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Table 1 Suggested solutions to overcome the challenges of implementing QOL assessments into clinical practice

From: Quality of life assessment in women with breast cancer: benefits, acceptability and utilization

Challenges Solutions
Instrument characteristics  
QOL assessments provide "soft data." Support the implementation of QOL assessments, as the soft data provides additional insights into a patient's health, as it provides qualitative data in addition to the quantitative data provided by "hard" measurement.
The types of questions asked can be too sensitive, personal, or irrelevant. It is recommended that, when developing questionnaires, potential questions be tested by a population of elderly patients to gauge respondents' sensitivity and how effectively the questions measure a patient's QOL.
Patient population  
Questionnaires do not assess long-term survivors (over 5 years) – only 1 year survivors. Long-term survivors of more than 5 years should be included in the original development and testing of instruments.
Among the elderly, there is illiteracy, worse compliance with questionnaires, and cognitive disorders. The option of questionnaires administered in an interview format should be available to elderly patients. This solution would address compliance. In addition, it would address illiteracy and cognitive disorders, because the questionnaires could be read to the respondents, explained, and discussed with them.
Healthcare professionals  
Physicians are less familiar with how to utilize QOL assessments and how to interpret or respond to results. Training classes about the importance, potential benefits, proper utilization of QOL assessments, interpretation of results, and appropriate action to be taken are recommended to be offered at medical schools and through Continuing Medical Education courses. To help better understand their utilization, healthcare providers could be taught whom the appropriate specialists to refer their patients would be based on the results of the QOL assessments.
Physicians do not have the proper tools needed to make QOL assessments part of their practice. QOL assessments could be made accessible through online availability, allowing physicians to have a centralized location to download efficiently instruments as needed.
Logistics and resources  
Time limitations exist. Questionnaires could be administered while the patient is waiting to be seen by the physician.
Measures are usually reported manually, which leads to inaccurate results and a long turnaround time. The utilization of computerized assessments would improve the accuracy of QOL assessments and increase the efficiency of their use.
Computerized assessment  
Respondents may be unfamiliar with how to use computers or touchpad personal computers (PCs). Brief training sessions of 10–15 minutes could be held while patients are in waiting rooms, where respondents would learn by the administrator how to manipulate the mouse, keyboard, and touchpad.
The programming of some questionnaires makes it difficult for patients to change their answers. Efforts could be made to modify computer programming and software to facilitate computerized administration of questionnaires.