Quality of Life: a critical assessment.

There is increased recognition that Health-Related Quality of Life (HRQOL) or Health Status (HS) is important and, together with other outcome measures, highly relevant to evaluating both the impact of diseases, and the individual and societal benefits/costs of different interventions, management strategies and health policies: yet many problems remain. While the methodology of HS assessment has been extensively studied and greatly improved, implementation has lagged in practice and in clinical research. Resources have been forthcoming for studies which promise increased profit (e.g., marketing advantage) or cost-containment, but funding has been scarce when the focus is on quality of care, patient utility, or health issues such as screening, monitoring or disease prevention. There are well-defined limitations associated with various assessment instruments, with interpretation of scores, and with the lack of relationship between disease activity and overall HRQOL. For these reasons, to date, HS assessment has not been clearly shown to be useful to physicians or to benefit patient outcomes to a degree sufficient to justify the burden of widespread use. Physicians remain cautious of the processes, especially with those aspects that relate to values, autonomy, equity, legal liability and potential for abuse.