Quality of life: questionnaires and questions.

Quality of life (QoL) is a phrase often used in health care settings at policy and administration levels, in clinical assessments of therapies, and in clinical management of individual cases. While QoL is a broad concept that covers such areas as social, environmental, economic, and health satisfaction, health-related quality of life (HRQL) is less wide ranging, including mental and physical health and their consequences. First, I question the singularity of HRQL, suggesting there are at least two distinct meanings of HRQL. Second, questionnaires designed to assess individual patients' HRQL allow a limited range of ways for patients to express their state of being. The Medical Outcomes Study Short Form (SF-36), which operationalises HRQL for a traditional clinical setting, is used to show in detail the restricted options that are available for patient respondents. The communications limitations of utility-based measures, designed as cost-effectiveness measures but often used as though they were HRQL instruments, are also discussed. For assessing the HRQL of individuals in a health setting, such questionnaires can provide only a starting point, which should be supplemented with good interaction and communication.