Experience with a generic quality of life instrument in a general surgical practice

The new emphasis on measuring outcomes has generated interest in quality of life instruments. One such instrument is the SF-36, a well-tested and widely used health status survey. This survey was prospectively evaluated over a three month period in a general surgical practice.

Ninety-seven patients completed 115 surveys. Patients were asked the following questions: (1) Do you like the survery? (2) Does it accurately reflect your present health condition? (3) Does it reflect the reason for which you came to the surgeon? Patients were then categorized into distinct groups. The results were averaged and compared with national norms of a cross-sectional survey of 2,474 individuals, 79.5% of whom had medical problems. RESULTS Sixty-four percent of patients liked the survey; 77% thought it accurately reflected their health status; but only 45% thought it accurately reflected the problem for which they came to the surgeon. Patients with breast masses did not differ from the norms in any of the eight domains measured by the SF-36. Those with fibrocystic disease/mastalgia showed poorer scores in three domains; patients with thyroid disease had poorer scores in three domains; those with irritable bowel syndrome/chronic abdominal pain had poorer scores in six domains; and those with anorectal disease in three domains. Follow-up surveys were obtained in 18 patients. The measurement of the effects of treatment by the SF-36 was variable.

In conclusion, the SF-36 can measure changes in health status as caused by disease seen by a general surgeon; however, it may be too insensitive to measure the effects of surgery on improvement in health status.