1

Monitoring Quality of Life in the Clinic

Prof. dr. Jan van Busschbach

Medical Psychology and Psychotherapy

Erasmus MC

Quality of life measurement suggested for use in the clinic

Bradley J, 1999 The adaptations of a quality of life questionnaire for routine

use in clinical practice: the Chronic Respiratory Disease Questionnaire in cystic fibrosis

Backman JW, 2003 The patient-computer interview: a neglected tool that can aid

the clinician.

Adam B, 2007 Measuring social difficulties in routine patient-centred

assessment: a Rasch analysis of the social difficulties inventory

2

3

Congresses

Applications of health status assessment measures in clinical practice. Med Care. 1992 May;30(5 Suppl):MS1-14

ISOQOL Conference on Patient Reported Outcomes in Clinical Practice June 24-26, 2007, Budapest, Hungary

4

An everlasting lasting promise

Budapest Conference Aaronson & Snyder. ISOQOL Newsletter July 2007

Improves patient doctor communication No clear influence on patient management In fact... little research

Publication bias?

5

What stops us?

Complex logistics Does it fit the clinical setting et al? Molla Donaldson

….simply urging clinicians to use PROs would not achieve large-scale adoption and that the systems in which clinicians work must be considered

• ISOQOL Newsletter July 2007

Is there no success at all?

6

Routine screening tools seem to be beneficial in pain

Monitoring psychotherapy

7

Results in psychotherapy

50

55

60

65

70

75

80

First measurement Last measurement

Feedback

No Fb

9

Monitoring in Quality of Life

De Man, Darlington, Gutteling Department of Gastroenterology and Hepatology

162 patients with chronic liver disease Computerised administration

SF-12

Disease specific instrument

11 physicians randomly assigned Feedback, no feedback

Real Time Feedback

10

Results

11

Patients No direct effect of feedback

• …on quality of life No difference in patient satifaction

But with feedback Older patients with feedback held better scores

• Interaction effect on mental health and disease specific Male patients

• Interaction effect on mental health

Physicians Altered treatment policy more often Were positive about feedback

12

Limitation

Difficulty recruiting patients 1850 patients invited

1263 turned invitation down

Logistic complications 244 did not show up at the computer (in time)

146 only 1 administration

Subgroup results...

Lessons learned

Logistics is everything! RCT hampers clinical logistics

Replace by routine outcome monitor

But it might work… Quality of Life

Treatment policy

13

New investigation

Inflammatory bowel disease Zuzana Zelinkova

Dr. Janneke van der Woude

Feedback on Quality of life Inflammatory Bowel Disease Questionnaire (IBDQ]?

SF-36?

Or make disease specific questionnaire? What is important for the patients?

Outcome Influence on treatment policy

Patient doctor communication

14

Conclusions

Feedback seems useful From theory

From empirical evidence

Logistics are an obstacle But somewhere out there is the future…

15