From: Does quality of life assessment in palliative care look like a complex screening program?
THE WHO SCREENING PRINCIPLES | THE QoL ASSESSMENT PRINCIPLES IN PALLIATIVE CARE |
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The disease, condition | The problem (the QoL impairment) |
1. The condition should be an important health problem, in terms of prevalence (e.g. breast cancer) or for the serious consequences if not early discovered and treated (e.g. phenylketonuria). | 1. The problem should be a serious condition for the patient either in terms of prevalence (e.g. pain, depression) and/or distress for the patient (e.g. itch, hiccup) or the result of late detection and management of the problem (e.g. a new or unusual distressing symptom occurred over the disease trajectory). |
2. There should be a recognizable latent or early symptomatic stage. | 2. The problem should be highly unlikely to be reported by all the patients or recognized by the professional if not actively assessed. |
3. The natural history of the condition, including development from latent to declared disease, should be adequately understood. | 3. The trajectory of the problem should be sufficiently understood to assure a timely assessment to anticipate and appropriately address the problem. |
The diagnostic test | The assessment tool |
1. There should be a suitable test or examination | 1. A validated, reliable and sensitive-to-change tool for detecting and measuring the problem should be available. |
2. There should be acceptable for the population | 2. The tool should be practical, easy to use and questions must not be distressing for the patients. |
The treatment | The treatment - intervention |
1. There should be an accepted treatment for patients with recognized disease. | 1. There should be an appropriate treatment/intervention for patients with the recognized problem. |
The screening programme | The clinical intervention focused on QoL assessment |
1. There should be an agreed policy on whom to treat as patients | 1. There should be an agreed policy on which a problem (or a problem with a certain degree of impairment) has to be addressed with appropriate treatment or intervention. |
2. Facilities for diagnosis and treatment should be available. | 2. There should be the possibility to appropriately administer the tool, including professionals trained with the procedure. |
3. The treatment-intervention for patients with QoL impairments should be available, including professionals trained for the treatment-intervention. | |
3. The cost of case-finding (including diagnosis and treatment of patient diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole | 4. The cost of problem-finding (including all the steps from the administration of the tool until the end of the treatment – intervention delivered) should be economically justified. |
4. Case-finding should be a continuing process and not a “once and for all” project. | 5. QoL assessment should be a continuing process and not a “once and for all” project. |