“Quality of life” umbrella often refers to self-reports of

associated with disease and treatment

•SymptomsSymptoms

•Functional statusFunctional status

•PerceptionsPerceptions

•OpportunitiesOpportunities

Alternative Concepts or Different Concepts?

Health Status: death, disease, disability, discomfort, dissatisfaction (5 D’s)

Functional Status: performance of social roles and activities

Well-Being: wellness, feelings Quality of life: safe environment, adequate

housing, guaranteed income, respect, love, freedom, spirituality, meaning and purpose

Health-related quality of life: those aspects of quality of life attributed to health and the importance of health

Concepts Intertwined

Most aspects of life involved in life-threatening illness and some chronic illnesses

Patients and clinicians use language that mixes concepts, e.g. “getting up at night to urinate”

Symptoms (G. symptoma) may be mixed with signs (L. signum) as subjective phenoma that may or may not be seen, heard, or measured

Symptoms and QoL

Symptoms sometimes confounded with function and perceived quality of life in measurement

Symptoms can be viewed as related to but separated from function and perceptions

Symptoms important to patients and clinicians in diagnosis and evaluating treatment effectiveness

Toward Conceptual Clarity

Health status and quality of life are different and useful in distinguishing proximal and distal impacts of treatment

Symptoms, functional status and perceptions often called QoL, can be highly related, but are not equal

Best chance of sorting out relationships is to label carefully and evaluate separately