Symptom status and health-related quality of life: clinical relevance

BACKGROUND: Nursing continues to struggle to identify outcomes that measure quality of care. Health-related quality of life (HRQOL) has been identified as an outcome indicator that is sensitive to health-care interventions. However, clinicians remain skeptical about its relevance. AIM: This article discusses the conceptual issues surrounding HRQOL research and provides an example that demonstrates how symptom status can serve as a clinically relevant and measurable dimension of HRQOL. METHODS: The study sample (n = 99) were patients presenting to the emergency department of an academic medical centre in the United States of America (USA) between July 1997 and March 1999 with the diagnosis of gastrointestinal bleeding. The mean age was 57.86 (17.52) years and 62.6% of the sample was male. The Short Form-12 (SF-12) (measurement used for HRQOL) and a 15-item symptom checklist were administered within the first 24 hours following the emergency department visit and by phone 1 month after discharge. RESULTS: Regression analysis controlling for age, gender, haematocrit and comorbidities was used to examine the relationships between symptom status and HRQOL. The analysis suggests that symptom status is a key predictor of HRQOL. STUDY LIMITATIONS: The sample was a relatively small convenience sample from one emergency department in the USA. CONCLUSIONS: Nurses are concerned with improving patients' HRQOL. Certainly, symptoms are amenable to nursing interventions. We provide one example that demonstrates the relationship between symptom status and HRQOL. By tracking and studying trends in the number of symptoms over time we can begin to track HRQOL as an outcome of care. Thus, we conclude that by helping patients manage their symptoms their overall HRQOL would improve.