1
|
Kameyama N, Sato T, Arai D, Fujisawa D, Takeuchi M, Nakachi I, Kawada I, Yasuda H, Ikemura S, Terai H, Nukaga S, Nakano Y, Hirano T, Minematsu N, Asakura T, Kamatani T, Tanaka K, Suzuki S, Miyawaki M, Naoki K, Fukunaga K, Soejima K. Most Important Things and Associated Factors With Prioritizing Daily Life in Patients With Advanced Lung Cancer. JCO Oncol Pract 2022; 18:e1977-e1986. [PMID: 36346964 DOI: 10.1200/op.22.00124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Patients' values and priorities in their lives should be appreciated from an early phase of incurable diseases such as advanced cancer. However, studies examining these characteristics have been lacking. This study attempted to determine what patients with advanced lung cancer valued most, once they had been diagnosed, and any associated factors. METHODS Patients with newly diagnosed advanced lung cancer (N = 248) were enrolled in a questionnaire survey conducted at 16 hospitals in Japan. Their priorities were assessed using a free-text response to the question what is the most important thing to you now? at the time of diagnosis and 3 months after diagnosis. The free-text responses were classified into 10 categories for quantification. The clinical characteristics associated with the category describing daily life were further examined. RESULTS Free-text comments were obtained from 103 (44.0%) and 66 (42.6%) patients at the time of diagnosis and at 3 months, respectively. The most frequent categories were family (at diagnosis: 50.5%; at 3 months: 50.0%) and daily life (at diagnosis: 33.0%; at 3 months: 36.4%), followed by health (at diagnosis: 32.0%; at 3 months: 27.3%) at both time points. The patients mentioning daily life, the issues related to how to spend daily life, showed significantly higher total scores and functional well-being subscale scores on the Functional Assessment of Cancer Therapy-Lung scale at both time points and lower depression scores at diagnosis and lower anxiety scores at 3 months on the Hospital Anxiety and Depression Scale. CONCLUSION Family and daily life were highly valued by patients with advanced lung cancer at diagnosis. A better quality of life and better mood were associated with mentioning daily life, which should be taken into account in care planning to maintain patients' involvement in daily life even with incurable diseases.
Collapse
Affiliation(s)
- Naofumi Kameyama
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Division of Pulmonary Medicine, Kawasaki Municipal Ida Hospital, Kawasaki, Japan
| | - Takashi Sato
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Daisuke Arai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Pulmonary Division, Internal Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Division of Patient Safety, Keio University School of Medicine, Tokyo, Japan
| | - Mari Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Palliative Care Center, Keio University Hospital, Tokyo, Japan
| | - Ichiro Nakachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Pulmonary Division, Internal Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Ichiro Kawada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yasuda
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinnosuke Ikemura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Terai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shigenari Nukaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
| | - Yasushi Nakano
- Division of Pulmonary Medicine, Kawasaki Municipal Ida Hospital, Kawasaki, Japan
| | - Toshiyuki Hirano
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Internal Medicine, Sano-Kosei General Hospital, Sano, Japan
| | - Naoto Minematsu
- Department of Internal Medicine, Hino Municipal Hospital, Tokyo, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan
| | - Takashi Kamatani
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Tokyo, Japan.,Department of Medical Science Mathematics, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyuto Tanaka
- Division of Pulmonary Medicine, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan.,Department of Respiratory Medicine, Nippon Kokan Hospital, Kawasaki, Japan
| | - Shoji Suzuki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan
| | - Masayoshi Miyawaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Pulmonary Medicine, Eiju General Hospital, Tokyo, Japan
| | - Katsuhiko Naoki
- Department of Respiratory Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kenzo Soejima
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.,Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| |
Collapse
|
2
|
