Abstract
Clinicians obviously need to understand the impact of illness and its management on
their patients’ quality of life (QOL). Objective, “hard” outcomes have taken primacy
in the assessment of treatment outcomes in cardiovascular care, at least in part because
they are relatively easy to measure precisely and accurately. QOL, on the other hand,
is a subjective and more nebulous concept. However, decades of clinical observation
and research have clearly shown that what matters most to patients is their subjective
QOL, and objective measures of disease burden are less salient to their concerns.
It is possible to measure QOL objectively and quantitatively using validated methods
and to incorporate these into both everyday clinical care and research to measure
the effect of various treatments and strategies. Physician beliefs about patients'
subjective states are often imprecise and imperfectly accurate. Patient-reported QOL
measures can help to predict the potential benefits of treatment; using validated
measures, an estimate of the relevance of a particular amount of change in QOL can
be obtained; the efficacy of different treatments from the patient’s perspective can
be compared. In patient-centred care, the patient is the central focus of attention;
this focus should be on patients and their subjective perceptions, more importantly
than on the disease or associated laboratory measures of severity.
Résumé
Il va de soi que les cliniciens doivent comprendre les répercussions de la maladie
sur la qualité de vie de leurs patients et savoir comment les prendre en charge. L'évaluation
de l'efficacité des soins cardiovasculaires tient principalement compte des résultats
objectifs et « tangibles », au moins en partie parce qu’ils sont relativement faciles
à mesurer avec précision et exactitude. En revanche, la qualité de vie demeure un
concept subjectif et plus nébuleux. Des décennies d’observation et de recherche clinique
montrent toutefois nettement que ce qui compte le plus pour les patients est leur
qualité de vie subjective; les mesures objectives du fardeau de la maladie sont moins
importantes à leurs yeux. Il est possible de mesurer la qualité de vie de manière
objective et quantitative grâce à des méthodes validées, qui peuvent être intégrées
tant aux soins cliniques courants qu’aux activités de recherche, afin de mesurer l’effet
des divers traitements et stratégies. Les croyances des médecins au sujet de l’état
subjectif de leurs patients sont souvent imprécises et incomplètes. Les mesures de
la qualité de vie rapportées par les patients peuvent aider à prédire les bienfaits
éventuels d’un traitement; grâce à des outils de mesure validés, il est possible d’estimer
l’importance d’une variation particulière de l’évaluation de la qualité de vie et
de comparer l’efficacité de différents traitements du point de vue du patient. Pour
prodiguer des soins réellement axés sur le patient, il faut tenir compte concrètement
de ce dernier et de ses perceptions subjectives, bien plus que de la maladie ou des
résultats des épreuves de laboratoire indiquant la gravité de l’atteinte.
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Article info
Publication history
Published online: March 19, 2020
Accepted:
March 10,
2020
Received:
January 30,
2020
Footnotes
See page 1030 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
