Clarifying quality of life assessment: do theoretical models capture the underlying cognitive processes?

Abstract

Objective To develop an analysis scheme capturing the cognitive processes underlying QoL assessment to increase our understanding on how to interpret responses to QoL items. Tourangeau et al.'s (The psychology of survey response, 2000) and Rapkin and Schwartz' (Health Qual Life Outcomes 2:14, 2004) cognitive process models form the basis for this analysis scheme. Methods We conducted think aloud interviews with six cancer patients prior to and following radiotherapy to elicit the cognitive processes underlying the assessment of 7 EORTC QLQ-C30 items. Content analysis was carried out by two to four researchers independently. Eighty text fragments were analyzed inductively and combined in an iterative process with deductive analyses based on both models.Results We have developed a comprehensive analysis scheme feasible for analyzing the cognitive processes underlying QoL assessment qualitatively. All cognitive components of both models could be distinguished in our data. The cognitive component 'reporting and response selection' needed extension to fully capture the cognitive processes used. Conclusion The two models combined are useful in describing the cognitive processes cancer patients use in answering QoL items, and as such facilitate insight into patients' self-reported QoL assessments. Interestingly, the content of the cognitive processes not only differed between patients but also between items within patients and over time.

Agreement of patient and physician ratings on mobility and self-care in neurological diseases

“…Some authors [54,55] state that patients focus more on the psychologic aspects (illness), while physicians focus more on the physical aspects (disease). An examination of such hypotheses could require the use of cognitive interviews [56] or other qualitative research approaches [57]. Our study indicates that in addition to the psychologic causes in the cognitive processes of the involved parties, the organizational conditions of treatment are also significant.…”

Guidelines for improving the stringency of response shift research using the thentest

“…Another approach that also would elucidate the cognitive processes involved is cognitive interviewing. In this approach, patients are interviewed or asked to ''think aloud'' while answering the questionnaires to explore the cognitive processes they used [38,50,51]. The cognitive interviewing approach is under-explored in response shift research to date, and deserves further attention.…”

Understanding appraisal processes underlying the thentest: a mixed methods investigation

“…Recent research by Tamineau-Bloem and colleagues [19] suggests that QOL appraisal changes not only between and within persons over time, but also within persons within a data collection time point. For example, in their cognitive interviewing study of 80 response processes of six cancer patients, Bloem and colleagues reported that patients compared themselves with other patients in one item and referred to their own functioning prior to cancer diagnosis in another [23]. These findings should be replicated on a larger, representative sample but do suggest, nonetheless, substantial changeability in appraisal states and that increased specificity may be important in characterizing QOL appraisal in patient-reported outcome measures.…”