Torrance advocates the inclusion of physical, emotional, sensory, cognitive, and self-care functioning, in addition to pain, but he excludes social functioning. In actual use the descriptions used in the standard gamble and time trade-off methods vary according to the disease or technology being evaluated. The QWB is narrow in focus because it encompasses only mobility, physical activity, social activity, and symptoms. The San Diego group has taken a different approach to assessing utility values (Kaplan et al. 1984, Kaplan and Bush 1982). Their first step was to categorize individuals in given health states with respect to levels of mobility, physical activity, and social activity.

Many NGOs do not focus at all on reducing poverty on a national or international scale, but rather attempt to improve the quality of life for individuals or communities. One example would be sponsorship programs that provide material aid for specific individuals. Although many organizations of this type may still talk about fighting poverty, the methods are significantly different.

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We found considerable discussion of linear analogue self-assessment (LASA) or visual analogue scales (VAS) for rating quality of life. These scales are typically 10 centimeters long with the low or poor end of the scale anchored at 0 and the upper end anchored at 100. In response to a cue word or phrase, patients mark their self-assessments on the line. Priestman and Baum (1976) were among the first to use this technique for quality-of-life assessments of cancer patients. In a number of studies these and other investigators have used items related to symptoms and side effects, anxiety and depression, personal relations, and functioning, but the actual cues have varied from study to study.

In 41 of the papers (25%), the investigators gave a specific reason for the choice of instrument to measure QOL (criterion 3). In 88 (53%) of the studies, the investigators had aggregated results from multiple items, domains, or instruments into a single composite score for QOL (criterion 4). However, few studies (9%) fulfilled criterion 5, concerning whether patients were asked to give their own global rating of QOL by a single item at the end of the questionnaire. Three hundred and eight patients with advanced breast cancer were randomized to continuous or intermittent chemotherapy. Quality of life was measured with five LASA scores for physical well-being, mood, pain, nausea, vomiting, and appetite; the QLI Uniscale was completed by patients, and the QLI by physicians.

1. They suggest cross-sectional comparisons of mean scores at each cycle rather than studying changes in the FLIC over time.
2. This has led to an increasing interest in QOL research by focusing not only on treatment options and effect, but also on the effects on people’s lives.
3. The resulting questionnaire is designed to be completed by either physicians or patients.
4. Several conceptual and methodological analyses of QOL have been published 1, 5–8.
5. As Schuessler and Fisher (1985) indicate, quality-of-life measures provide ratings or rankings of health and life.
6. When there exists a variable external to the measure against which the scores can be checked, that variable can be used as a criterion to judge the measures.

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Valid measurements methods require that the instruments employed are suitable for the intended task 7. Our results showed that in 25% of the studies, the authors gave reasons for choosing an instrument. However, few studies have distinguished QOL from HRQOL, only 6% of the articles found in our study did so. According to Moons et al. 19, it is important to report and state clearly whether overall QOL or HRQOL has been measured.

Objective Versus Subjective Measures

A Chinese review of QOL studies from 2009 commented that such studies in China were rare and that the research was conducted predominantly in the West 9. Shek 9 argued that this can be explained by the socioeconomic and political circumstances, in addition to cultural differences, such as different sets of values and philosophical foundations. It is possible that the concept of QOL is understood differently in different cultures, and the quality of life definition relevance from the cross-cultural context is unclear. Therefore, it is of interest to conduct more QOL studies in Asian and other non-Western cultures to understand QOL and its manifestation from the cross-cultural context.

Examples are the SF-36, EQ-5D, and WHOQOL-BREF for adults, and Kidscreen, CHQ, and PedsQL for children. Knowledge about QOL is important for understanding the consequences of illness and treatment, and for medical decision-making across age groups and culture. QOL is an important endpoint in medical and health research, and QOL research involves a variety of target groups and research designs. However, based on the current evaluation of the methodological and conceptual clarity of QOL research, we conclude that many QOL studies in health and medicine have conceptual and methodological challenges.

Fletcher et al. (1988) state that the clinical endpoints commonly used for assessing prognoses include evidence of improvement following intervention, remission of disease, and recurrence. Clinical endpoints traditionally focus on sets of outcomes that are assessed near the time of diagnosis and treatment. Long-range outcomes can be viewed as those that are important to patients as they live with their resulting states of health. Quality of life has been deemed an important concept in the field of international development because it allows development to be analyzed on a measure that is generally accepted as more comprehensive than standard of living. Within development theory, however, there are varying ideas concerning what constitutes desirable change for a particular society. The different ways that quality of life is defined by institutions, therefore, shape how these organizations work for its improvement as a whole.