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Vanier A, Oort FJ, McClimans L, Ow N, Gulek BG, Böhnke JR, Sprangers M, Sébille V, Mayo N. Response shift in patient-reported outcomes: definition, theory, and a revised model. Qual Life Res 2021; 30:3309-3322. [PMID: 33909187 PMCID: PMC8602159 DOI: 10.1007/s11136-021-02846-w] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/24/2022]
Abstract
Purpose The extant response shift definitions and theoretical response shift models, while helpful, also introduce predicaments and theoretical debates continue. To address these predicaments and stimulate empirical research, we propose a more specific formal definition of response shift and a revised theoretical model. Methods This work is an international collaborative effort and involved a critical assessment of the literature. Results Three main predicaments were identified. First, the formal definitions of response shift need further specification and clarification. Second, previous models were focused on explaining change in the construct intended to be measured rather than explaining the construct at multiple time points and neglected the importance of using at least two time points to investigate response shift. Third, extant models do not explicitly distinguish the measure from the construct. Here we define response shift as an effect occurring whenever observed change (e.g., change in patient-reported outcome measures (PROM) scores) is not fully explained by target change (i.e., change in the construct intended to be measured). The revised model distinguishes the measure (e.g., PROM) from the underlying target construct (e.g., quality of life) at two time points. The major plausible paths are delineated, and the underlying assumptions of this model are explicated. Conclusion It is our hope that this refined definition and model are useful in the further development of response shift theory. The model with its explicit list of assumptions and hypothesized relationships lends itself for critical, empirical examination. Future studies are needed to empirically test the assumptions and hypothesized relationships. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02846-w.
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Affiliation(s)
- Antoine Vanier
- Inserm - University of Nantes - University of Tours, UMR 1246 Sphere "Methods in Patient-Centered Outcomes and Health Research", Nantes, France. .,University Hospital of Tours - Inserm, CIC 1415, Unit of Methodology Biostatistics and Data-Management, Tours, France. .,Inserm U1246 Sphere, Institut de Recherche en Santé 2 - Université de Nantes, 22, Boulevard Bénoni-Goullin, 44200, Nantes, France.
| | - Frans J Oort
- University of Amsterdam, Research Institute of Child Development and Education, Amsterdam, The Netherlands
| | - Leah McClimans
- Department of Philosophy, University of South Carolina, Columbia, SC, USA
| | - Nikki Ow
- Center for Outcomes Research and Evaluation, McGill University, Montreal, Canada
| | - Bernice G Gulek
- Harborview Medical Center, University of Washington, Seattle, WA, USA.,College of Nursing, Washington State University, Spokane, WA, USA
| | - Jan R Böhnke
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Mirjam Sprangers
- Department of Medical Psychology, Location AMC, Research Institute Amsterdam Public Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Véronique Sébille
- Inserm - University of Nantes - University of Tours, UMR 1246 Sphere "Methods in Patient-Centered Outcomes and Health Research", Nantes, France.,Unit of Methodology in Clinical Research and Biostatistics, University Hospital of Nantes, Nantes, France
| | - Nancy Mayo
- Center for Outcomes Research and Evaluation, McGill University, Montreal, Canada.,Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre Research Institute, Montreal, Canada
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Lee CY, Lee Y, Wang LJ, Chien CY, Fang FM, Lin PY. Depression, anxiety, quality of life, and predictors of depressive disorders in caregivers of patients with head and neck cancer: A six-month follow-up study. J Psychosom Res 2017; 100:29-34. [PMID: 28789790 DOI: 10.1016/j.jpsychores.2017.07.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/28/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Caregivers of patients with cancer experience a variety of psychological distress. This study aimed to investigate the mental health status and depressive disorder predictors in caregivers of patients with head and neck cancer (HNC) over a six-month follow-up. METHODS We recruited the participants for this study from a HNC outpatient clinic in a medical center from February 2012 to January 2013. Caregivers of HNC patients were evaluated with the Structured Clinical Interview for the DSM-IV, Clinician Version, the Hospital Anxiety and Depression Scale, the Short Form 36 Health Survey (SF-36), and the Family APGAR index. Baseline evaluations were performed, and additional evaluations were performed again 3months and 6months later. RESULTS We assessed a total of 132 caregivers in this study. Over the 6-month follow-up period, the severity of the caregivers' depression and anxiety significantly decreased, while their quality of life improved significantly. At the 6-month assessment, the most prevalent psychiatric disorders were depressive disorders (12.9%), followed by alcohol abuse (1.5%) and primary insomnia (1.5%). Older age, hypnotics use, pre-existing depressive disorders at baseline, and a lower mental component of SF-36 score at baseline were found to significantly predict depressive disorders after 6months. CONCLUSION Our findings show that the mental health of caregivers of HNC patients improves during the 6-month follow-up, as well as that depressive disorders were the most prevalent psychiatric diagnosis. Clinicians need to be alert to and manage any emerging mental health problems in caregivers during patient care, especially depressive disorders.
