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Quantitative assessment of changes in patients' constructs of quality of life: An application of multilevel models

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Abstract

It has often been proposed that quality of life (QL) instruments should account for potentially changing conceptualisations of QL as patients adapt to disease (response-shift). Most instruments do not do this, and some that do are relatively complicated and burdensome for patients. The extent to which patients reconceptualise QL is unknown, and it is unclear whether this additional complication is necessary. This paper reviews existing methods for assessing response-shift and introduces an alternative approach using multilevel models. The method is described using data from a cancer clinical trial, and its performance is evaluated in simulations. The models reveal substantial response-shift in these cancer patients. Simulations under the null hypothesis of zero response-shift confirm that the method performs correctly in terms of its risk of type I error, and further simulations illustrate its statistical power to detect pre-defined levels of response-shift. The method is a relatively simple extension of familiar multiple regression models and yields parameters with a simple interpretation, representing the changes in importance of QL domains over time. It can be applied to existing datasets collected with other analysis strategies in mind and may have application in the investigation of response shifts and other manifestations of adaptation.

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References

  1. The EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 1990; 16(3): 199–208.

    Google Scholar 

  2. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30(6): 473–483.

    PubMed  Google Scholar 

  3. Brazier J, Usherwood T, Harper R, Thomas KJ. Deriving a preference-based single index from the UK SF-36 Health Survey. J Clin Epidemiol 1998; 51: 1115–1128.

    Article  PubMed  Google Scholar 

  4. Bergner M, Bobbitt RA, Carter WB, et al. The sickness impact profile: Development and final revision of a health status measure. Med Care 1981; 19: 787–805.

    PubMed  Google Scholar 

  5. Rosser R. A health index and output measure. In: Walker SR, Rosser RM (eds), Quality of Life: Assessment and Application, Lancaster: MTP Press, 1988.

    Google Scholar 

  6. Sprangers M, Schwartz C. Integrating response shift into health-related quality of life research: A theoretical model. Soc Sci Med 1999; 48: 1507-1515.

    Google Scholar 

  7. Schwartz C, Sprangers M. Methodological approaches for assessing response shift in longitudinal health-related quality-of-life research. Soc Sci Med 1999; 48: 1531–1548.

    Article  PubMed  Google Scholar 

  8. Trauer T, Mackinnon A. Why are we weighting? The role of importance ratings in quality of life measurement. Qual Life Res 2001; 10(7): 579–585.

    Article  PubMed  Google Scholar 

  9. Hickey AM, Bury G, Boyle CA, et al. A new short form individual quality of life measure (SEIQoL-DW): Application in a cohort of individuals with HIV/AIDS. Br Med J 1996; 313: 29–33.

    Google Scholar 

  10. Ruta DA, Garratt AM, Leng M, et al. A new approach to the measurement of quality of life. The Patient-Generated Index. Med Care 1994; 32(11): 1109–1126.

    PubMed  Google Scholar 

  11. Henrich G, Herschbach P. Questions on Life Satisfaction (FLZ(M))-A short questionnaire for assessing subjective quality of life. Eur J Psychol Assessment 2000; 16: 150–159.

    Article  Google Scholar 

  12. Sprangers M, Schwartz C. The challenge of response shift for quality-of-life based clinical oncology research. Ann Oncol 1999; 10: 747–749.

    Article  PubMed  Google Scholar 

  13. Bernhard J, Hürny C, Maibach R, et al. Quality of life as subjective experience: Reframing of perception in patients with colon cancer undergoing radical resection with or without adjuvant chemotherapy. Ann Oncol 1999; 10: 775–782.

    Article  PubMed  Google Scholar 

  14. Bernhard J, Lowy A, Maibach R, et al. Response shift in the perception of health for utility evaluation. An explorative investigation. Eur J Cancer 2001; 37(14): 1729–1735.

    Article  PubMed  Google Scholar 

  15. Sprangers MA, Tempelaar R, van den Heuvel WJ, et al. Explaining quality of life with crisis theory. Psychooncology 2002; 11(5): 419–426.

    Article  PubMed  Google Scholar 

  16. Jansen SJ, Stigglebout A, Nooij M, et al. Response shift in quality of life measurement in early-stage breast cancer patients undergoing radiotherapy. Qual Life Res 2000; 9(6): 603–615.

