title: Patients' attitudes and perceptions of two health-related quality-of-life questionnaires used to collect patient-reported outcome measures in the English National Health Service: A qualitative study of patients undergoing cardiac interventions.
abstract: OBJECTIVE
  To explore patients' views on the EuroQol-5D and Coronary Revascularisation Outcome Questionnaire, tools currently used for collecting patient-reported outcome measures in the English National Health Service. The key questions were as follows: (1) whether patients consider them sensitive enough to detect change in their health after cardiovascular disease interventions and (2) whether they consider the health-related quality-of-life questions as meaningful.
  
  
  METHODS
  Data were collected on patients' views using focus groups. We held four focus groups selecting participants on the basis of their baseline and follow-up EuroQol-5D scores. Data were analysed using framework analysis and grounded theory.
  
  
  RESULTS
  Focus group participants confirmed that they had derived substantial health benefits from their cardiac interventions despite the lack of measurable effects on the EuroQol-5D scores. Participants felt that the EuroQol-5D questionnaire was limited because of the following reasons: Their health fluctuates from day to day.They had difficulty assessing their general health status on the visual analogue scale.They felt that the Coronary Revascularisation Outcome Questionnaire was limited because of the following reasons: They did not understand the clinical terms used.The impact of tiredness on their quality of life was not captured.They were unable to distinguish between the effects of their heart condition and other health issues.Additionally, neither questionnaire considers the adjustments people have made to their domestic arrangements to improve their health-related quality of life.
  
  
  CONCLUSIONS
  This study provides evidence that the two questionnaires do not capture some aspects of health that patients consider important. Furthermore, the presence of co-morbidities masks the symptoms relating to the heart disease and the effect of their cardiac interventions. Future work on patient-reported outcome measures should consider developing new questionnaires that address these major concerns.
authors.affiliation: Clinical Trials Unit, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK.
authors.forename: Bashir M
authors.initials: BM
authors.lastname: Matata
authors.affiliation: RaFT Research & Consulting Ltd, Clitheroe, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Hinder
authors.affiliation: Clinical Trials Unit, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Steele
authors.affiliation: Department of Public Health, University of Oxford, Oxford, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gibbons
authors.affiliation: Institute of Cardiovascular Medicine & Science, Liverpool Heart & Chest Hospital NHS Foundation Trust, Liverpool, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Jackson
keywords: Patient-reported outcome measures; focus groups; framework analysis; health-related quality-of-life questionnaires; illness severity; qualitative research