Chapter 4: Measuring Wellbeing: A Critical Rapid Review of Scales Used in Advanced Cancer Contexts

Symptom control is a key aim of advanced cancer and palliative care. Yet, wellbeing in this context is complex, highly contextual, and contested. The World Health Organisation’s (WHO, 2021, p. 10) recent definition of wellbeing, for example, emphasises ‘meaning and purpose’. Models of care – such as the biopsychosocial model – aim to attend to this complexity. And such models matter: if assessments of an intervention lowlight effects relating to psychological and social domains, the potential benefits of these interventions may go unrecognised. In this chapter, the authors provide the results of a review of symptom assessment scales used in advanced cancer and palliative care settings. Combining the analytic strengths of a critical review with the brevity of a rapid review (Grant & Booth, 2009), this critical rapid review asks: to what degree do scales measuring the impacts/effects of symptoms on wellbeing in advanced cancer contexts incorporate the three components of the ‘biopsychosocial’ model: biological, psychological, and social? Findings – considered in the context of conflicting evidence on the effectiveness of medicinal cannabis in supporting patient wellbeing – show that only five of the eleven scales identified through the review attend to social aspects of wellbeing. These findings reinforce critiques of the biopsychosocial model and demonstrate the dominance of dualistic, biomedical conceptualisations of wellbeing. Drawing on Barry et al.’s (2008) scholarship on interdisciplinarity, the findings underscore the limitations of numeric measures of wellbeing conducted in isolation and support calls for an ontological reimagination of wellbeing in advanced cancer and palliative care contexts.