Domains of quality of life: results of a three-stage Delphi consensus procedure among patients, family of patients, clinicians, scientists and the general public.
OBJECTIVE
Our key objective is to identify the core domains of health-related quality of life (QoL). Health-related QoL utility scales are commonly used in economic evaluations to assess the effectiveness of health-care interventions. However, health-care interventions are likely to affect QoL in a broader sense than is quantifiable with traditional scales. Therefore, measures need to go beyond these scales. Unfortunately, there is no consensus in the scientific literature on the essential domains of QoL.


METHODS
We conducted a three-stage online Delphi consensus procedure to identify the key domains of health-related QoL. Five stakeholder groups (i.e., patients, family of patients, clinicians, scientists and general public) were asked, on three consecutive occasions, what they perceive as the most important domains of health-related QoL. An analysis of existing (health-related) QoL and well-being measurements formed the basis of the Delphi-procedure.


RESULTS
In total, 42 domains of QoL were judged, covering physical, mental and social aspects. All participants rated 'self-acceptance', 'self-esteem' and 'good social contacts' as essential. Strikingly, mental and social domains are perceived as more essential than physical domains across stakeholders groups.


CONCLUSIONS
In traditionally used health-related QoL utility measures, physical domains like 'mobility' are prominently present. The Delphi-procedure shows that health-related QoL (utility) scales need to put sufficient emphasis on mental and social domains to capture aspects of QoL that are essential to people.
Department of Medical Decision Making, Leiden University Medical Center, Post Zone J10-S, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Suzanne
S
Pietersma
Marieke
M
de Vries
M Elske
ME
van den Akker-van Marle
D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D003362:Cost-Benefit Analysis; D003697:Delphi Technique; D005190:Family; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods*; D010361:Patients; D026684:Personal Autonomy; D010549:Personal Satisfaction; D011369:Professional-Patient Relations; D011639:Public Opinion; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D012108:Research Personnel; D012649:Self Concept; D011795:Surveys and Questionnaires