Quality of life assessment and clinical decision-making

被引:23
作者
Casali, P
Licitra, L
Costantini, M
Santoro, A
Viterbori, P
Bajetta, E
Bruzzi, P
机构
[1] Ist Nazl Studio & Cura Tumori, Teleconsultat Ctr Rare Tumors, I-20133 Milan, Italy
[2] Ist Nazl Studio & Cura Tumori, Div Med Oncol A, I-20133 Milan, Italy
[3] Ist Nazl Studio & Cura Tumori, Div Med Oncol C, I-20133 Milan, Italy
[4] Ist Nazl Ric Canc, Unit Clin Epidemiol & Trials, I-16132 Genoa, Italy
[5] Ist Clin Rozzano, Med Oncol & Haematol Unit, Rozzano, Italy
[6] Ist Nazl Studio & Cura Tumori, Div Med Oncol A&B, I-20133 Milan, Italy
关键词
clinical decision making; outcome research; quality of life;
D O I
10.1023/A:1008276901910
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Survival and quality of life are the two end-points of cancer treatment. Recommendations are available as to how quality of life should be assessed in clinical studies in order for quantitative scores to be provided for it, along with survival data. The two measurements can be combined, and their total should yield a definition of the state of the art in cancer treatment with respect to both the quantity and the quality of life. However, at the individual level: quality of life can be traded off against survival only by taking into account the patient's attitude toward risk. More importantly, the quality of health status may be valued in a completely different way from patient to patient. Thus, when a clinical choice is to be made from among different treatment options, the ethical principle of respect for the patient's autonomy would require that the patient be informed of their possible respective outcomes, and allowed to provide his/her own assessment of the quality of life associated with these outcomes. This might have consequences for quality of life assessment in clinical studies, which should not only quantify average scores for treatment comparisons, but also provide a 'health state description' with respect to the aftermath of each of the treatment options. These data could be formalized in the already proposed decision instruments incorporating clinical scenarios for patient information. In any case, this should allow individualized clinical decisions incorporating each patient's preferences for the quality of his/her expected life span. Providing average quality of life scores may be useful, indeed, for population-based health decisions, as are those on resource allocation and those on registration of new drugs.
引用
收藏
页码:1207 / 1211
页数:5
相关论文
共 14 条
[1]  
[Anonymous], 1996, J Clin Oncol, V14, P671
[2]  
[Anonymous], 1992, ANN INTERN MED, V117, P947
[3]   THE PATIENTS ROLE IN CLINICAL DECISION-MAKING [J].
BRODY, DS .
ANNALS OF INTERNAL MEDICINE, 1980, 93 (05) :718-722
[4]   A CLINICIAN GUIDE TO COST-EFFECTIVENESS ANALYSIS [J].
DETSKY, AS ;
NAGLIE, IG .
ANNALS OF INTERNAL MEDICINE, 1990, 113 (02) :147-154
[5]   4 MODELS OF THE PHYSICIAN-PATIENT RELATIONSHIP [J].
EMANUEL, EJ ;
EMANUEL, LL .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1992, 267 (16) :2221-2226
[6]   COSTS AND BENEFITS OF ADJUVANT THERAPY IN BREAST-CANCER - A QUALITY-ADJUSTED SURVIVAL ANALYSIS [J].
GOLDHIRSCH, A ;
GELBER, RD ;
SIMES, RJ ;
GLASZIOU, P ;
COATES, AS .
JOURNAL OF CLINICAL ONCOLOGY, 1989, 7 (01) :36-44
[7]   MEASURING HEALTH-RELATED QUALITY-OF-LIFE [J].
GUYATT, GH ;
FEENY, DH ;
PATRICK, DL .
ANNALS OF INTERNAL MEDICINE, 1993, 118 (08) :622-629
[8]   The problem of quality of life in medicine [J].
Leplege, A ;
Hunt, S .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1997, 278 (01) :47-50
[9]   A BEDSIDE DECISION INSTRUMENT TO ELICIT A PATIENTS PREFERENCE CONCERNING ADJUVANT CHEMOTHERAPY FOR BREAST-CANCER [J].
LEVINE, MN ;
GAFNI, A ;
MARKHAM, B ;
MACFARLANE, D .
ANNALS OF INTERNAL MEDICINE, 1992, 117 (01) :53-58
[10]   HEALTHY-YEARS EQUIVALENTS VERSUS QUALITY-ADJUSTED LIFE YEARS - IN PURSUIT OF PROGRESS [J].
MEHREZ, A ;
GAFNI, A .
MEDICAL DECISION MAKING, 1993, 13 (04) :287-292