A staging approach to measuring patient‐centred subjective outcomes*

Abstract

Introduction: In assessing clinical change, measurement is often based on psychometric scales. However, change is best revealed within the constellation of problems salient to the patient, rather than in alterations in the abstract constructs, psychometrically measured. These patients' problems often serially unfold in qualitative stages, even before the full‐blown disorder emerges. These qualitative stages constitute the natural history extending from early to late, fluctuating from mild to severe, and progressing from full‐blown disorder to recovery. Method: We reviewed the literature on clinimetrics and patient‐centred subjective measures, and related these findings to the use of the discretized‐analogue scaling method. Results: There is increasing recognition of clinimetric approaches that structure the pre‐clinical and clinical material into a scale that reflects the symptoms, consequences and complications in a manner understandable to the patient, and enabling the quantification of severity or change. This monograph provides criteria and methods for developing these building blocks that enable the assessment of severity, stage or change. We show examples of their use in quantitative clinical outcome measurement. Conclusion: We encourage further studies in the ideology and procedures for measuring clinical change in terms of personally subjective experiences.

Early Identification and Intervention in Depressive Disorders: Towards a Clinical Staging Model

“…Such a model is a more refined form of diagnosis, placing emphasis on where a person lies along the continuum of the course of illness [30, 31,39,40,41]. The benefits of such a model are well recognized in medicine, especially malignancies, where early detection and intervention are often crucial to survival.…”

“…Bilsbury and Richman [40 ]point to the need for ‘clinimetric’ methods that take a phenomenological approach to using patients’ subjective experience information from the preclinical and clinical stages to understand severity, stage and, importantly, change [40, 114]. The extension of this approach to understanding change and progression in terms of treatment outcome is an important contribution.…”

Hacia una mayor incorporación de la perspectiva del paciente en el diseño de los instrumentos de evaluación de la efectividad y calidad de los cuidados

“…En este sentido algunos autores destacan que "la búsqueda de la virtud psicométrica es inútil si el instrumento está tan mal enfocado que es irrelevante para el paciente" (8) .…”

Collaborative Versus Adversarial Stances in Scientific Discourse: Implications for the Role of Systematic Case Studies in the Development of Evidence-Based Practice in Psychotherapy

“…Self-report questions are usually employed for this. Bilsbury and Richman (2002) argue that it is more important that self-report scales accurately tap the psychological processes relevant to change than that they be standardized on large samples. Scales standardized on large samples have the advantage that they allow statistical benchmarking and cross-case comparisons.…”

“…However, they may measure such broad factors that they have limited use clinically. Bilsbury and Richman (2002) show how to design scales that explicitly address the idiosyncratic features of an individual case (for a brief summary of their procedure, with an example, see Edwards, 2006, in this Journal). As understanding of particular clinical problems deepens, so researchers are able to develop customized self-report instruments that are sensitive to more specific targets for change, behaviorally, cognitively and emotionally.…”