Just whose quality of life is it anyway? Controversies and consistencies in measurements of quality of life

The proper means of measuring quality of life (QOL) in patients with renal disease, including end-stage renal disease, have not been agreed upon. QOL has health-related and non-health-related domains. QOL measures may be subjective or objective, function-based or satisfaction-based, non-specific or applied to a particular disease. Domains of health-related QOL typically include measures of physical functioning, mental health, and social relationships. There is increasing interest in measures of happiness or global satisfaction in patients and in assessing how patients' feelings reflect their relationships with caregivers. There are advantages and disadvantages to the use of older psychologically based measures as QOL indicators as well as newer questionnaires such as the Kidney Disease Quality of Life (KDQOL) Instrument. Challenges for the future include correlation of QOL measures with patient biochemical and disease measures, and with meaningful patient outcomes. Most important, we must create and apply methods to enhance our patients' QOL.