Measuring Quality of Life

Quality of life is considered an important marker within healthcare, particularly as concerns individuals living with chronic disease. Quality of life (QoL) implies a life well-lived: an apt if rather vague descriptor. Given that scientists like to quantify things, the question arises as to what determines quality of life, and what is the best way to measure those determinants in clinical situations where time is of the essence?

According to the World Health Organization (WHO), quality of life includes health, work capacity, social support and the physical environment (Wulfovich et al., 2022). The WHO Quality of Life instrument (WHOQOL) divides quality of life into five domains: physical health, psychological health, levels of independence (function), social relationships and environment, with each domain divided into numerous subdomains (33 in all) (WHO, n.d.). While this level of granularity is well suited for research, the 100-question tool is impractical for a busy clinic. Even the briefer 26-item version may be a hard sell to patients. The ultra-brief PEG pain questionnaire (see the “Study section on this website) was developed specifically for primary care, asking respondents to rate their pain intensity, enjoyment of life and ability to perform general activities (ADLs) on a numeric scale (Krebs et al., 2009).

An alternative approach to measuring QoL is that proposed by the quantified self movement: individuals who track biometrics and lifestyle habits using digital tools such as the Apple watch, Fitbit and Garmin devices. “Smart” wristwatches are able to record speed, time and distance during an exercise workout, track sleep via actimetry, heart rate variability (HRV), stress, calories consumed and burned, hydration, etc. An increasingly diverse library of phone apps adds specific monitoring for chronic conditions such as diabetes and chronic back pain, with some providing virtual coaching. What is appealing about this method is its potential for better self-management, by giving persons real-time feedback on physical activity, sleep and diet: three key contributors to QoL.

While biometrics is easy to quantify, other aspects of QoL are not. Specifically, QoL inevitably involves life meaning, encompassing both formal religious beliefs and spirituality (Dyer & Stieg, 2015). Acceptance and commitment therapy (ACT) stresses the importance of living one’s values, despite day-to-day challenges. This concept has roots in Buddhist philosophy, which accepts suffering as part of life. Buddhism challenges individuals to live and find joy in the moment, often via meditation. ACT suggests that life-long values are the glue that hold life together, and help individuals move beyond the day-to-day.

Whether or not clinicians can quantify all aspects of QoL, they are ethically bound to help patients achieve it. This is the soft part of medicine: the time consuming, but essential art of listening, establishing rapport and empathizing with those who come in search of better health. Challenging as it may be this art of medicine is what makes its practice most gratifying. By helping our patients to improve their quality of life, we also improve our own.

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