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Affiliation(s)
- Chun-Yi Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Fu-Min Fang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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Michel P, Baumstarck K, Ghattas B, Pelletier J, Loundou A, Boucekine M, Auquier P, Boyer L. A Multidimensional Computerized Adaptive Short-Form Quality of Life Questionnaire Developed and Validated for Multiple Sclerosis: The MusiQoL-MCAT. Medicine (Baltimore) 2016; 95:e3068. [PMID: 27057832 PMCID: PMC4998748 DOI: 10.1097/md.0000000000003068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The aim was to develop a multidimensional computerized adaptive short-form questionnaire, the MusiQoL-MCAT, from a fixed-length QoL questionnaire for multiple sclerosis.A total of 1992 patients were enrolled in this international cross-sectional study. The development of the MusiQoL-MCAT was based on the assessment of between-items MIRT model fit followed by real-data simulations. The MCAT algorithm was based on Bayesian maximum a posteriori estimation of latent traits and Kullback-Leibler information item selection. We examined several simulations based on a fixed number of items. Accuracy was assessed using correlations (r) between initial IRT scores and MCAT scores. Precision was assessed using the standard error measurement (SEM) and the root mean square error (RMSE).The multidimensional graded response model was used to estimate item parameters and IRT scores. Among the MCAT simulations, the 16-item version of the MusiQoL-MCAT was selected because the accuracy and precision became stable with 16 items with satisfactory levels (r ≥ 0.9, SEM ≤ 0.55, and RMSE ≤ 0.3). External validity of the MusiQoL-MCAT was satisfactory.The MusiQoL-MCAT presents satisfactory properties and can individually tailor QoL assessment to each patient, making it less burdensome to patients and better adapted for use in clinical practice.
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Affiliation(s)
- Pierre Michel
- From the Aix-Marseille University, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit (PM, KB, BG, AL, MB, PA, LB); Aix-Marseille University - I2 M UMR 7373 - Mathematics Institute of Marseille (PM, BG); and Departments of Neurology and CRMBM CNRS6612, La Timone University Hospital, APHM, Marseille, France (JP)
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Rousseau MC, Baumstarck K, Alessandrini M, Blandin V, Billette de Villemeur T, Auquier P. Quality of life in patients with locked-in syndrome: Evolution over a 6-year period. Orphanet J Rare Dis 2015; 10:88. [PMID: 26187655 PMCID: PMC4506615 DOI: 10.1186/s13023-015-0304-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/09/2015] [Indexed: 12/13/2022] Open
Abstract
Background Improved knowledge of the quality of life (QoL) of locked-in syndrome (LIS) patients have implications for managing their care, and assists clinicians in choosing the most appropriate interventions. We performed a survey of a population of LIS patients to describe the course of the QoL of LIS patients over a 6-year period and to determine the potential predictive factors of QoL changes over time. Method This is a study performed over a 6-year period in patients with a LIS diagnosis. Questionnaires were sent in 2007 and 2013. The following data were recorded: i) sociodemographic data; ii) clinical data related to LIS, physical/handicap status, psychological status; iii) self-reported QoL: Anamnestic Comparative Self-Assessment (ACSA); iv) Integration in life: French Reintegration to Normal Living Index (RNLI). Results Among the 67 patients included in 2007, 39 (58 %) patients returned their questionnaire in 2013. The LIS etiology was stroke in 51 individuals. The QoL of the patients was relatively satisfactory compared to populations in other severe conditions. Twenty-one (70 %) individuals reported a stable/improved QoL between 2007 and 2013. The physical/handicap statuses in 2007 and 2013 were not related to the QoL 6 years later, with the exception of one communication parameter: the individuals who used yes-no code reported significantly lower QoL levels than those who did not in 2013. Discussion In opposition to a widespread opinion, LIS persons report a relatively satisfactory QoL level that stays stable over time, suggesting that life with LIS is worth living. Preservation of autonomy and communication may help them to live as normal life as possible.
