Bakgrund: Individer med psykisk sjukdom har sämre hälsa och ökad dödlighet i somatiska sjukdomar jämfört med befolkningen i övrigt. Sjukdomstillstånden kan också leda till svårigheter att klara av vardagen och bidra till försämrad livskvalitet. Det är av stor vikt att sjuksköterskan får en tydlig bild av vad som påverkar livskvaliteten hos patienten och till hjälp finns ett antal olika instrument för att mäta hälsa och livskvalitet, bl.a. The Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW). Syfte: Att undersöka individuell livskvalitet hos patienter med psykisk sjukdom med hjälp av SEIQoL-DW, samt att undersöka patienters och behandlares uppfattning om instrumentets tillämpbarhet och användbarhet. Metod: Patienter inom den psykiatriska vården fyllde i SEIQoL-DW-formuläret med stöd av behandlare. Därefter fyllde båda parterna i en enkät om instrumentets användbarhet. Materialet analyserades kvantitativt och kvalitativt. Resultat: Patienterna som deltog i studien skattade Relationer/Socialt nätverk som det viktigaste livsområdet, följt av Arbete. Det område som upplevdes fungera bäst, det vill säga det område som hade högst nivå, var Familj. Lägst nivå hade Arbete, vilket var det område som fungerade sämst. De flesta patienter och alla behandlare ansåg att frågorna i formuläret var relevanta respektive angelägna, samt att formuläret kan vara ett bra stöd vid samtalet. Runt hälften av patienterna ansåg att det helt eller delvis tog lång tid att fylla i formuläret. Slutsats: Trots att livskvalitet är något individuellt anger många patienter samma livsområden som viktiga. Instrumentet är användarvänligt till stor del, men patienten kan behöva stöd för att fylla i formuläret. / Background: People with mental illness have poorer health and increased mortality from somatic diseases compared with the general population. The diseases can also lead to difficulties in coping with everyday life and reduced quality of life. It is very important that the nurse gets a clear picture of what affects the patient’s quality of life. There are a number of different instruments for measuring health and quality of life, e.g. The Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW). Aim: To examine individual quality of life amongst patients with mental illness with the assistance of SEIQoL-DW. The second aim was to study the feasibility and applicability of the instrument. Method: Patients in psychiatric care filled in the SEIQoL-DW-form with support of the health care staff. Then both the patient and the health care staff filled in a questionnaire about the instrument's usability. The material was analyzed quantitatively and qualitatively. Results: Patients participating in the study estimated Relationships/Social network as the most important area of life. The area that generally was perceived to work best was Family, Work had the lowest level. Most of the patients and all of the health care staff considered the instrument to be relevant and a good support for the dialogue. About half of the patients considered the form to be time-consuming. Conclusion: Although quality of life is something individual, many of the patients stated the same areas of life as important. The instrument is user-friendly to a great extent, but the patient may need assistance to complete the form.

健康相關生活品質越來越重視病人主觀的感受，然而將這個部分納入測量之後，許多研究結果卻出現殘疾悖論(disability paradox)的現象，也就是重度疾病病人的自評生活品質並不比程度輕微或甚至健康的人差。反應轉移理論認為，造成這個現象的原因在於個人的自評生活品質會受到個體對於生活品質定義的改變（重新構念）、內在測量尺度標準的改變（重新校準）、以及價值的改變（重新權重）的影響，到目前為止，反應轉移尚未發展出合適的測量工具。 SEIQoL-DW (Schedule for the Evaluation of Individual Quality of Life- direct weighting)做為一個生活品質測量個人化的代表，其評估分成三個步驟，分別是提名重要的生活領域、評估提名領域的滿意程度、以及評估提名領域的相對權重，許多研究者嘗試用SEIQoL-DW在兩點間的領域變化做為重新構念，權重變化做為重新權重，重新校準則需要搭配then test來測量，then test是在第二個測量點時邀請受試重新對第一個時間點的提名領域進行評估，然而這三個成分指標的操作型定義不一，then test也有使用上的不便，同時過去這些指標對生活品質的效用檢驗也都未達顯著。本研究分認為，若能解決上述的問題，將有助於解釋殘疾悖論，同時可以區辨不同類別病人的反應轉移模式，並運用在臨床來幫助病人進行調適。 本研究以立意取樣招募3期以上之慢性腎臟病患者、以及血液透析、腹膜透析未滿一年以上之三組病患共85名，除了背景和臨床資料外，在間隔三個月的兩點分別填寫SEIQoL-DW、ideal scale（評估期待）、生活滿意問卷、正負向情緒問卷，並在後測時填寫then test。研究結果顯示，三組病人的生活品質符合殘疾悖論，並無顯著差別。重新構念、重新校準、和重新權重當中，僅重新校準有助於生活品質的提升，並能夠顯著解釋生活品質的改變。 對腎臟病患者來說，期待越高，生活品質提升得越多，進一步的分析顯示，受試會捨棄相對權重較低的領域，新提名領域的滿意程度、期待、和相對權重都顯著高於捨棄的舊領域，這可以作為臨床上協助病人調適的策略。雖然then test的結果顯著，但實證結果和理論卻相當混亂，尚待未來研究釐清。 / Health-related quality of life (HRQoL) is increasingly recognized as being subjective, which emphasized patient-reported outcomes. Many HRQoL studies reported that people with serious illness perceived no less quality of life (QoL) than those without such illness. This phenomenon is labeled as disability paradox. Response shift theory provides an explanation for it and refers to a change in the meaning of one’s self-evaluation of QoL as a result of changes in internal standards (recalibration), values (reprioritization), and reconceptualization of QoL. It is these changes that will influenced perceived QoL. Current methods to detect Response Shift are still evolving. SEIQoL-DW (Schedule for the Evaluation of Individual Quality of Life- direct weighting) is one of individualized QoL instruments and measures three elements of QoL, including five important aspects of life, current satisfaction with each aspect, and relative importance of each aspect. Many researchers tried to use SEIQoL-DW to detect response shift. Changes in the content of aspects of life between two time points reflect reconceptualization. Changes in the relative weighting between two time points reflect reprioritization. Recalibration is measured by then test, which is a method by asking respondents at time two to provide a renewed rating of their aspects of life given at time one. However, there are no consensus operational definition of indices of reconceptualization , reprioritization, and recalibration. The examination between indices and improvements in QoL was not significant, either. Besides, then test with SEIQoL-DW has a disadvantage when aspects nominated between time one and two are different. This study tried to resolve issues above. If these issues are resolved, disability paradox will be explained. Response Shift will possibly differentiate patients of various disease, and provide ideas to help patients adjust to illness. 85 patients were recruited, including those with renal disease stage 3-5, and those undergoing hemodialysis or peritoneal dialysis within one year. All patients completed SEIQoL-DW, ideal scale, Satisfaction with Life Scale, the Positive And Negative Affect Scale at time one and three months after , except questionnaire on personal background and biological information (at time one) and then test (at time two). Results indicated that the QoLs of these three groups of patients showed no different, which confirmed disability paradox. Only recalibration showed helpful. Regression analyses also showed that recalibration indices were better predictors in QoLs. For End-stage Renal Disease patients, higher expectation suggested higher QoL improvement. Further analysis showed that patients would abandon lower-weighted aspect of life. Compared to the abandoned aspects, higher satisfaction, expectation and weighting were seen in new-nominated aspect. This finding could be useful in helping patients adjust. Although then test also reached significance, evidences was contradicted to its prediction. More research is needed in the future.