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Quality-of-Life Inquiries Aid Doctor-Patient Relationships
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Am Fam Physician. 2003 Mar 15;67(6):1381-1385.
Health-related quality-of-life (HRQL) assessments are thought to improve detection of physical and psychosocial problems and delivery of care, but few studies have convincingly evaluated these effects. Detmar and colleagues administered HRQL assessments to patients to determine whether they improve physician-patient communication. Effective communication is a proximal outcome measured in terms of physician awareness of HRQL, clinical management activities, physician and patient satisfaction with their medical interactions, and changes in each patient’s self-reported HRQL over time.
Ten physicians and 214 patients undergoing palliative chemotherapy participated in the longitudinal, randomized, crossover study. Patients in the intervention group completed an HRQL questionnaire before each standard chemotherapy follow-up visit. Physicians and patients received training in score interpretation. The control group did not fill out the HRQL and, in mid-study, physicians crossed over from the control to the intervention arm or vice versa. Measures included physician awareness of their patients’ HRQL, effects of HRQL on patient management, and patient and physician satisfaction, and a health survey administered at visits 1 and 4 of the study. Patients and physicians also evaluated the intervention.
Ten of the 12 HRQL issues were discussed more frequently in the intervention group, reaching statistically significant differences in social functioning, fatigue, and dyspnea (see the accompanying table). There were no significant differences between groups in physician awareness of patient HRQL problems. However, in the intervention group, an increase of at least 10 percent over time in physician recognition of moderate to severe problems was observed for daily activities, pain, fatigue, feelings, and social activities.
Patient management was similar in both groups, although the intervention groups received more counseling. Patient satisfaction was high in both groups. A statistically significant percentage of patients in the intervention group compared with the control group exhibited improvement in the health scale over time. The patients in the intervention group had a positive response to the HRQL tool; 87 percent believed it would be useful as a standard part of an outpatient clinic protocol.
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The authors conclude that regularly administered HRQL assessments improve physician-patient communication and may be especially helpful in identifying less obvious areas of difficulty, such as social functioning. Even though physician awareness, patient management activities, and the self-reported health ratings were not affected by the intervention, improvement in certain categories, especially those relating to emotional health, suggests that using an HRQL assessment is worthwhile. These conclusions are supported, the authors observe, by the favorable response of many patients and all participating physicians to the HRQL tool administered in this study.
Detmar SB, et al. Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial. JAMA. December 18, 2002;288:3027–34.
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