    Article  PubMed  Google Scholar 

  17. Armenakis A, Feild H, Wilmoth J. An algorithm for assessing factor structure congruence. Educ Psychol Meas 1992; 37: 213–214.

    Google Scholar 

  18. Schmitt N. The use of analysis of covariance structures to assess beta and gamma change. Multivariate Behav Res 1982; 17: 343–358.

    Google Scholar 

  19. Bollen K, Lennox R. Conventional wisdom on measurement: A structural equation perspective. Psychol Bull 1991; 110(2): 305–314.

    Article  Google Scholar 

  20. Fayers P, Hand D, Bjordal K, Groenvold M. Causal indicators in quality of life research. Qual Life Res 1997; 6: 393–406.

    Article  PubMed  Google Scholar 

  21. Fayers P, Hand D. Factor analysis, causal indicators and quality of life. Qual Life Res 1997; 6: 139–150.

    PubMed  Google Scholar 

  22. Ratcliffe J, Van Haselen R, Buxton M, et al. Assessing patients' preferences for characteristics associated with homeopathic and conventional treatment of asthma: A conjoint analysis study. Thorax 2002; 57: 503–508.

    Article  PubMed  Google Scholar 

  23. Groenvold M, Fayers P. Testing for differences in multiple quality of life dimensions: generating hypotheses from the experience of hospital staff. Qual Life Res 1998; 7: 479–485.

    Article  PubMed  Google Scholar 

  24. Goldstein H. Multilevel Statistical Models. London: Edward Arnold, 1995.

    Google Scholar 

  25. Bernhard J, Lowy A, Mathys N, et al. Health-related quality of life: A changing construct? Qual Life Res, 2004; 13: 1187–1197.

    Article  PubMed  Google Scholar 

  26. Hürny C, Bernhard J, Coates A, et al. Responsiveness of a single-item indicator versus a multi-item scale: Assessment of emotional well-being in an international adjuvant breast cancer trial. Med Care 1996; 34: 234–248.

    Article  PubMed  Google Scholar 

  27. Hürny C, Bernhard J, Bacchi M, et al. The Perceived Adjustment to Chronic Illness Scale (PACIS): A global indicator of coping for operable breast cancer patients in clinical trials. Support Care Cancer 1993; 1(4): 200–208.

    PubMed  Google Scholar 

  28. Rasbash J, Browne W, Goldstein H. A user's guide to MLwiN. Centre for Multilevel Modelling, Institute of Education, University of London, 2000.

  29. Tsukino M, Nishimura K, McKenna SP, et al. Change in generic and disease-specific health-related quality of life during a one-year period in patients with newly detected chronic obstructive pulmonary disease. Respiration 2002; 69(6): 513–520.

    Article  PubMed  Google Scholar 

  30. Albrecht G, Devlieger P. The disability paradox: High quality of life against all odds. Soc SciMed1999; 48: 977–988.

    Google Scholar 

  31. Jansen S, Stigglebout A, Wakker P, et al. Unstable preferences: A shift in evaluation or an effect of the elicitation procedure? Med Decis Making 2000; 20: 62–71.

    PubMed  Google Scholar 

  32. Badia X, Herdman M, Kind P. The influence of ill-health experience on the valuation of health. Pharmacoeconomics 1998; 13(6): 687–696.

    PubMed  Google Scholar 

  33. Adang EM, Kootstra G, Engel GL, et al. Do retrospective and prospective quality of life assessments differ for pancreas-kidney transplant recipients? Transpl Int 1998; 11(1): 11–15.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Swiss Institute for Applied Cancer Research, SIAK Coordinating Center, Switzerland

    Adam Lowy & Jürg Bernhard

  2. Institute of Medical Oncology, Inselspital, Bern, Switzerland

    Jürg Bernhard

Authors
  1. Adam Lowy
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  2. Jürg Bernhard
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Lowy, A., Bernhard, J. Quantitative assessment of changes in patients' constructs of quality of life: An application of multilevel models. Qual Life Res 13, 1177–1185 (2004). https://doi.org/10.1023/B:QURE.0000037510.17893.d2

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  • DOI: https://doi.org/10.1023/B:QURE.0000037510.17893.d2

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