Defining and using quality of life: a survey of health care professionals

Objective: 'Quality of life' is an important but poorly defined outcome in health and health care research. We sought to identify stroke professionals' definitions of quality of life and views of the purpose of its assessment. Design: Using issues identified during in-depth interviews with stroke care professionals, we designed a postal survey questionnaire. Participants were asked to define quality of life, identify the purposes of assessing it and report experiences of measuring patient quality of life. Comparisons between professional groups were analysed using chi-squared tests of significance. Subjects: Care of the elderly physicians, physiotherapists and occupational therapists in the UK. Results: Of 2793 questionnaires distributed, 1572 were returned (56% response rate). Quality of life was defined in terms of 'happiness' by 72%; 25% included social well-being; 25% included physical abilities. Most (91%) identified 'asking patients' as an effective way to assess quality of life; 40% using standardized measures. Half those who reported using quality of life measures experienced difficulties, including being unsure about which measure to use and concerns about validity. Conclusions: The idea of quality of life as happiness dominated responders' definitions. We argue that the term may be used in both a technical sense (an outcome) and in a broad colloquial sense, without necessarily distinguishing between the two. Clarification of the concept and its uses is required if recent calls to introduce quality of life assessment in clinical care are to be feasible.