Spitzer’s Uniscale is a single-item scale measuring patients’ global QoL. Patients were asked to place a mark on a horizontal 10 cm line indicating his/her QoL from very poor to very good. The wording was: “How would you rate your overall quality of life?” The instrument is valid and has been used in clinical trials. A visual analogue scale like the Uniscale is appropriate and effective, especially for patients who are seriously ill [37, 38]. The scale was converted to points between 0 and 100 (0 = very poor, 100 = very good). Mean values of patients’ results at baseline and 4–6 months visits were used.

A VAS-scale was created by the researchers to measure the patient’ overall assessment of the quality of the patient-physician communication during the consultation. Patients were asked to place a mark on a horizontal 10 cm line ranging from very poor to very good. The scale was converted to points between 0 and 100 (0 = very poor, 100 = very good). Mean values of patients’ results at baseline and 4–6 months visit were used.

The ‘Medical Interview Satisfaction Scale’ was developed to analyze patient satisfaction with individual physician-patient consultations and has been shown to be reliable and valid [39]. It is a 21-statement survey divided into four subcategories: communication comfort (CC), distress relief (DR), compliance intent (CI), and rapport (R). It consists of a seven-point Likert scale, ranging from 1 (very strongly disagree) to 7 (very strongly agree). The maximum score is 147 indicating the highest possible satisfaction.

Patients indicated their level of agreement on the 7-point Likert scale with options: Very strongly disagree = 1, Strongly disagree = 2, Disagree = 3, Uncertain = 4, Strongly agree = 6 and Very strongly agree = 7. The subscales were summed and divided by number of items. The summary score was compiled by summing all items.

The PGIC is a global measure indicating the degree of perceived change. In this study the change in question was in overall quality of life since the start of treatment. PGIC ratings are increasingly being used as a “gold standard” for determining clinically important change in measures such as ratings of pain [40]. It has also been used for ratings of pain in cancer populations [40, 41] and to determine important changes in HRQL in relation to the EORTC QLQ-C30 [42].

All patients were asked to complete the PGIC after every visit. The first question was: “How would you rate your quality of life now, compared to about two months ago?” Response options are: 1 = About the same, 2 = Better and 3 = Worse. If the patients chose option 2 or 3, they were referred to a 7-point Likert response scale with the following categories: 1 = “Very much”, 2 = “Much”, 3 = “Not so much”, 4 = “Moderate”, 5 = “Quite a bit”, 6 = “A little” and 7 = “Minimally”. Response options were combined to produce a single score ranging from − 7 (very much worse) to 7 (very much better).

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