Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients

Abstract

BackgroundAssessments of change in subjective patient reported outcomes such as health-related quality of life (HRQoL) are a key component of many clinical and research evaluations. However, conventional longitudinal evaluation of change may not agree with patient perceived change if patients' understanding of the subjective construct under evaluation changes over time (response shift) or if patients' have inaccurate recollection (recall bias). This study examined whether older adults' perception of change is in agreement with conventional longitudinal evaluation of change in their HRQoL over the duration of their hospital stay. It also investigated this level of agreement after adjusting patient perceived change for recall bias that patients may have experienced.MethodsA prospective longitudinal cohort design nested within a larger randomised controlled trial was implemented. 103 hospitalised older adults participated in this investigation at a tertiary hospital facility. The EQ-5D utility and Visual Analogue Scale (VAS) scores were used to evaluate HRQoL. Participants completed EQ-5D reports as soon as they were medically stable (within three days of admission) then again immediately prior to discharge. Three methods of change score calculation were used (conventional change, patient perceived change and patient perceived change adjusted for recall bias). Agreement was primarily investigated using intraclass correlation coefficients (ICC) and limits of agreement.ResultsOverall 101 (98%) participants completed both admission and discharge assessments. The mean (SD) age was 73.3 (11.2). The median (IQR) length of stay was 38 (20-60) days. For agreement between conventional longitudinal change and patient perceived change: ICCs were 0.34 and 0.40 for EQ-5D utility and VAS respectively. For agreement between conventional longitudinal change and patient perceived change adjusted for recall bias: ICCs were 0.98 and 0.90 respectively. Discrepancy between conventional longitudinal change and patient perceived change was considered clinically meaningful for 84 (83.2%) of participants, after adjusting for recall bias this reduced to 8 (7.9%).ConclusionsAgreement between conventional change and patient perceived change was not strong. A large proportion of this disagreement could be attributed to recall bias. To overcome the invalidating effect of response shift (on conventional change) and recall bias (on patient perceived change) a method of adjusting patient perceived change for recall bias has been described.

Hospital Recovery and Full Recovery

“…PROs are also relatively inexpensive and easy to administer. A potential disadvantage is that changes in PRO scores may be confounded by postoperative cognitive decline [ 1 ], recall bias (i.e., inaccurate recollection of events), and response shift (i.e., change in patients' standards and values in relation to their health status over time) [ 19 ]. Multidimensional questionnaires of generic health status (e.g., Short-Form 36 [ 20 ]) and recovery-related health status (e.g., Quality of Recovery Score [ 21 ] and Postoperative Quality of Life [ 22 ]) had their validity supported in the context of late recovery.…”

Empirical likelihood inference for the odds ratio of two survival functions under right censoring

“…There is an extensive literature on the issue of recall bias in epidemiological studies that use odds ratios to quantify associations (see, e.g. Hassan, 2006;McPhail and Haines, 2010;Parr et al, 2009;Vrijheid et al, 2009). Nonetheless, as far as we know, there have been no attempts to address the problem from the perspective of right-censoring (apart from simply discarding the right-censored observations).…”

Using Twitter to Elicit the Patient Perspective

“…Limitations can often be associated with subjectivity, in which either the researcher or the research participant may influence the study results for various reasons [14]. For example, the solicitation of study participants presents a level of partiality due to the possibility of selection bias, where the sampling procedure favors selection of some individuals over others [15]. Additionally, an overarching limitation of traditional research methods is patient recall bias.…”