Further work is required to decide which scale is most suited to which purpose. Assessment of multiple sclerosis-specific health-related quality of life should be included in future clinical trials to provide a complete picture of patients' health status.
Clinicians are increasingly seeking efficient methods to identify distress in cancer settings, using short screening tools with fewer than 14 items that take less than 5 minutes to complete. This article examines the value of these tools for identifying cancer-related distress, defined by semi-structured interview. An updated search, appraisal, and meta-analysis, with adjustments made for heterogeneity and underlying prevalence variations, identified 45 potentially useful short and ultra-short tools, although most were intended to help diagnose depression, with few targeted at distress (or anxiety). Very few studies attempted robust validation in cancer settings. When studies were limited to those tested against distress defined by semi-structured interview, only 6 methods had been validated, namely the Hospital Anxiety and Depression Scale (HADS; 13 studies, 14 items), the Distress Thermometer (DT; 4 studies, 1 item), a single verbal question (4 studies, 1 item), the Psychological Distress Inventory (PDI; 1 study, 13 items), combined DT and an impact thermometer (1 study, 2 items), and combined 2 verbal questions (1 study, 2 items). Comparing these 6 approaches side-by-side suggests that for screening, all tools have approximately the same accuracy. Therefore, choice of a short screening tool for distress can be based on acceptability or cost-effectiveness. Here, best evidence supports use of the DT or single verbal question. Remarkably, the overall accuracy of these single-item approaches seems comparable to that of the 14-item HADS (total score), whereas their efficiency is superior. For case-finding, data are sparse but no method seems to be entirely satisfactory. Current evidence suggests that the optimal short methods for identifying distress are 2 verbal questions or PDI. Of these approaches, the 2 verbal questions has superior efficiency. All short methods may be augmented by repeated application, an assessment of unmet needs (problem list), and clarification regarding the need for professional help. No screening tool should be seen as an alternative to careful clinical assessment and management. Despite much interest in the development of short and ultra-short tools, data on validation and implementation are currently incomplete. Nevertheless, short methods seem to be at least as successful as the HADS, although substantially more efficient and hence more acceptable, and therefore may be a suitable initial method of assessment in busy clinical settings.
Background-With the increasing use of quality of life measures in evaluations of cardiac interventions, criteria are needed for selecting appropriate quality of life measures. An important criterion is the sensitivity of a measure for detecting clinically important changes. Objectives-To compare the sensitivity of four measures when used in a group of cardiac patients undergoing the same intervention. Methods-The short form 36 (SF-36), the quality of life index-cardiac version (QLI), the quality of life after myocardial infarction questionnaire (QLMI), and the schedule for the evaluation of individual quality of life (SEIQoL) were used to evaluate quality of life in a group of 22 patients after myocardial infarction or coronary artery bypass graft (CABG), at the beginning of rehabilitation and six weeks later. Analysable data were obtained from 16 patients. Results-A significant improvement over time was only observed for the SF-36 subscale, vitality (p < 0.05). Five of the eight SF-36 subscales and one of the four QLMI subscales showed modest sensitivity (index: > 0.2 and < 0.5), while all other subscales showed poor sensitivity (index: < 0.2). Using SEIQoL, family was most often nominated as an area of importance to quality of life (n = 13), followed by health (n = 10), leisure/hobbies (n = 8), marriage (n = 8), and work (n = 6). Conclusions-All four QOL measures used in this study were found to lack sensitivity to change. Further research is needed using other cardiac populations and interventions in order to verify these findings, with a view to developing more sensitive quality of life scales. (Heart 2000;84:390-394) Keywords: quality of life; heart disease; short form 36; quality of life index-cardiac version; quality of life after myocardial infarction questionnaire; schedule for the evaluation of individual quality of life
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