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Affiliation(s)
- Marie-Christine Rousseau
- Fédération des Hôpitaux de Polyhandicap et Multihandicap Hôpital San Salvadour, Assistance Publique Hôpitaux de Paris, BP 30 080, 83 407, Hyères, Cedex, France. .,EA 3279 Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France.
| | - Karine Baumstarck
- EA 3279 Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France. .,Methodologic and Clinical Research Plateform, Assistance Publique Hôpitaux de Marseille, Marseille, France.
| | - Marine Alessandrini
- EA 3279 Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France.
| | | | - Thierry Billette de Villemeur
- Fédération des Hôpitaux de polyhandicap et Multihandicap Hôpital Trousseau, Assistance Publique Hôpitaux de Paris, Paris, France.
| | - Pascal Auquier
- EA 3279 Self-Perceived Health Assessment Research Unit, School of Medicine, Aix Marseille Université, Marseille, France. .,Methodologic and Clinical Research Plateform, Assistance Publique Hôpitaux de Marseille, Marseille, France.
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Boucekine M, Boyer L, Baumstarck K, Millier A, Ghattas B, Auquier P, Toumi M. Exploring the Response Shift Effect on the Quality of Life of Patients with Schizophrenia. Med Decis Making 2014; 35:388-97. [DOI: 10.1177/0272989x14559273] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background. Interpretation of quality of life (QoL) scores over time can be difficult because of possible changes in internal standards, values, and conceptualization of QoL by individuals. This effect is called a response shift (RS). The purpose of this study was to examine whether an RS effect occurred over a 24-mo period in patients who were suffering from schizophrenia. Methods. The random forest method was applied to detect any RS reprioritization in a multicenter cohort study. QoL was recorded using a generic questionnaire (SF36) at baseline (T0), 12 mo (T12), and 24 mo (T24). Patients were categorized into 3 groups based on psychotic symptoms and relapse (stable, improved, and worsened groups) from their clinical profiles. The random forest method was performed to predict the General Health score of the SF36 from the other QoL domain scores of the SF36. We estimated the average variable importance of the QoL domain for each of the 3 groups. Results. A total of 124 (53.2%) patients were defined as stable, 59 (25.3%) as improved, and 50 (21.5%) as worsened. Among the stable group, the Social Functioning domain became more important over time. Of those classified as improved, the Mental Health domain became more important over time, while the Vitality domain became less important. Among those in the group who worsened, the Mental Health domain became less important while the Vitality and Bodily Pain domains became more important. Conclusions. Our study identified differential RS reprioritization among patients with different clinical profiles. Further work is needed to determine whether RS should be interpreted as a measurement bias or as an effect integrated in a true change.
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Affiliation(s)
- Mohamed Boucekine
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
| | - Laurent Boyer
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
| | - Karine Baumstarck
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
| | - Aurelie Millier
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
| | - Badih Ghattas
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
| | - Pascal Auquier
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
| | - Mondher Toumi
- Aix-Marseille University, Marseille, France (MB, LB, KB, BG, PA)
- Creativ-Ceutical France, Paris, France (AM, MT)
- UCBL 1, Chair of Market Access University, Claude Bernard Lyon I, Decision Sciences & Health Policy, Villeurbanne, France (MT)
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Boyer L, Baumstarck K, Guedj E, Auquier P. What's wrong with quality-of-life measures? A philosophical reflection and insights from neuroimaging. Expert Rev Pharmacoecon Outcomes Res 2014; 14:767-9. [PMID: 25269567 DOI: 10.1586/14737167.2014.950236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors propose a reflection on quality of life (QoL) measures in medicine following the work of G. Canguilhem on health and disease and the latest results from neuroimaging. The use of QoL measures implies that the tension between the two competing visions of health (i.e., normative and descriptive) needs to be overcome. A profound cultural change is needed if we want clinicians, researchers and decision makers to suspend their prevailing scientific ideologies about disease and examine the content of the patient's experience. Another issue that concerns the direction of future QoL is that until now, the available measurements and recent work were ambiguous, trying to find a commonly acceptable, intermediate position halfway between these normative and descriptive visions. It may be time to discard the medical normative vision and instead assume a radically humanistic approach to medicine by providing purely descriptive measures based on the values and emotions of patients.
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