Quality of life: A process view

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Abstract
The use of quality of life assessments in clinical trials and general medical settings has proliferated, though the conceptualization of quality of life, and the cognitive processes underlying its judgement, have been neglected. To meet the needs of outcome assessments, available assessment tools currently mix function, affect, and quality of life items within the same scales. A process-oriented approach to quality of life disentangles determinants of quality of life (such as affect and function) from judgements of quality of life. The process model addresses three issues: (1) how patients attribute symptoms, emotions, and functioning to disease or treatment; (2) how individuals interpret and assign meaning to physical and emotional sensations; and (3) how patients integrate their assessments into overall quality of life judgements. Thus, in this model, the very same symptoms can be interpreted by one patient as detracting from quality of life, while another patient may see them as positively contributing to quality of life. Studies of quality of life and cancer are used to illustrate the model.