Assessing Quality of Life – Listening is Key!

December 21, 2020

In healthcare, quality of life is defined as the perceived quality of an individual’s daily life including all physical, emotional and social factors, and is used as a patient-centered metric to evaluate a patient’s well-being or lack thereof.   Quality of life is assessed with regard to the patient’s feedback, as well as that of the patient’s family and the interdisciplinary team. 

Quality of life is a metric that can be challenging to assess and quantify, but in hospice, there is a unique opportunity to learn the various ways that patients define “quality” and how that interpretation of quality may change over time.  One imperative principle that must be acknowledged is the premise that the patient is always right.

Although hospice providers have learned to actively listen to their patients and pay close attention to both their verbal and nonverbal communication, it is possible to miss or misjudge when assessing quality of life.

Studies have shown that a patients’ standards of quality of life can be very different from those of their families or physicians, and regardless of any expert observation or the provision of well-informed clinical information, only the patient can attest to their experience with their severe illness.

According to surgeon and writer Atul Gawande, there are five questions that patients who are nearing end of life can be asked to help patients, families and care teams prioritize what’s important for the patient at the given moment.  Furthermore, these questions should be asked periodically as statuses and plans change over time.

The 5 questions that Dr. Gawande outlines are:

  1. What is your understanding of where you are and of your illness?
  2. What are your fears or worries for the future?
  3. What are your goals and priorities?
  4. What are you willing to sacrifice for the prospect of more time? What outcomes are unacceptable for you?
  5. What does a good day look like?


Campbell, S. (2015, February 10). Atul Gawande’s 5 Questions to Ask at Life’s End. Next Avenue.

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