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Advances in the clinical sciences this century have resulted in an impressive range of diagnostic procedures, therapies, drugs and surgical techniques which have revolutionised the management of heretofore fatal conditions. In addition to being concerned about life expectancy, people are also concerned about the quality of their lives. Partly in response to the views of patients, assessment of patient Quality of Life (QoL) is becoming increasingly important in medicine, nursing and in the behavioural sciences. It has already become an important outcome variable in assessing the impact of disease, illness and treatment (Spilker, 1990; Walker and Rosser, 1993; Bowling 1991; O'Boyle, 1992). QoL is a multi-dimensional construct and there are various approaches to its evaluation. The approach varies depending on the aims of the exercise. Health economists, for example, use techniques such as the QALY (Quality Adjusted Life Year), standard gamble and time-trade-off techniques in order to incorporate QoL measures into economic analysis and clinical trials. Clinical research has utilised standardised and disease specific measures, usually in the form of questionnaires, in order to determine the impact of disease and treatment on patients' QoL. One of the problems of conducting research in this area is that there is no single agreed definition of QoL nor is there a single 'gold standard' measurement technique. However, there is broad agreement that studies of health related QoL should include assessments of physical functioning, including somatic sensations such as physical symptoms and pain; psychological function including concentration and mood; social and sexual functioning and occupational status. Many researchers also assess patients' global satisfaction and the economic impact of the condition. While QoL scales and questionnaires, as well as the methods of rating and analysing them, have been developed by assessing the QoL of individuals, the specific items and the response categories do not represent the free choice of individuals who are subsequently investigated using the scale. Furthermore, the measures will often have been standardised in samples other than those currently being assessed. Results are generally presented as group statistics and provide little or no data on the QoL of individual patients.
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