“Important difference” for interpreting health-related quality of life outcome measures: important to whom?

Excerpt

In a hospital-based cancer clinic, a typical visit of an advanced cancer patient might start with this exchange: “Mrs. J, how are you doing?” “Well, I have been better…” “What’s bothering you the most these days?” “I feel nauseated all the time…I can’t do anything any more.” The clinician then evaluates the acuity and severity of the symptom, but also considers the whereabouts of the patient on her disease trajectory, whether her current combination therapy should be delayed, changed or stopped; whether opioid should be rotated, or steroid added, or new antiemetic, etc. Very quickly a complicated plan of management emerges, but one important thought the patient wishes to tell someone is lost in the shuffle, “I don’t like being so dependent on others; I’m a burden to my family…I have no energy for anything or anyone.” …