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. 2007 Dec;16(10):1627-34.
doi: 10.1007/s11136-007-9265-6. Epub 2007 Oct 5.

Response shift due to diagnosis and primary treatment of localized prostate cancer: a then-test and a vignette study

Ida J Korfage  1 , Harry J de Koning, Marie-Louise Essink-Bot
Affiliations

Response shift due to diagnosis and primary treatment of localized prostate cancer: a then-test and a vignette study

Ida J Korfage et al. Qual Life Res. 2007 Dec.

Abstract

Aim: Whether a prostate cancer diagnosis induces response shift has not been established so far. Therefore, we assessed response shift in men who were diagnosed with localized prostate cancer.

Patients and methods: Out of 3,892 men who completed a questionnaire before screening, 82 were subsequently diagnosed with prostate cancer. Response shift was assessed in 52 (response 63%) by the then-test (EuroQol self-rating of health, Short-Form 36 mental health and vitality) and a novel method: rating of vignettes relating to side effects of prostate cancer treatment (urinary, bowel and erectile dysfunction). Three then-tests were conducted: two referencing pre-diagnosis (measured pre- and post-treatment), and one referencing pre-treatment (measured post-treatment).

Results: Then-test scores of pre-diagnosis health were significantly higher than original scores, indicating a more positive judgement in retrospect. Then-test scores of pre-treatment health were lower than original scores. Especially the vignette on erectile dysfunction was rated less bad after diagnosis versus before (P < 0.001, moderate effect size).

Conclusions: We found evidence for response shift in men who were diagnosed with prostate cancer. Men evaluated urinary, bowel, and erectile dysfunction as less bad after they had become patients who can expect to experience these side effects. The rating of vignettes is a promising additional technique to assess response shift.

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Figures

Fig. 1
Fig. 1
Study scheme
Fig. 2
Fig. 2
Original and then-test scores of the EuroQol valuation of own health by prostate cancer patients (n = 52). If we measure only EQ-VAS preceding diagnosis and at 1-month post-diagnosis, the difference between these scores is regarded the ‘observed change’. However, if the retrospective pre-diagnosis assessment provides a more valid comparison with the post-diagnosis assessment, the ‘true change’ is reflected by the difference between the retrospective pre-diagnosis assessment and the post-diagnosis assessment. The difference between the pre-diagnosis assessment and the retrospective pre-diagnosis assessment provides an indication of the size and direction of the ‘response shift’ induced by the diagnosis. Similar explanations are valid for the other data points in the figure
Fig. 3
Fig. 3
Original and then-test scores of the SF-36 mental health by prostate cancer patients (n = 52). ‘Observed change’, ‘True change’ and ‘Response shift’ refer to the differences in SF-36 mental health scores between the assessment at 2 months before diagnosis and post- and then-test at 1 month after diagnosis (for further explanation, see caption at Fig. 2.)
Fig. 4
Fig. 4
Original and then-test scores of the SF-36 vitality by prostate cancer patients (n = 52). ‘Observed change’, ‘True change’ and ‘Response shift’ refer to the differences in SF-36 vitality scores between the assessment at 2 months before diagnosis and post- and thentestthen-test at 1 month after diagnosis (for further explanation, see caption at Fig. 2.)
See this image and copyright information in PMC

References

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