Assuntos
Antineoplásicos/uso terapêutico , Procedimentos Clínicos/história , Transtorno Depressivo/classificação , Transtorno Depressivo/história , Serviços Médicos de Emergência/métodos , Medicina Baseada em Evidências/métodos , Fibrinolíticos/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Avaliação de Estado de Karnofsky/história , Neoplasias/tratamento farmacológico , Neoplasias/psicologia , Escalas de Graduação Psiquiátrica/história , Escalas de Graduação Psiquiátrica/normas , Psicometria/métodos , Qualidade de Vida/psicologia , Acidente Vascular Cerebral/história , Feminino , Humanos , MasculinoRESUMO
OBJECTIVES: To use the history of the Karnofsky Performance Scale as a case study illustrating the emergence of interest in the measurement and standardisation of quality of life; to understand the origins of current-day practices. METHODS: Articles referring to the Karnofsky scale and quality of life measurements published from the 1940s to the 1990s were identified by searching databases and screening journals, and analysed using close-reading techniques. Secondary literature was consulted to understand the context in which articles were written. RESULTS: The Karnofsky scale was devised for a different purpose than measuring quality of life: as a standardisation device that helped quantify effects of chemotherapeutic agents less easily measurable than survival time. Interest in measuring quality of life only emerged around 1970. DISCUSSION: When quality of life measurements were increasingly widely discussed in the medical press from the late 1970s onwards, a consensus emerged that the Karnofsky scale was not a very good tool. More sophisticated approaches were developed, but Karnofsky continued to be used. I argue that the scale provided a quick and simple, approximate assessment of the 'soft' effects of treatment by physicians, overlapping but not identical with quality of life.
