The Challenge of Understanding Articles about Health-Related Quality of Life

(See the article by Coplan et al. on pages 426–33). Even without formal training in study design and biostatistics, clinicians can often use common sense, clinical judgment, and experience to help them decide which journal articles to pay attention to. Just as you do not have to be a professional baseball player to appreciate the subtleties of a well-played baseball game, most clini-cians have an intuitive feel for what makes good clinical research. On the other hand, for most clinicians (in this country), reading an article about health-related quality of life (HRQoL) is a bit like listening to cricket scores on Brit-ish Broadcasting Corporation radio: you know that it involves a ball and a bat, and you strongly suspect that the people watching it are very civilized and drink tea. But that is about it. Even though interest in the measurement of HRQoL has grown over the past 10 or 15 years [1, 2], most readers of clinical journals have not yet developed an intuitive feel for the measures used to assess HRQoL. Understanding HRQoL measurements is not as difficult as it might seem. Below, I highlight some issues to consider when reading articles that use HRQoL measurements and then use the article by Co-plan et al. [3] in this issue to illustrate these issues. But before I do so, I would like to briefly discuss 2 things that can make understanding quality-of-life measurement difficult. The first relates to what HRQoL measurements hope to determine; the second relates to how the measurement is done. What HRQoL measurements hope to capture are patients' subjective perceptions and assessments of their health. These perceptions and assessments cannot be measured by blood testing, electroence-phalography, MRI, or any other " objective " testing [4–6]. Physicians should be very comfortable with these subjective elements of health—they are what we strive to understand when we obtain a history. When a patient reports chest pain or fatigue, we try to assess (among other things) the severity of the symptom, what activities it interferes with, how the patient is adapting and coping, and how the symptom is affecting the patient's overall sense of well being. Thus, HRQoL measurements attempt to capture a subset of the data that would be captured in a routine patient interview [7, 8]. These data exist on a continuum of increasing biological, social, and psychological complexity [9, 10]. The frequency and severity of chest pain …