TY - JOUR
T1 - Implications of response shift for micro-, meso-, and macro-level healthcare decision-making using results of patient-reported outcome measures
AU - Sawatzky, Richard
AU - Kwon, Jae-Yung
AU - Barclay, Ruth
AU - Chauhan, Cynthia
AU - Frank, Lori
AU - van den Hout, Wilbert B.
AU - Nielsen, Lene Kongsgaard
AU - Nolte, Sandra
AU - the Response Shift – in Sync Working Group
AU - Sprangers, Mirjam A. G.
N1 - Publisher Copyright: © 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Purpose: Results of patient-reported outcome measures (PROMs) are increasingly used to inform healthcare decision-making. Research has shown that response shift can impact PROM results. As part of an international collaboration, our goal is to provide a framework regarding the implications of response shift at the level of patient care (micro), healthcare institute (meso), and healthcare policy (macro). Methods: Empirical evidence of response shift that can influence patients’ self-reported health and preferences provided the foundation for development of the framework. Measurement validity theory, hermeneutic philosophy, and micro-, meso-, and macro-level healthcare decision-making informed our theoretical analysis. Results: At the micro-level, patients’ self-reported health needs to be interpreted via dialogue with the clinician to avoid misinterpretation of PROM data due to response shift. It is also important to consider the potential impact of response shift on study results, when these are used to support decisions. At the meso-level, individual-level data should be examined for response shift before aggregating PROM data for decision-making related to quality improvement, performance monitoring, and accreditation. At the macro-level, critical reflection on the conceptualization of health is required to know whether response shift needs to be controlled for when PROM data are used to inform healthcare coverage. Conclusion: Given empirical evidence of response shift, there is a critical need for guidelines and knowledge translation to avoid potential misinterpretations of PROM results and consequential biases in decision-making. Our framework with guiding questions provides a structure for developing strategies to address potential impacts of response shift at micro-, meso-, and macro-levels.
AB - Purpose: Results of patient-reported outcome measures (PROMs) are increasingly used to inform healthcare decision-making. Research has shown that response shift can impact PROM results. As part of an international collaboration, our goal is to provide a framework regarding the implications of response shift at the level of patient care (micro), healthcare institute (meso), and healthcare policy (macro). Methods: Empirical evidence of response shift that can influence patients’ self-reported health and preferences provided the foundation for development of the framework. Measurement validity theory, hermeneutic philosophy, and micro-, meso-, and macro-level healthcare decision-making informed our theoretical analysis. Results: At the micro-level, patients’ self-reported health needs to be interpreted via dialogue with the clinician to avoid misinterpretation of PROM data due to response shift. It is also important to consider the potential impact of response shift on study results, when these are used to support decisions. At the meso-level, individual-level data should be examined for response shift before aggregating PROM data for decision-making related to quality improvement, performance monitoring, and accreditation. At the macro-level, critical reflection on the conceptualization of health is required to know whether response shift needs to be controlled for when PROM data are used to inform healthcare coverage. Conclusion: Given empirical evidence of response shift, there is a critical need for guidelines and knowledge translation to avoid potential misinterpretations of PROM results and consequential biases in decision-making. Our framework with guiding questions provides a structure for developing strategies to address potential impacts of response shift at micro-, meso-, and macro-levels.
KW - Health policy
KW - Healthcare decision-making
KW - Organization
KW - Patient
KW - Patient-reported outcomes
KW - Response shift
UR - http://www.scopus.com/inward/record.url?scp=85101076673&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s11136-021-02766-9
DO - https://doi.org/10.1007/s11136-021-02766-9
M3 - Article
C2 - 33651278
SN - 0962-9343
VL - 30
SP - 3343
EP - 3357
JO - Quality of life research
JF - Quality of life research
IS - 12
ER -