Measuring patients' views: between enthusiasm and reality.

In 1947, the World Health Organization broadened the definition of health as 'a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity' [1]. This new paradigm, representing the ideals of modern medicine, measuring patients' views on their psychological fulfilment, satisfaction and well-being, became an important outcome both in clinical assessment and in policy decision-making. A number of instruments were then developed and used to measure the views of persons with chronic illness. In particular, regulatory agencies such as the Food and Drug Administration in the USA, the National Institute for Health and Clinical Excellence in England and the National Authority for Health in France recommended assessing the quality of life in patients with chronic illness. The quality of life measurement has thus become increasingly accepted as playing a key role in helping individual patient care, in addition to the traditional assessment of clinical outcomes. Considering this evolution, oncology and surgery were precursors unlike other, more reluctant, areas such as mental health. In an article published in this issue of the journal, Sak et al. [2] make an important contribution by using a new measure, 'patients' meaning of life', and by assessing its relationships with perception of illness and satisfaction with life (SWL). They reported negative correlations between sub-optimal hospitalization-related perception of illness due to self-realization constraints and a better feeling of satisfaction with one's life and meaning of life. Beyond the importance of measuring patients' views and the evident interest of these findings, a necessary autocritique tends to clearly moderate our enthusiasm. An important limitation concerns the multiplicity of measuring scales and the absence of common metrics. The literature identifies a large number of instruments that have been psychometrically validated with varying evidence and without clear conceptual models. Little guidance for selecting the most appropriate instruments may explain the failure of these measures to have a real impact on clinical management and policy decision-making. In particular, several studies have reported that clinicians believe that quality of life measures lack clinical relevance for their patients [3]. In the present study, we find two common problems in publications on patients' views. The first one concerns the 'Life Meaningfulness Scale', which constitutes the originality of this work [4]. Metrological properties' integrated aspects such as content validity, construct validity and responsiveness, are not detailed in the manuscript and the reference does not allow easy access to …