Schwartz CE, Rohde G, Biletch E, Stuart RBB, Huang IC, Lipscomb J, Stark RB, Skolasky RL. If it's information, it's not "bias": a scoping review and proposed nomenclature for future response-shift research. Qual Life Res 2021; 31:2247-2257. [PMID: 34705159 DOI: 10.1007/s11136-021-03023-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The growth in response-shift methods has enabled a stronger empirical foundation to investigate response-shift phenomena in quality-of-life (QOL) research; but many of these methods utilize certain language in framing the research question(s) and interpreting results that treats response-shift effects as "bias," "noise," "nuisance," or otherwise warranting removal from the results rather than as information that matters. The present project will describe the various ways in which researchers have framed the questions for investigating response-shift issues and interpreted the findings, and will develop a nomenclature for such that highlights the important information about resilience reflected by response-shift findings. METHODS A scoping review was done of the QOL and response-shift literature (n = 1100 articles) from 1963 to 2020. After culling only empirical response-shift articles, raters characterized how investigators framed and interpreted study research questions (n = 164 articles). RESULTS Of 10 methods used, papers using four of them utilized terms like "bias" and aimed to remove response-shift effects to reveal "true change." Yet, the investigators' reflections on their own conclusions suggested that they do not truly believe that response shift is error to be removed. A structured nomenclature is proposed for discussing response-shift results in a range of research contexts and response-shift detection methods. CONCLUSIONS It is time for a concerted and focused effort to change the nomenclature of those methods that demonstrated this misinterpretation. Only by framing and interpreting response shift as information, not bias, can we improve our understanding and methods to help to distill outcomes with and without response-shift effects.
Collapse
Affiliation(s)
- Carolyn E Schwartz
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA. .,Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA, USA.
| | - Gudrun Rohde
- Department of Clincal Research Sorlandet Hospital, Faculty of Health and Sport Sciences at University of Agder, Kristiansand, Norway
| | - Elijah Biletch
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA
| | | | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, and the Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Roland B Stark
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
3
|
Glare PA, Nikolova T, Alickaj A, Patil S, Blinder V. Work Experiences of Patients Receiving Palliative Care at a Comprehensive Cancer Center: Exploratory Analysis. J Palliat Med 2017; 20:770-773. [PMID: 28562160 DOI: 10.1089/jpm.2016.0478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Employment-related issues have been largely overlooked in cancer patients needing palliative care. These issues may become more relevant as cancer evolves into more of a chronic illness and palliative care is provided independent of stage or prognosis. OBJECTIVE To characterize the employment situations of working-age palliative care patients. DESIGN Cross-sectional survey setting/subjects: Consecutive sample of 112 patients followed in palliative care outpatient clinics at a comprehensive cancer center. MEASUREMENTS Thirty-seven-item self-report questionnaire covering demographics, clinical status, and work experiences since diagnosis. RESULTS The commonest cancer diagnoses were breast, colorectal, gynecological, and lung. Eighty-one percent had active disease. Seventy-four percent were on treatment. Eighty percent recalled being employed at the time of diagnosis, with 65% working full time. At the time of the survey, 44% were employed and 26% were working full time. Most participants said work was important, made them feel normal, and helped them feel they were "beating the cancer". Factors associated with being employed included male gender, self-employed, and taking less than three months off work. Respondents with pain and/or other symptoms were significantly less likely to be working. On multivariate analysis, only pain (odds ratio [OR] 8.16, p < 0.001) and other physical symptoms (OR 5.90, p = 0.012) predicted work status; gender (OR 2.07), self-employed (OR 3.07), and current chemotherapy (OR 1.81) were included in the model, but were not statistically significant in this small sample. CONCLUSION Work may be an important issue for some palliative care patients. Additional research is needed to facilitate ongoing employment for those who wish or need to continue working.
