Limits...
Listen to their answers! Response behaviour in the measurement of physical and role functioning.

Westerman MJ, Hak T, Sprangers MA, Groen HJ, van der Wal G, The AM - Qual Life Res (2008)

Bottom Line: Patients had scores suggesting they were less limited than they actually were by taking the wording of questions literally, by guessing their functioning in activities that they did not perform, and by ignoring or excluding certain activities that they could not perform.Their answers can be interpreted in terms of change in the appraisal process (Rapkin and Schwartz 2004; Health and Quality of Life Outcomes, 2, 14).More care should be taken in assessing the quality of a set of questions about physical and role functioning.

View Article: PubMed Central - PubMed

Affiliation: Department of Public and Occupational Health, EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands. marjan.westerman@falw.vu.nl

ABSTRACT

Background: Quality of life (QoL) is considered to be an indispensable outcome measure of curative and palliative treatment. However, QoL research often yields findings that raise questions about what QoL measurement instruments actually assess and how the scores should be interpreted.

Objective: To investigate how patients interpret and respond to questions on the EORTC-QLQ-C30 over time and to find explanations to account for counterintuitive findings in QoL measurement.

Methods: Qualitative investigation was made of the response behaviour of small-cell lung cancer patients (n = 23) in the measurement of QoL with the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). Focus was on physical functioning (PF, items 1 to 5), role functioning (RF, items 6 and 7), global health and QoL rating (GH/QOL, items 29 and 30). Interviews were held at four points: at the start of the chemotherapy, 4 weeks later, at the end, and 6 weeks after the end of chemotherapy. Patients were asked to 'think aloud' when filling in the questionnaire.

Results: Patients used various response strategies when answering questions about problems and limitations in functioning, which impacted the accuracy of the scale. Patients had scores suggesting they were less limited than they actually were by taking the wording of questions literally, by guessing their functioning in activities that they did not perform, and by ignoring or excluding certain activities that they could not perform.

Conclusion: Terminally ill patients evaluate their functioning in terms of what they perceive to be normal under the circumstances. Their answers can be interpreted in terms of change in the appraisal process (Rapkin and Schwartz 2004; Health and Quality of Life Outcomes, 2, 14). More care should be taken in assessing the quality of a set of questions about physical and role functioning.

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Examples of response strategies used to answer question 1, 2, 4, 6, and 7 of the EORTC-QLQC30 questionnaire. These strategies and change in the use of a certain strategy over time may explain why patients do not report the deterioration in physical and role functioning that would objectively be expected
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Fig1: Examples of response strategies used to answer question 1, 2, 4, 6, and 7 of the EORTC-QLQC30 questionnaire. These strategies and change in the use of a certain strategy over time may explain why patients do not report the deterioration in physical and role functioning that would objectively be expected

Mentions: Questions 1 to 7 on the QoL instrument reveals important clues to how patients report physical and role limitations. Patients responded in unexpected ways: by focusing on one aspect of the question, by taking the wording of the question literally, and by ignoring or excluding certain activities that they could not perform. This resulted in patients producing QoL scores that suggested they were less limited than they actually were (see Fig. 1 for examples). Furthermore, a few patients guessed their level of functioning in activities that they did not perform or used the strategy “I didn’t do it, so I don’t have any trouble” (example see item 2), and a few compared present with previous experiences (e.g., “I feel not too bad, compared to last week”) or with expectations (e.g., “I feel better as expected”). The following examples illustrate for each question how, during the first interview (T1), a certain strategy resulted in a different QoL score than would be expected.Fig. 1


Listen to their answers! Response behaviour in the measurement of physical and role functioning.

Westerman MJ, Hak T, Sprangers MA, Groen HJ, van der Wal G, The AM - Qual Life Res (2008)

Examples of response strategies used to answer question 1, 2, 4, 6, and 7 of the EORTC-QLQC30 questionnaire. These strategies and change in the use of a certain strategy over time may explain why patients do not report the deterioration in physical and role functioning that would objectively be expected
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2358935&req=5

Fig1: Examples of response strategies used to answer question 1, 2, 4, 6, and 7 of the EORTC-QLQC30 questionnaire. These strategies and change in the use of a certain strategy over time may explain why patients do not report the deterioration in physical and role functioning that would objectively be expected
Mentions: Questions 1 to 7 on the QoL instrument reveals important clues to how patients report physical and role limitations. Patients responded in unexpected ways: by focusing on one aspect of the question, by taking the wording of the question literally, and by ignoring or excluding certain activities that they could not perform. This resulted in patients producing QoL scores that suggested they were less limited than they actually were (see Fig. 1 for examples). Furthermore, a few patients guessed their level of functioning in activities that they did not perform or used the strategy “I didn’t do it, so I don’t have any trouble” (example see item 2), and a few compared present with previous experiences (e.g., “I feel not too bad, compared to last week”) or with expectations (e.g., “I feel better as expected”). The following examples illustrate for each question how, during the first interview (T1), a certain strategy resulted in a different QoL score than would be expected.Fig. 1

Bottom Line: Patients had scores suggesting they were less limited than they actually were by taking the wording of questions literally, by guessing their functioning in activities that they did not perform, and by ignoring or excluding certain activities that they could not perform.Their answers can be interpreted in terms of change in the appraisal process (Rapkin and Schwartz 2004; Health and Quality of Life Outcomes, 2, 14).More care should be taken in assessing the quality of a set of questions about physical and role functioning.

View Article: PubMed Central - PubMed

Affiliation: Department of Public and Occupational Health, EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands. marjan.westerman@falw.vu.nl

ABSTRACT

Background: Quality of life (QoL) is considered to be an indispensable outcome measure of curative and palliative treatment. However, QoL research often yields findings that raise questions about what QoL measurement instruments actually assess and how the scores should be interpreted.

Objective: To investigate how patients interpret and respond to questions on the EORTC-QLQ-C30 over time and to find explanations to account for counterintuitive findings in QoL measurement.

Methods: Qualitative investigation was made of the response behaviour of small-cell lung cancer patients (n = 23) in the measurement of QoL with the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). Focus was on physical functioning (PF, items 1 to 5), role functioning (RF, items 6 and 7), global health and QoL rating (GH/QOL, items 29 and 30). Interviews were held at four points: at the start of the chemotherapy, 4 weeks later, at the end, and 6 weeks after the end of chemotherapy. Patients were asked to 'think aloud' when filling in the questionnaire.

Results: Patients used various response strategies when answering questions about problems and limitations in functioning, which impacted the accuracy of the scale. Patients had scores suggesting they were less limited than they actually were by taking the wording of questions literally, by guessing their functioning in activities that they did not perform, and by ignoring or excluding certain activities that they could not perform.

Conclusion: Terminally ill patients evaluate their functioning in terms of what they perceive to be normal under the circumstances. Their answers can be interpreted in terms of change in the appraisal process (Rapkin and Schwartz 2004; Health and Quality of Life Outcomes, 2, 14). More care should be taken in assessing the quality of a set of questions about physical and role functioning.

Show MeSH
Related in: MedlinePlus