CLINICAL HANDBOOK OF SCHIZOPHRENIA

Use in Treatment57. Quality of Life 589Since 2000, quality-of-life measures have increasingly been used to improve individualtreatment processes in mental health services, mostly in forms of outcome management inwhich data are assessed regularly and individually—and later possibly aggregated on thelevels of groups and services. The results are fed back to clinicians, managers, and patientsto inform their decisions on care and service management (McCabe & Priebe,2002). There have been attempts to implement outcomes management in routine practice,with a view toward improving quality and outcome of treatment, although there isno consistent evidence for its effectiveness in mental health care.An example of outcome management is the Quality of Life Profiling Project that wasdeveloped around the LQOLP. The project used a computerized system to assess qualityof life with results fed back to patients through graphs. In a randomized controlled trial(Slade et al., 2006), researchers assessed patients’ quality of life and other outcome criteria,and reported the results to clinicians in community mental health care teams. The interventionwas associated with lower care costs but did not lead to an improvement ofpatients’ quality of life. Another trial conducted in six European countries incorporatedquality-of-life assessments in the routine sessions between patients and clinicians in communitymental health care teams. Computer-mediated procedures were used to displayresults, including comparisons with previous ratings, and results were expected to feedinto the therapeutic dialogue between clinicians and patients (Priebe, McCabe, et al.,2002). Compared with a control group receiving treatment as usual, patients in the interventiongroup showed a small but significant improvement in subjective quality of life after1 year.KEY POINTS• There is no universally agreed-upon concept of quality of life.• In clinical practice, data on both objective and subjective indicators of quality of life areused, and the importance of subjective indicators reflecting the views of patients has increasedover time.• Quality of life in patients with schizophrenia is measured by generic and disease-specificscales; whereas the former have concepts pertaining to both patients and the general population,the latter have greater clinical appeal due to the specificity of content.• The selection of a quality-of-life scale depends on its psychometric properties, the clinicaltime to administer it, and practicalities related to collecting the data.• Symptom level, particularly depression, is the most important factor negatively influencingsubjective quality of life of patients with schizophrenia.• Quality of life is a distal outcome criterion to evaluate the effects of all types of therapeuticinterventions, particularly long-term treatment.• Quality-of-life measures are used to improve individual treatment processes in mentalhealth services in the form of outcomes management.REFERENCES AND RECOMMENDED READINGSArns, P. G., & Linney, J. A. (1993). Work, self and life satisfaction for persons with severe and persistentmental disorders. Psychosocial Rehabilitation Journal, 17, 63–69.Awad, A. G., Vorauganti, L. N. P., & Heslegrave, R. J. (1997). A conceptual model of quality of life inschizophrenia: Description and preliminary validation. Quality of Life Research, 6, 21–26.Baker, F., & Intagliata, J. (1982). Quality of life in the evaluation of community support systems. Evaluationand Program Planning, 5, 69–79.