Collapse
Affiliation(s)
- Paul A Glare
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Tanya Nikolova
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Alberta Alickaj
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Sujata Patil
- 2 Department of Biostatistics and Epidemiology, Palliative Medicine Service, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Victoria Blinder
- 1 Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, New York.,2 Department of Biostatistics and Epidemiology, Palliative Medicine Service, Memorial Sloan Kettering Cancer Center , New York, New York
| |
Collapse
|
4
|
Abdulla S, Vielhaber S, Kollewe K, Machts J, Heinze HJ, Dengler R, Petri S. The impact of physical impairment on emotional well-being in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:392-7. [DOI: 10.3109/21678421.2014.932380] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
5
|
Selman LE, Higginson IJ, Agupio G, Dinat N, Downing J, Gwyther L, Mashao T, Mmoledi K, Moll T, Sebuyira LM, Ikin B, Harding R. Quality of life among patients receiving palliative care in South Africa and Uganda: a multi-centred study. Health Qual Life Outcomes 2011; 9:21. [PMID: 21477274 PMCID: PMC3094195 DOI: 10.1186/1477-7525-9-21] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 04/08/2011] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Quality of life (QOL) is a core outcome of palliative care, yet in African settings there is a lack of evidence on patients' levels of QOL. We aimed to describe QOL among patients with incurable, progressive disease receiving palliative care in South Africa and Uganda, to compare QOL in cancer and HIV, to determine how domains of QOL correlate with overall QOL, and compare levels of QOL in this population with those in other studies using the same tool. METHODS A cross-sectional survey was conducted using the Missoula Vitas Quality of Life Index (MVQOLI), a 26-item QOL questionnaire with five subscales (Function, Symptom, Interpersonal, Well being, Transcendent) covering physical, social, psychological and spiritual domains and one global QOL item. One item in each subscale assesses the subjective importance of the domain on a score from 1 (least important) to 5 (most important), used to weight the contribution of the subscale towards the Total QOL score. The tool was translated into 6 languages and administered to consecutively recruited patients at four facilities in South Africa and one in Uganda. RESULTS 285 patients were recruited, with a mean age of 40.1; 197 (69.1%) were female. Patients' primary diagnoses were HIV (80.7%), cancer (17.9%) and other conditions (1.4%). The mean global QOL score was 2.81 (possible range 0 (worst) to 5 (best)); mean Total score 17.32 (possible range 0 to 30). Patients scored most poorly on Function (mean 0.21), followed by Well being (2.59), Symptoms (5.38), Transcendent (5.50), Interpersonal (9.53) (possible range for subscale scores -30 to 30). Most important to patients were: close relationships (mean 4.13), feeling at peace (4.12), sense of meaning in life (4.10), being active (3.84), physical comfort (2.58). Cancer patients were predominantly recruited at three of the sites; hence comparison with HIV-infected patients was restricted to these sites. HIV+ patients (n = 115) scored significantly worse than cancer patients (n = 50) on Well being (Z = -2.778, p = 0.005), Transcendence (Z = -2.693, p = 0.007) and Total QOL (Z = -2.564, p = 0.01). Global QOL score was most weakly correlated with Total QOL (r = 0.37) and the Transcendent subscale was most highly correlated (r = 0.77) (both p < 0.001). Patients receiving palliative care in South Africa and Uganda exhibited significantly poorer QOL compared to similar populations in the USA. CONCLUSIONS Feeling at peace and having a sense of meaning in life were more important to patients than being active or physical comfort, and spiritual wellbeing correlated most highly with overall QOL. It is therefore vital to identify and meet the psychological and spiritual care needs of patients, as well as to assess and treat pain and other symptoms. Our finding that patients scored most poorly on the Function domain warrants further research.
