et al.  The sickness impact profile . Med Care . 1976;;19:787-805.
6 +
Mahoney F, Barthel D.  Functional evaluation: the Barthel Index . Md Med J . 1965;;14:61-65.
7 +
Lough ME, Lindsey AM, Shinn AJ, Stotts NA.  Life satisfaction following heart transplantation . J Heart Transplant . 1985;;4:446-449.
8 +
Elinson J, Siegmann AE. Socio-medical Health Indicators . Farmingdale, NY: Baywood Publishing Co Inc; 1976;.
9 +
Hunt SM.  Cross-cultural comparability of quality of life measures . In: Guggenmoos-Holzmann I, Bloomfield K, Brenner H, Flick U, eds. Quality of Life and Health . Berlin, Germany: Blackwell Wissenschafts-Verlag; 1995;:1.
10 +
World Health Organization Working Group.  The WHO quality of life assessment instrument . In: Orley J, Kuyken W, eds. Quality of Life Assessment in Health Care Settings . Heidelberg, Germany: Springer-Verlag; 1994;.
11 +
Leplège A, Verdier A.  The adaptation of health status measures: methodological aspects of the translation procedure . In: Shumaker S, Berzon R, eds. International Use and Performance of Health Related Quality of Life Instruments . Oxford, United Kingdom:Rapid Communication of Oxford; 1995;:93-101.
12 +
Warwick D, Osherson S. Comparative Research Methods . Englewood Cliffs, NJ: Prentice-Hall International Inc; 1973;.
13 +
Hunt SM, Wiklund I.  Cross cultural variation in the weighting of health statements: a comparison of English and Swedish valuation . Health Policy . 1987;; 8:227.
14 +
Hunt SM.  Cross cultural issue in the use of sociomedical indicators . Health Policy . 1986;;6:149-158.
15 +
Hodge J.  The quality of life: a contrast between utilitarian and existential approaches . In: Baldwin S, Godfrey C, Protter C, eds. Quality of Life: Perspectives and Policies . London, United Kingdom: Routledge; 1990;.
16 +
Bury M.  The sociology of chronic illness . Sociol Health Illness . 1991;;13:451-468.
17 +
Weinstein MC, Stason WB.  Foundation of cost-effectiveness analysis for health and medical practices . N Engl J Med . 1977;;296:716-721.
18 +
Smith GT.  The economics of hypertension and stroke . Am Heart J . 1990;;119( (suppl 3) ):725-728.
19 +
Drummond M, Torrance G, Mason J.  Cost effectiveness league tables: more harm than good? Soc Sci Med . 1993;;37:33-40.
20 +
Carr-Hill RA, Morris J.  Current practice in obtaining the 'Q' in QALYs . BMJ . 1991;;303:699-701.
21 +
Savage LJ. The Foundations of Statistics . 2nd rev ed. New Haven, Conn: Yale University Press; 1972;.
22 +
Kahneman D, Slovic P, Tversky A, eds. Judgment Under Uncertainty: Heuristics and Biases . New York, NY: Cambridge University Press; 1982;.
23 +
Pearlman RA, Jonsen A.  The use of quality of life considerations in medical-decision making . Ann Intern Med . 1985;;97:420-425.
24 +
Jachuck SJ, Brierley H, Jachuck S, Willcox PM.  The effect of hypotensive drugs on the quality of life . J R Coll Gen Pract . 1982;;32:103-105.
25 +
Hall R, Horrocks JC, Clamp SE, De Dombal FT.  Observer variation in assessment of results of surgery for peptic ulceration . BMJ . 1976;;1:814-816.
26 +
Thomas MR, Lyttle D.  Patient expectations about success of treatment and reported relief from low back pain . J Psychosom Res . 1980;;24:297-301.
27 +
Sugarbaker PH, Barofsky I, Rosenberg SA, Gianda FJ.  Quality of life assessment of patients in extremity sarcoma clinical trials . Surgery . 1982;;91:17-23.
28 +
Finlayson T, McEwen J. Coronary Heart Disease and Pattern of Living . London, United Kingdom: Croom Helm; 1977;.
29 +
Mossey JM, Shapiro E.  Self-rated health: a predictor of mortality among the elderly . Am J Public Health . 1982;;72:800-808.
30 +
Scambler G, Hopkins A.  Generating a model of epileptic stigma . Soc Sci Med . 1990;;30:1187-1194.
31 +
Anderson R, Aaronson NK, Leplège A, Wilkin D.  Review of the International Assessment of Health Related Quality of Life . In: Spilker B, ed. Quality of Life and Pharmacoeconomics in Clinical Trials . New York, NY: Raven Press; 1995;.
32 +
Sartre JP. L'existentialisme est un humanisme . Paris, France: Nagel; 1946;.
33 +
Adorno TW. Cited by: Hodge J.  The quality of life: a contrast between utilitarian and existential approaches . In: Baldwin S, Godfrey C, Protter C, eds. Quality of Life: Perspectives and Policies . London, United Kingdom: Routledge; 1990;.
34 +
Lerner M.  Conceptualization of health and social well-being . Health Serv Res . 1973;;8:6-12.
35 +
Drummond N. The Quality of Life of Patients With Asthma. Aberdeen, Scotland: University of Aberdeen; 1997. Thesis.
36 +
Leplège A.  Mesurer la quelité de vie . L'enseignement Philosophique . 1996;;46:23-37.

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