Response shift in results of patient-reported outcome measures: a commentary to The Response Shift—in Sync Working Group initiative

Abstract

Purpose The Working Group undertook a critical, comprehensive synthesis of the response shift work to date. We aimed to (1) describe the rationale for this initiative; (2) outline how the Working Group operated; (3) summarize the papers that comprise this initiative; and (4) discuss the way forward. Methods Four interdisciplinary teams, consisting of response shift experts, external experts, and new investigators, prepared papers on (1) definitions and theoretical underpinnings, (2) operationalizations and response shift methods, (3) implications for healthcare decision-making, and (4) on the published magnitudes of response shift effects. Draft documents were discussed during a two-day meeting. Papers were reviewed by all members. Results Vanier and colleagues revised the formal definition and theory of response shift, and applied these in an amended, explanatory model of response shift. Sébille and colleagues conducted a critical examination of eleven response shift methods and concluded that for each method extra steps are required to make the response shift interpretation plausible. Sawatzky and colleagues created a framework for considering the impact of response shift on healthcare decision-making at the level of the individual patient (micro), the organization (meso), and policy (macro). Sajobi and colleagues are conducting a meta-analysis of published response shift effects. Preliminary findings indicate that the mean effect sizes are often small and variable across studies that measure different outcomes and use different methods. Conclusion Future response shift research will benefit from collaboration among diverse people, formulating alternative hypotheses of response shift, and conducting the most conclusive studies aimed at testing these (falsification).

Response shift in patient-reported outcomes: definition, theory, and a revised model

“…This definition and the model are useful in the further development of response shift theory and in advancing empirical research. The model with its explicit list of assumptions and hypothesized (time order and mediation) relationships lends itself for critical, empirical examination, including refutation [14]. Future studies are warranted to empirically test the assumptions and hypothesized relationships.…”

“…Multiple methods were proposed to analyze response shift in PROM data [11,12]. Response shift was evidenced in various conditions [13,14]. These studies have helped to better understand occasional discrepancies between researchers' or healthcare professionals' expected assessments of patients' health and patients' self-reported health, by highlighting processes such as psychological adaptation to illness or the appraisal of PROM items.…”

“…Hence, a critical, comprehensive review and synthesis of the work on response shift was deemed crucial. In 2019, an international, interdisciplinary working group of 26 researchers, consisting of response shift experts, new investigators, and independent external experts was formed to achieve this synthesis [14]. They were divided in four teams [12,14,15], with the current team focusing on definition and theory.…”

Implications of response shift for micro-, meso-, and macro-level healthcare decision-making using results of patient-reported outcome measures

“…In so doing, we intend to raise awareness and provide guidance for PRO researchers who play an important role in informing healthcare providers, healthcare leaders, health policymakers, and regulators regarding the implications of response shift. This work is part of an international, interdisciplinary collaboration (see Appendix for the participating members) to synthesize the research on response shift to date [6][7][8].…”

What should progress in response-shift research look like?

“…Clearly, there is a growing consensus among researchers that response-shift phenomena are central to any understanding of quality of life (QOL). However, as this series of papers clearly states, much of the uncertainty about how to align and reconcile different definitions and methods remains unclear [1][2][3][4]. Twenty-five years after the initial work on response shift [5], it feels less than satisfactory to leave these as unresolved.…”