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Quality of life is a process not an outcome

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Abstract

Quality improvement mechanisms increasingly use outcome measures to evaluate health care providers. This move toward outcome measures is a radical departure from the traditional focus on process measures. More radical still is the proposal to shift from relatively simple and proximal measures of outcome, such as mortality, to complex outcomes, such as quality of life. While the practical, scientific, and ethical issues associated with the use of outcomes such as mortality and morbidity to compare health care providers have been well rehearsed, the specific concerns associated with the use of quality of life measures in quality of care research have received little attention. As with much research on quality of life there is a tendency to assume that the disadvantages are outweighed by the general virtue of “listening” to patients. In this paper we disagree with this assumption and argue that quality of life is a process, not an outcome.

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Notes

  1. There are other reasons to favor PROMs. As Nigel Hawkes wrote in the British Medical Journal, although mortality rates may be a more intuitve outcome, they can also be misleading [4]. For mortality statistics to be meaningful researchers need large sample sizes, and at least with regard to surgical interventions, few are common enough for mortality statistics to be meaningful.

  2. For a comparison of the differences between utilitarianism and the capability approach, see [11, 12].

  3. In 2006 the final NICE guidance did allow for the provision of these drugs in cases of “moderate” Alzheimer’s, but mild cases were still ineligible until 2010.

  4. Although PROMs researchers tend to see this lack as a problem specific to the social sciences, all forms of scientific measurement face the same problem [19–21].

  5. The idea of “direct validation” is, perhaps, philosophically niave. As Bas van Fraassen and others have argued, “What counts as a measurement of x” and “What is x” cannot be answered independently of one another [19, 23]. This is in fact the heart of the coordination problem.

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Authors and Affiliations

  1. Department of Philosophy, University of South Carolina, Columbia, SC, 29208, USA

    Leah McClimans

  2. Department of Epidemiology and Public Health, University College Cork, College Road, Cork, Ireland

    John P. Browne

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  1. Leah McClimans
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  2. John P. Browne
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Correspondence to Leah McClimans.

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McClimans, L., Browne, J.P. Quality of life is a process not an outcome. Theor Med Bioeth 33, 279–292 (2012). https://doi.org/10.1007/s11017-012-9227-z

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