MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA.
Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Qual Life Res. 2022 Aug;31(8):2357-2366. doi: 10.1007/s11136-022-03110-5. Epub 2022 Mar 17.
System science offers a unique set of tools, including causal loop diagrams (CLDs), for stakeholders to better grasp the complexity of factors surrounding quality of life. Because the health-related quality of life (HRQoL) of cancer immunotherapy patients exists within an intricate system affected by and affecting many factors across multiple dimensions, the development of a systems-level model can provide a powerful framework to aid the understanding of this complexity. We developed a CLD for HRQoL of cancer immunotherapy patients.
We first applied a literature-based approach to construct a CLD for patients following immunotherapy. We then iteratively reviewed and enhanced the CLD through interviews with subject matter experts.
Based on the reviewed literature and subject matter expert input, we produced a CLD representing the system surrounding cancer immunotherapy patients' HRQoL. Several feedback loops are identified that span clinical experiences, oncology teams' perceptions about immunotherapy, social support structures, and further research and development in cancer immunotherapy, in addition to other components. The CLD enables visualization of thought experiments regarding how a change anywhere in the system can ultimately worsen or improve patients' HRQoL.
The CLD illustrates the valuable contribution of a systems perspective to quality-of-life research. This systems-based qualitative representation gives insight on strategies to inhibit harmful effects, enhance beneficial effects, and inherent tradeoffs within the system. The CLD identifies gaps in the literature and offers a communication tool for diverse stakeholders. Our research method provides an example for studying the complexities of quality of life in other health domains.
系统科学提供了一套独特的工具，包括因果关系图（CLD），使利益相关者能够更好地理解围绕生活质量的复杂因素。由于癌症免疫疗法患者的健康相关生活质量（HRQoL）存在于一个复杂的系统中，这个系统受到多个维度的许多因素的影响，并对这些因素产生影响，因此开发一个系统级模型可以为理解这种复杂性提供一个强大的框架。我们为癌症免疫疗法患者的 HRQoL 开发了一个 CLD。
我们首先应用基于文献的方法为接受免疫治疗的患者构建了一个 CLD。然后，我们通过与主题专家的访谈反复审查和增强了 CLD。
根据综述文献和主题专家的意见，我们生成了一个代表癌症免疫疗法患者 HRQoL 周围系统的 CLD。确定了几个反馈回路，这些回路跨越了临床经验、肿瘤团队对免疫疗法的看法、社会支持结构以及癌症免疫疗法的进一步研究和开发，以及其他组成部分。CLD 可以可视化关于系统中任何地方的变化如何最终恶化或改善患者 HRQoL 的思维实验。
CLD 说明了系统观点对生活质量研究的宝贵贡献。这种基于系统的定性表示提供了关于在系统内抑制有害影响、增强有益影响和固有权衡的策略的见解。CLD 确定了文献中的差距，并为不同的利益相关者提供了沟通工具。我们的研究方法为研究其他健康领域的生活质量复杂性提供了一个范例。
