Understanding appraisal processes underlying the thentest: a mixed methods investigation

Schwartz, Carolyn E.; Rapkin, Bruce A.

doi:10.1007/s11136-011-0023-4

Cited by 26 publications

(9 citation statements)

References 23 publications

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“…However, we showed that not only recalibration, but also reprioritization simultaneously contributed to observed changes, as our method was, as compared to previous studies, more comprehensive, combining all aspects of response shift in a single quantitative model. Future studies should directly compare the traditional then-test with the structural equation modeling method to examine the hypothesis that the then-test is not only capturing recalibration effects, but also those of reprioritization [5,21].…”

Section: Discussionmentioning

confidence: 99%

Prostate cancer patients’ quality of life assessments across the primary treatment trajectory: ‘True’ change or response shift?

et al. 2016

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Background Self-report questionnaires are widely used to assess changes in quality of life (QoL) during the course of cancer treatment. However, comparing baseline scores to follow-up scores is only justified if patients' internal measurement standards have not changed over time, that is, no response shift occurred. We aimed to examine response shift in terms of reconceptualization, reprioritization and recalibration among prostate cancer patients. Material and methods We included 402 newly diagnosed patients (mean age 65 years) and assessed QoL at the beginning of cancer treatment and three months later. QoL was measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). We employed structural equation modeling testing measurement invariance between occasions to disentangle 'true' change and change in the measurement model (response shift). Results We found reprioritization effects for both the Physical Functioning and Role Functioning subscales of the EORTC QLQ-C30, indicating that both had gained importance for representing the latent construct of QoL at follow-up. These effects added to the worsening effect evident in the latent construct, thus rendering observed changes even more pronounced. In addition, we found recalibration effects for both the Emotional Functioning and Cognitive Functioning subscales indicating judgments becoming more lenient over time. These effects counteracted 'true' negative changes thus obscuring any substantial changes on the observed level. Conclusion Our results suggest that changes observed in some subscales of the EORTC QLQ-C30 should not be taken at face value as they may be affected by patients' changed measurement standards.

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Section: Discussionmentioning

confidence: 99%

Prostate cancer patients’ quality of life assessments across the primary treatment trajectory: ‘True’ change or response shift?

et al. 2016

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“…In studies of diverse patient populations, this tool has documented differences in patterns of emphasis between people who fare better, fare worse, or have a variable course with multiple sclerosis (MS) [ 4 ], after spinal surgery [ 8 ], or before [ 25 ] and after invasive cancer treatment [ 26 , 27 ]. It has documented differences in key indicators of clinically important change, suggesting that interpretation of change over time depends on many factors beyond post-minus-pre scores [ 28 ]. Next-generation appraisal measures focused on reducing the need to code text generated from open-ended questions.…”

Section: Introductionmentioning

confidence: 99%

Capturing patient experience: does quality-of-life appraisal entail a new class of measurement?

Schwartz

Stark

Rapkin

2020

J Patient Rep Outcomes

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Background Two decades of research on quality-of-life (QOL) appraisal have demonstrated links between patient experience and health outcomes and have accounted for both intra-individual change and inter-individual differences in a wide range of research contexts. The present work investigates patterns across diagnostic and demographic groupings to demonstrate how population-specific circumstances drive the structure of QOL appraisal. Methods This secondary analysis (N = 6448) utilized data from six patient groups: spine surgery, multiple sclerosis, heterogeneous chronically ill, heterogeneous cancer, bladder cancer, and human immunodeficiency virus (HIV). We explored patterns of inter-item correlation across patient samples, using items from the Standards of Comparison and Sampling of Experience subsections of the QOL Appraisal Profile v1 and v2. Similar matrices were compared by demographic characteristics. Results Patterns of inter-item correlations for Standards of Comparison items varied sharply across disease groups and racial groups while being similar across age, gender, and education levels. Inter-item correlation matrices for Sampling of Experience items revealed marked differences among disease groups and educational and racial categories but were similar across age and gender groups. Conclusions Appraisal parameters showed evidence of shared and unique aspects across samples and circumstances, findings which make sense in light of sample differences in health status and demographic influences. Tools to assess patient experience and meaning may be best understood as idiometric instruments. We discuss their distinctions from psychometric and clinimetric tools at theoretical, statistical, and applied levels.

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“…However, research has demonstrated that the method is con-founded by recall bias 2,60 and implicit theories of change, 41 and only a small proportion of the scores reflect recalibration response shift. 57 Consequently, the then-test is no longer commonly used for detecting response shift.…”

Section: Response Shift Research In Spine Surgerymentioning

confidence: 99%

Patient-reported outcomes in spine surgery: past, current, and future directions

Finkelstein

Schwartz

2019

Journal of Neurosurgery: Spine

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The purpose of this article is to review the current state of outcome measurement in spine surgery, with an emphasis on patient-reported outcome measures (PROMs). The commonly used generic and disease-specific outcome measures used in spinal surgery and research will be discussed. The authors will introduce the concepts of response shift and appraisal processes, which may affect the face validity of PROMs, as well as their interpretation over time. It is not uncommon for there to be a discrepancy between the observed and expected outcome, which is not wholly explainable by objective measures. Current work on understanding how appraisal affects outcome measurement will be discussed, and future directions will be suggested to facilitate the continued evolution of PROMs.There has been an evolution in the way clinicians measure outcomes following spinal surgery. In moving from purely physical, objective measures to a growing emphasis on the patient’s perspective, spine surgery outcomes are better able to integrate the impact at multiple levels of relevant change. Appraisal concepts and methods are gaining traction as ways to understand the cognitive processes underlying PROMs over time. Measurement of appraisal is a valuable adjunct to the current spine outcome tools.

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Understanding appraisal processes underlying the thentest: a mixed methods investigation

Abstract: Ipsative and normative discrepancy scores measure distinct constructs, represent different configurations of appraisal change, and are not invalidated or explained by recall bias. The thentest does not imply recalibration alone but rather a host of health- and self-care-related concerns.

Cited by 26 publications

References 23 publications

Prostate cancer patients’ quality of life assessments across the primary treatment trajectory: ‘True’ change or response shift?

Prostate cancer patients’ quality of life assessments across the primary treatment trajectory: ‘True’ change or response shift?

Capturing patient experience: does quality-of-life appraisal entail a new class of measurement?

Patient-reported outcomes in spine surgery: past, current, and future directions

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