Quality of life assessments in clinical practice.

OBJECTIVES: To provide information about the value of quality of life (QOL) assessments to improve clinical care. DATA SOURCES: Published articles, web resources, clinical practice. CONCLUSION: Clinical assessment of QOL can lead to improved patient outcomes and provide a means of evaluating the effectiveness of interventions. IMPLICATIONS FOR NURSING PRACTICE: QOL assessment provides nurses with a more holistic view of the patient and improves communication between the patient and health care providers.

Oncology nursing society putting evidence into practice resources: where are we now and what is next?

Evidence-based practice can be hard to implement in the "real world" of clinical care. A set of reference cards with outcome-specific intervention options can make that practice possible. The Oncology Nursing Society Putting Evidence Into Practice (ONS PEP) resources cover 16 topics to improve care for patients with cancer and their families. A survey evaluated awareness of the tools and the need for further research on their adoption. The survey also elicited target topics for future ONS PEP resources. Awareness of the resources varies among different nursing roles. Increased awareness among clinicians can guide and support improved patient care.

2008 ONS research priorities survey.

PURPOSE/OBJECTIVES: To determine the priorities of oncology nursing research, including the effect of evidence-based practice resources as identified by the Oncology Nursing Society (ONS) membership in June 2008. DESIGN: Descriptive, cross-sectional. SETTING: A Web-based survey of ONS members. SAMPLE: Stratified into three groups: a representative random sample of the general membership (n = 4,460, 421 responded), an over-sampled random sample of advanced practice nurses (n = 980, 149 responded), and all ONS members who were doctorally prepared (n = 589, 143 responded); 713 responded overall. METHODS: The 2004 survey was revised and the new 2008 survey was beta tested. The invitation to complete the survey was sent via e-mail with a link to the survey Web site. A follow-up reminder was sent one week after the initial invitation. MAIN RESEARCH VARIABLES: 70 oncology nursing research topic questions, divided into five categories, and two additional categories regarding ONS Putting Evidence Into Practice resources. FINDINGS: Quality of life and pain were the two highest rated topics, consistent with 2000 and 2004 research priority survey findings. Eleven topics were new to the top 20 ranked priority topics in 2008. Differences in rankings were apparent between member groups. CONCLUSIONS: The respondents represented the broad spectrum of ONS membership. Changes in topic rankings indicate that oncology nursing research priorities have shifted since the 2004 survey. The lag in research result dissemination to clinical practice may account for differences in topic rating between groups. IMPLICATIONS FOR NURSING: The survey results will be used to develop the 2009-2013 ONS Research Agenda. The results also will assist the ONS Foundation and other funding agencies in setting priorities.

Exploration of the value of health-related quality-of-life information from clinical research and into clinical practice.

Quality-of-life (QOL) instruments used in clinical research can provide important evidence to inform decisions about alternative treatments. This is particularly true when patients, such as those with cancer who are contemplating toxic chemotherapy, face tradeoffs between quantity of life and QOL or when the primary goal of therapy is to improve how patients feel. Surrogate measures (cardiac function, exercise capacity, bone density, tumor size) are inadequate substitutes for direct measurement of QOL. Quality-of-life measures will be most valuable when they comprehensively measure aspects of QOL that are both important to patients and likely to be influenced by therapy, when the QOL measurement instruments are valid (measuring what is intended) and responsive (able to detect all important changes, even if small), and when the results are readily interpretable (determining whether treatment-related changes are trivial, small but important, or large). Researchers are finding new, imaginative ways to help clinicians understand the magnitude of treatment impact on QOL. Additionally, QOL measures may be useful in clinical practice. Recent results from well-designed randomized controlled trials suggest that information on patient QOL provided to clinicians might, in some circumstances, result in benefits for these patients. Further investigation is warranted to confirm these observations and to define the particular combination of methods and settings most likely to yield important benefits.

Measurement issues in quality-of-life assessments.

PURPOSE/OBJECTIVES: To describe issues to be considered when measuring the quality of life (QOL) of patients with cancer. DATA SOURCES: Published articles and books, conference proceedings, and abstracts. DATA SYNTHESIS: A review of the existing literature reveals an emerging field of research and considerable discussion of measurement issues. Consensus is growing about measurement approaches to this subjective concept; however, agreement differs regarding specific aspects of measurement approaches and interpretation of data. CONCLUSIONS: The purpose of the QOL assessment and how the data will be analyzed are the main determinants of the choice of assessment and measurement approaches. Differences regarding how QOL is measured may be encountered based on a clinical or research purpose. IMPLICATIONS FOR NURSING: QOL assessments may be used as part of data collection to address a specific research question or may be used to guide clinical practice. Research findings used to guide clinical practice should be evaluated for validity, reliability, and fit of the sample before being incorporated into clinical practice. QOL assessment in clinical practice may be used as an exploratory tool to identify potential problems or may be used to evaluate the effectiveness of a targeted intervention.

Assessing the clinical significance of single items relative to summated scores.

How many items are needed to measure an individual's quality of life (QOL)? This article describes the strengths and weaknesses of single items and summated scores (from multiple items) as QOL measures. We also address the use of single global measures vs multiple subindices as measures of QOL. The primary themes that recur throughout this article are the relationships between well-defined research objectives, the research setting, and the choice single item vs summated scores to measure QOL. The conceptual framework of the study, the conceptual fit with the measure, and the purpose of the assessment should all be considered when choosing a measure of QOL. No "gold standard" QOL measure can be recommended because no "one size fits all." Single items have the advantage of simplicity at the cost of detail. Multiple-item indices have the advantage of providing a complete profile of QOL component constructs at the cost of increased burden and of asking potentially irrelevant questions. The 2 types of indices are not mutually exclusive and can be used together in a single research study or in the clinical setting.