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Surveying quality of life in patients with vein problems Easy conversation starters

Issue 03/2021

In order to measure the quality of life of patients suffering from venous disorders, increasing numbers of physicians are using specific questionnaires. They are the perfect starting point for a conversation about what currently puts the highest burden on those affected. They can also positively influence the success of the treatment.

“The aspect of quality of life in cases of chronic disorders has fascinated me even during my studies.” Psychologist Dr. Christine Blome has stayed with this subject, which has become a focus area of her work at Hamburg-Eppendorf University Hospital (UKE), Germany. As the director of the “Patient Reported Outcomes” department at the Institute of Health Services Research in Dermatology and Nursing (IVDP), she plays a crucial part in designing questionnaires that survey, for example, the quality of life of patients suffering from venous disorders. Her main goal is to offer conversation starters for the treating physicians and their patients.

Ten questions to facilitate the conversation

She recommends for patients to complete the questionnaire in the waiting room. “The physician can then use it during the consultation, check where problems are and ask further questions.” For example, the short version of the “Freiburg Life Quality Assessment for Chronic Venous Disease” (FLQA-VS-10): while many tools for measuring the quality of life in cases of chronic venous insufficiency (CVI) sometimes contain more than 100 items, this short version of the FLQA-VS-10 focuses on ten questions. When these questions were selected, criteria such as a factor analysis of all items, their psychometric characteristics as well as considerations relating to clinical contents were borne in mind. Four dimensions emerge from the factor analysis which are incorporated in the questionnaire: negative emotions, everyday impairment, burden caused by treatment, social problems.

The short version of the “Freiburg Life Quality Assessment for Chronic Venous Disease” (FLQA-VS-10) focuses on ten questions.
The short version of the “Freiburg Life Quality Assessment for Chronic Venous Disease” (FLQA-VS-10) focuses on ten questions.

Gathering empirical data

Adjunct Professor Dr. Christine Blome explains that whether the longer or shorter version is used during treatment is also a question of time and must be weighted up because: “if the questions are too generic, patients may not feel that their personal needs are properly addressed.” An extensive patient-doctor conversation is then all the more important. After all, it shows that we are interested in how you are, including your state of mind, so we can then make a decision together on an equal footing. “Overall, the use of a questionnaire and a comprehensive conversation aren’t necessarily more time-consuming during long-term treatment,” the certified psychologist explains. She knows: “If something burdens the patient, and this is not resolved, it keeps coming up.” If the cause of the problem is found by asking the right questions, and this can be considered during treatment, patients are not only happier and feel they are taken seriously, but the treatment goal is also achieved more quickly. This also saves money, and the treating physician can gather empirical information. The following is important: in order for a questionnaire to be of statistical value, it has to show changes over time, meaning the most important aspects have to be queried at regular intervals.

“Overall, the use of a questionnaire and a comprehensive conversation aren’t necessarily more time-consuming during long-term treatment.”
Adjunct Professor Dr. phil. Christine Blome

Practice makes perfect

The subject of quality of life is becoming increasingly important: students at UKE are practicing with mock patients to explore their psycho-social background. They learn to ask questions in an empathic manner, to find out about specific circumstances and mental strain, to let patients finish talking and to allow breaks in the conversation. This is designed to increase their awareness of how important quality of life is for successful treatment.
Quality of life includes much more than just physical symptoms. Some patients, for example, feel self-conscious about wearing compression stockings at work, they don’t sleep well, are worried about burdening their family and suffer from depression. In short, it is about the patient’s entire background, rather than purely medical considerations.

The patient is an expert when it comes to their life

Questionnaires also influence the prescription of the appropriate compression stockings, like the “Patient Benefit” questionnaire, for example: this questionnaire does not ask about current impairments but about what patients are hoping to gain from treatment, and specifically from compression stockings. The answers may not be the same. According to Dr. Christine Blome, a distinction has to be made between maximum treatment effectiveness and what is most important to the patient when it comes to quality of life. Treatment may target the reduction of pain, wounds or swelling. But the patient may prioritize being able to go swimming or to work without impairment. This is what needs to be found out.
It has been proven that, all in all, it is not a waste of time to address quality of life during a consultation, beyond purely medical aspects. Everyone benefits, as Dr. Christine Blome has realized: “Two experts come together. The physician specializes in medicine, the patient is an expert when it comes to their life.”

Quality of life can be measured

The short questionnaire FLQA-VS-10 includes ten targeted questions about the physical and mental condition over the past seven days of patients suffering from venous disorders. They range from family problems and despondency as well irritability to pain and heavy legs. It is easy to use and allows a reliable survey and measurement of the patient’s health-related quality of life. Physicians who are interested can request the FLQA-VS-10 questionnaire as well as the long version by e-mail directly from Dr. Christine Blome:

Images: Stefan Volk, Bauerfeind

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