Imagine a doctor trying to decide whether to recommend medical cannabis to a chronic pain patient. He already has enough difficulty trying to understand the severity of the patient’s pain. Why? Because pain is subjective. Unfortunately, so is another measurement doctors often rely on – quality of life.
Quality of life (QOL) is a measurement utilized both in the doctor’s office and in medical research. From a researcher’s standpoint, QOL plays a role in determining the efficacy of a particular drug or therapy. But measuring it is not an exact science. QOL is problematic as a tool for determining efficacy because it is wrought with challenges.
A Lack of Cohesion
QOL tends to account for physical, mental, and emotional wellbeing. But ranking factors within each three are not necessarily cohesive. In other words, there is no standard for understanding the relationship between physical and mental health. There is no standard for quantifying emotional wellbeing based on physical symptoms alone.
A lack of cohesion is exacerbated by the uniqueness of each patient’s experience. In a medical cannabis scenario, experiences can differ dramatically among patients being treated for the exact same condition. According to the operators of the Utahmarijuana.org website, healthcare providers need to be cognizant of individual experiences if they hope to provide sound medical cannabis advice.
Different Methodologies
QOL measurements are also problematic due to different methodologies. Patient questionnaires make this clear enough. In order to measure QOL, doctors and researchers have access to several different questionnaires. But the questionnaires pose different types of questions. Answers are scored based on criteria that differ from one assessment to the next.
In addition, every method of measuring QOL is heavily dependent on timing. QOL measurements can differ significantly based on when an assessment is conducted. Averaging assessment results over a period of time can help resolve this somewhat, but doing so isn’t foolproof.
Drawing Incorrect Conclusions
Doctors and researchers also face ethical and social challenges, implementation challenges, and even the practical challenges that come with conducting and analyzing QOL assessments. But perhaps the biggest problem of all is the risk of drawing incorrect conclusions. It is a significant risk.
Take physical function. On the surface, it might seem that a patient experiencing reduced function as a result of a chronic medical condition is also experiencing a lower quality of life. But that is an assumption. Researchers and doctors are subject to bias based on such assumptions, and that bias could impact how QOL assessments are analyzed.
Along similar lines, social influences normally associated with health and wellbeing might actually be more closely related to individual attitudes. What a person perceives about wellbeing might have more to do with social perceptions than actual health. Therefore, a low QOL score may not be entirely accurate when social influences are included in the assessment.
Keep It Simple
This post began with a hypothetical scenario involving a doctor and his medical cannabis recommendation for a chronic pain patient. If that doctor is relying on QOL to inform his decision, perhaps it’s best that he does not overthink things. Let medical researchers continue wrestling with the inherent problems of QOL measurements. The doctor can simply ask the patient her perceptions of QOL and then go from there.
Quality of life is subjective by any measurement. So while it is important to both medical research and routine patient care, no one should expect QOL measurements to be accurate or objective. They are neither. The best we can hope for from QOL assessments is to get a general idea of how patients perceive their own wellbeing.
