Relevance of quality of life to clinical nursing practice.

UALITY OF LIFE is an important concept for nurses who practice in oncology settings because the physical, psychological, and social well-being of the patients are affected by the disease and its treatments. These domains are recognized as aspects of quality of life. Assessment of quality of life relates directly to the goals of nursing care, which include the promotion of health and restoration of a maximum level of function for the patient. Recent developments in cancer treatment have resulted in increasingly toxic therapies. Advances in supportive care technology have allowed patients to tolerate these toxic treatments and to live longer. End points selected for evaluation of cancer therapy have traditionally been tumor response rates and absolute survival, not functional ability or quality of life. ‘** There is a movement to recognize and include quality of life as an acceptable end point in clinical trials. The impetus to include quality of life assessment is influenced by the shift from thinking about cancer as an acute event to cancer as a chronic condition.3 In addition, the growth of cancer survivors groups has indicated to the health care community that, related to the choice of treatment, quality of life is perhaps as important to the patient as the overall therapeutic effect. There is a growing recognition that cancer patients’ perceptions of their disease and treatment contribute a unique and important perspective to assessing outcomes.3 Although patients are demanding information about the relative risks and benefits of treatment options, they are equally concerned with the impact of the therapy on their daily lives.495 The possible and actual quality of life of a patient should influence the selection of the therapeutic plan. The uses of valid, reliable, and clinically relevant measures of quality of life will facilitate planning of appropriate care and the evaluation of specific interventions. To justify these activities and to assure that they are based on meaningful data, an accurate assessment of quality of life is needed. Quality of life evaluation has not been a routine part of cancer clinical trials despite the mission statement of the Division of Cancer Treatment (CTEP) of the National Cancer Institute: “Research aimed at improving survival and quality of life for persons with cancer is of highest priority to CTEP. “6 The “psychosocial toxicities’ ’ of cancer therapy have not been addressed in traditional approaches to the evaluation of therapeutic interventions. At the clinical level, assessment of quality of life in any given situation can monitor the effect of standard therapy on the daily lives of patients. In clinical trials, the inclusion of quality of life measures can help establish patterns relevant to shortand long-term psychosocial adjustment of patients. These patterns can then be the basis of screening programs to identify high-risk individuals who might benefit from psychosocial interventions to maximize the overall outcomes of the cancer therapy. Quality of life parameters can become means of redefining and refining what is meant by the “best” treatment for a given disease or stage of illness .4-6 Therefore, this article addresses the measurement of quality of life by discussing related concepts in nursing practice, clinical usefulness, selection of an assessment method, and the influence of quality of life assessment on clinical decisions and research design.