Weighting

As mentioned above, the QL is individual and subjective, and although carefully constructed subscales can be formed by combining individual items, there are few current examples where account is made of patient-specific weightings of symptoms or the fact that some patients may consider certain symptoms more important than others. The important symptoms may themselves differ across patients.

Most questionnaires ask whether a patient is experiencing a symptom, or can or cannot perform a function. However, it may appear more relevant to ask whether a patient is concerned by a symptom. For instance, does it matter if a patient has hair loss if he or she is not concerned by it? To get round this, some questionnaires ask 'have you been bothered by... ' rather than just 'have you had..

With all the unresolved issues regarding the incorporation of QL into trials, incorporating patient-specific weights is probably currently too complex. However, a number of groups have addressed this issue. For example, at the end of each section in the SF36 there is an additional question about how important patients rate this section. Quite how this information is then utilized is unclear at present.

In addition, attempts have been made which allow the patient to define areas of their life which contribute most to overall quality of life. The qualitator for instance [70] asks patients, at each assessment, to choose the most important item from four groups of items. Although this may appear to be more tailored and sensitive to individual patients' concerns, it makes the analysis and presentation of the data collected from such instruments much more complicated and difficult to understand.

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