When Amy Messier was preparing to undergo back surgery, doctors asked her to fill out a survey with an unusual question: "Have you felt so down in the dumps that nothing could cheer you up?"
Many medical conditions significantly affect the quality of a patient's emotional and social life, which often isn't apparent from physical measurements and lab tests alone. Now, more doctors are inquiring about their patients' pain, difficulty accomplishing everyday activities, embarrassment about a condition and other issues that physicians traditionally haven't considered. The insights can help determine how aggressively to treat an illness and what alternative therapies to offer certain patients, health-care experts said.
"We are trying to define health not just in the degree of rotation you have in your new knee, but can you walk your grandson to the school bus and do the things that make your life full and meaningful," said Martha Bayliss, a vice president and senior scientist at QualityMetric, a unit of UnitedHealth Group Inc. that designs questionnaires for use in various medical specialties.
Messier, 44, is a patient at the Spine Center at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., which inquires in a questionnaire about patients' limitations due to emotional issues and problems with social functioning. The surveys are completed at a patient's first visit and at return visits more than six weeks apart to identify any changes that might call for altering treatment. The questions "are a useful tool as far as keeping tabs on how well I'm doing," Messier said.
William Abdu, the spine center's medical director, says the surveys are part of the center's shared decision-making approach between doctors and patients. Understanding how a spinal condition affects quality of life can help determine, for example, whether a patient needs surgery or would do just as well with physical therapy, he said. "We pick up information [with the questionnaires] that patients are generally not planning to share with us," he said. "For us, it is as important as looking at an X-ray or an MRI."
Tools to measure quality of life have been used in medical research for decades. Now, health-care companies are adopting them for patient care, in part to identify which people would most benefit from aggressive treatments, especially those that are costly and carry extra risks. Such measurements are also being taken after treatment, including as part of a new federally funded program, to gauge outcomes and patient satisfaction.
QualityMetric licenses 3.8 million surveys a year to health-care providers, drug companies and researchers; it scored 350,000 surveys completed by patients in U.S. health systems and doctors' offices last year, compared to 10,000 in 2000. Among the most popular is a general 12-question survey that asks how a patient's health limits the ability to accomplish regular daily activities. Another is a five-question asthma-control test that inquires how often the condition has kept a patient from getting much done at work, school or home.
Discussing quality of life can help doctors and patients weigh the benefits and risks of different therapies.