• EuroQol, EQ-5D. It is completed at baseline at after every clinic visit by the patients.
  

• Clinician-patient communication. Clinician-patient encounter will be audio tape-recorded with the patient’s consent at every clinic visit.
  
• Patient satisfaction is a measure of the patient’s experience with the health care received. The Consumers Association of Health Plans Study (CAHPS) clinician-group survey is a measure of satisfaction with care that focuses on individual clinicians with
  
• Patient management. Chart review will be used to record the changes in clinical management, such as reduction/addition of medicines, change in treatment, number of test ordered, number of visits, and referrals to other healthcare providers.
  
• The Hospital Anxiety and Depression Scale,HADS. Completed at baseline and end of the study.
  
• Adherence measures:Godin’s survey measures physical activity monitoring daily activities and exercise. Godin’s measure is valid, reliable and easy to complete by patients. Morisky’s scale. Morisky’s medication adherence scale is a widely used meas
  
• Patient’s sociodemographic characteristics. At the first study visit the patients will complete a brief sociodemographic questionnaire. Completed at baseline.
  
• Clinician's expectation form. At the first study visit, clinicians will be invited to complete this form.
  
• Clinician’s characteristics. Clinicians will complete a survey at the beginning of the study. Patients and clinicians evaluation of the intervention. At the end of the study period.
  

Recently there has been increasing interest in the use of health-related quality of life (HRQL) measures in routine clinical practice. Traditionally, patient care has been based on laboratory results, medical history, and signs and symptoms diagnosed by clinicians. The inclusion of HRQL measures in routine practice may provide important and often otherwise missing information, revealing the impact of the disease or its treatment on the patient’s physical, emotional and social well-being, and may assist in patient management. HRQL assessments may assist in changing the medical paradigm from a disease-centered approach to a patient-centered one.

Several studies in mental health and oncology discuss the application of HRQL measures in clinical practice.

Taenzer et al (2000) and Detmar et al. (2002) provide evidence that using HRQL measures improves patient-clinician communication. Velikova et al (2004) detected impacts on communication and the emotional well-being of patients. Using a framework based on these previous studies and the methods for the health technology assessment of diagnostic technologies (Guyatt et al. 1986), we will assess the effects of including HRQL assessments in the routine clinical care of patients undergoing solid organ transplantation (lung).

We expect that the routine use of HRQL measures in clinical practice will affect patient-clinician communication, patient management, and patient outcome. Lung transplantation trades a fatal disease (end-stage pulmonary disease) for a chance at prolonged survival and improved quality of life, albeit with immunosuppression. In this context, generic preference-based measures such as Health Utilities Index System are preferred to specific measures, because they measure a broader range of health dimensions, including pain, ambulation and emotional issues that are expected to be relevant.

Preference-based measures provide scores on the conventional 0.00 (dead) to 1.00 (perfect health) scale that allows for the integration of morbidity and mortality effects and calculation of quality adjusted life years (QALYs) and health-adjusted life expectancy (HALE).