THE QUALITY-OF-LIFE, RESEARCH, AND CARE

As medical care is directed increasingly toward management of chronic diseases, measuring the quality of life as an outcome becomes more important. Therapeutic trials traditionally have focused on physiologic outcomes, but these outcomes may be only modestly associated with symptoms or functional ability. Although quality-of-life measures may be regarded as "soft" and inferior to laboratory measures, newer instruments achieve high levels of reproducibility and validity. These newer questionnaire measures appear to offer important advantages over older and simpler scales, some dating from the 1940s. Despite conceptual and methodologic challenges, several quality-of-life instruments are ready for wider incorporation into clinical trials. Research is needed to improve existing measures, to provide head-to-head comparisons, and to assess the feasibility of incorporating these instruments into routinely maintained databases.