Collapse
Affiliation(s)
- Lucy E Selman
- King's College London, Dept. Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London SE5 9PJ, UK
| | - Irene J Higginson
- King's College London, Dept. Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London SE5 9PJ, UK
| | - Godfrey Agupio
- Hospice Africa Uganda, PO Box 7757, Makindye, Kampala, Uganda
| | - Natalya Dinat
- The Division of Palliative Care, Department of Internal Medicine, University of the Witwatersrand, Theatre Road, The Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Julia Downing
- Formerly of the African Palliative Care Association, PO Box 72518, Plot 850, Dr Gibbons Road, Kampala, Uganda
| | - Liz Gwyther
- Hospice Palliative Care Association of South Africa, PO Box 38785, Howard Place, 7450 Suite 11a, Lonsdale Building, Lonsdale Way, Pinelands, 7430, Cape Town, South Africa
| | - Thandi Mashao
- Palliative Medicine Unit, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa
| | - Keletso Mmoledi
- The Division of Palliative Care, Department of Internal Medicine, University of the Witwatersrand, Theatre Road, The Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Tony Moll
- Church of Scotland Hospital, P/Bag X502, Tugela Ferry 3010, KwaZulu Natal, South Africa
| | - Lydia Mpanga Sebuyira
- Infectious Diseases Institute, Faculty of Medicine, Makerere University, PO Box 22418, Kampala, Uganda
| | - Barbara Ikin
- Msunduzi Hospice, Head Office, PO Box 22023, Mayors Walk 3208, Pietermaritzburg, KwaZulu Natal, South Africa
| | - Richard Harding
- King's College London, Dept. Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London SE5 9PJ, UK
| |
Collapse
|
6
|
Suedfeld P, Legkaia K, Brcic J. Changes in the Hierarchy of Value References Associated With Flying in Space. J Pers 2010; 78:1411-35. [DOI: 10.1111/j.1467-6494.2010.00656.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Taminiau-Bloem EF, van Zuuren FJ, Koeneman MA, Rapkin BD, Visser MRM, Koning CCE, Sprangers MAG. A 'short walk' is longer before radiotherapy than afterwards: a qualitative study questioning the baseline and follow-up design. Health Qual Life Outcomes 2010; 8:69. [PMID: 20637086 PMCID: PMC2915972 DOI: 10.1186/1477-7525-8-69] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 07/16/2010] [Indexed: 11/30/2022] Open
Abstract
Background Numerous studies have indirectly demonstrated changes in the content of respondents' QoL appraisal process over time by revealing response-shift effects. This is the first known study to qualitatively examine the assumption of consistency in the content of the cognitive processes underlying QoL appraisal over time. Specific objectives are to examine whether the content of each distinct cognitive process underlying QoL appraisal is (dis)similar over time and whether patterns of (dis)similarity can be discerned across and within patients and/or items. Methods We conducted cognitive think-aloud interviews with 50 cancer patients prior to and following radiotherapy to elicit cognitive processes underlying the assessment of 7 EORTC QLQ-C30 items. Qualitative analysis of patients' responses at baseline and follow-up was independently carried out by 2 researchers by means of an analysis scheme based on the cognitive process models of Tourangeau et al. and Rapkin & Schwartz. Results The interviews yielded 342 comparisons of baseline and follow-up responses, which were analyzed according to the five cognitive processes underlying QoL appraisal. The content of comprehension/frame of reference changed in 188 comparisons; retrieval/sampling strategy in 246; standards of comparison in 152; judgment/combinatory algorithm in 113; and reporting and response selection in 141 comparisons. Overall, in 322 comparisons of responses (94%) the content of at least one cognitive component changed over time. We could not discern patterns of (dis)similarity since the content of each of the cognitive processes differed across and within patients and/or items. Additionally, differences found in the content of a cognitive process for one item was not found to influence dissimilarity in the content of that same cognitive process for the subsequent item. Conclusions The assumption of consistency in the content of the cognitive processes underlying QoL appraisal over time was not found to be in line with the cognitive processes described by the respondents. Additionally, we could not discern patterns of (dis)similarity across and within patients and/or items. In building on cognitive process models and the response shift literature, this study contributes to a better understanding of patient-reported QoL appraisal over time.
