Quality of life: questionnaires and questions.

Quality of life (QoL) is a phrase often used in health care settings at policy and administration levels, in clinical assessments of therapies, and in clinical management of individual cases. While QoL is a broad concept that covers such areas as social, environmental, economic, and health satisfaction, health-related quality of life (HRQL) is less wide ranging, including mental and physical health and their consequences. First, I question the singularity of HRQL, suggesting there are at least two distinct meanings of HRQL. Second, questionnaires designed to assess individual patients' HRQL allow a limited range of ways for patients to express their state of being. The Medical Outcomes Study Short Form (SF-36), which operationalises HRQL for a traditional clinical setting, is used to show in detail the restricted options that are available for patient respondents. The communications limitations of utility-based measures, designed as cost-effectiveness measures but often used as though they were HRQL instruments, are also discussed. For assessing the HRQL of individuals in a health setting, such questionnaires can provide only a starting point, which should be supplemented with good interaction and communication.

An ecological framing of HIV preventive intervention: a case study of non-government organizational work in the developing world.

The work that non-governmental organizations (NGOs) perform in terms of HIV and AIDS is wide-ranging. Financial resources are available from government and other agencies if NGOs can frame their work in alignment with their interests. We take the particular case of Disha Foundation, an NGO working in Nasik, in the state of Maharashtra in India, whose clients are migrant workers. Drawing upon a broad notion of frame, we focus on the way in which activities such as 'intervention', 'prevention', 'empowerment' and 'community' in the HIV field can differ radically from articulation (at a government level) to practice (of NGOs). Disha's interventions can be described as ecological, in so far as they map and change root causes. Thus, Disha can be seen as doing HIV prevention. Further, we argue that framing HIV funding calls primarily in terms of 'quality of life' would facilitate the work of NGOs, especially of ecological interventions.

The problematic of decision-sharing: deconstructing 'cholesterol' in a clinical encounter.

Shared decision-making is increasingly advocated as a means of interacting with patients but there is also a widely accepted view that many factors will militate against this ideal. While some patients may not wish to take on the responsibility of decision-making, it is also evident that many find it difficult to assimilate probabilities about future events and overestimate the likelihood of some outcomes, especially when terms such as 'stroke', 'bleeding' and 'heart attack' are used in consultation and bring with them emotional connotations and reactions. Under such circumstances, should clinicians portray risks as best they can, in the hope that even a marginally improved understanding will be an improvement on unilateral professional decision-making? Or, conversely, should they 'guide' the decision process, acting in a way that is known as 'professional agency'? Developing some perspectives put forward in recent work by the authors and applying it to a distinct clinical context, this paper will provide (i) a discourse analytic exploration of a single extended example from clinical practice employing aspects of Bakhtin's theory of dialogism, and (ii) a discussion and summary of what we can learn from this analysis in the context of shared decision-making and risk communication.