Collapse
Affiliation(s)
- Elsbeth F Taminiau-Bloem
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
8
|
Farquhar M, Ewing G, Higginson IJ, Booth S. The experience of using the SEIQoL-DW with patients with advanced chronic obstructive pulmonary disease (COPD): issues of process and outcome. Qual Life Res 2010; 19:619-29. [PMID: 20224901 DOI: 10.1007/s11136-010-9631-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To report the experience of using the SEIQoL-DW for the measurement of quality of life with patients with advanced COPD and consider its feasibility, acceptability and appropriateness for a Phase III randomised controlled trial (RCT). METHODS The SEIQoL-DW was administered according to its instructions within a Phase II RCT 3-5 times per patient, across 13 patients and the process audio-recorded. Quantitative and qualitative criteria were used to assess feasibility, acceptability and appropriateness. Qualitative analysis of the transcripts and fieldwork notes was conducted using Framework Analysis. RESULTS The SEIQoL-DW steps (of identifying five quality of life cues, rating their functioning and importance) were completed at 48/51 interviews. However, some respondents were overwhelmed by the scripted introduction, experienced difficulty with cue identification, and focused only on certain types of cues (Step 1); some had difficulty interpreting and rating the concept of Step 2; and some had difficulty interpreting 'importance' and manipulating the SEIQoL-DW disc (Step 3). CONCLUSIONS Patients with advanced COPD were able to complete the SEIQoL-DW but analysis of its administration identified practical and conceptual concerns which question the validity of the results obtained. Suggestions for the development of the SEIQoL-DW and future feasibility studies are given.
Collapse
Affiliation(s)
- Morag Farquhar
- General Practice and Primary Care Research Unit, Department of Public Health & Primary Care, Institute of Public Health, University of Cambridge, and Addenbrooke's Hospital, Cambridge University Hospitals' NHS Foundation Trust, Robinson Way, Cambridge, CB2 0SR, UK.
| | | | | | | |
Collapse
|
9
|
Westerman MJ, Hak T, Sprangers MAG, Groen HJM, van der Wal G, The AM. Listen to their answers! Response behaviour in the measurement of physical and role functioning. Qual Life Res 2008; 17:549-58. [PMID: 18389384 PMCID: PMC2358935 DOI: 10.1007/s11136-008-9333-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 03/13/2008] [Indexed: 12/02/2022]
Abstract
Background Quality of life (QoL) is considered to be an indispensable outcome measure of curative and palliative treatment. However, QoL research often yields findings that raise questions about what QoL measurement instruments actually assess and how the scores should be interpreted. Objective To investigate how patients interpret and respond to questions on the EORTC-QLQ-C30 over time and to find explanations to account for counterintuitive findings in QoL measurement. Methods Qualitative investigation was made of the response behaviour of small-cell lung cancer patients (n = 23) in the measurement of QoL with the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). Focus was on physical functioning (PF, items 1 to 5), role functioning (RF, items 6 and 7), global health and QoL rating (GH/QOL, items 29 and 30). Interviews were held at four points: at the start of the chemotherapy, 4 weeks later, at the end, and 6 weeks after the end of chemotherapy. Patients were asked to ‘think aloud’ when filling in the questionnaire. Results Patients used various response strategies when answering questions about problems and limitations in functioning, which impacted the accuracy of the scale. Patients had scores suggesting they were less limited than they actually were by taking the wording of questions literally, by guessing their functioning in activities that they did not perform, and by ignoring or excluding certain activities that they could not perform. Conclusion Terminally ill patients evaluate their functioning in terms of what they perceive to be normal under the circumstances. Their answers can be interpreted in terms of change in the appraisal process (Rapkin and Schwartz 2004; Health and Quality of Life Outcomes, 2, 14). More care should be taken in assessing the quality of a set of questions about physical and role functioning.
Collapse
Affiliation(s)
- Marjan J Westerman
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|