Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 May;17(4):549-58.
doi: 10.1007/s11136-008-9333-6.

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

Marjan J Westerman  1 , Tony Hak, Mirjam A G Sprangers, Harry J M Groen, Gerrit van der Wal, Anne-Mei The
Affiliations

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

Marjan J Westerman et al. Qual Life Res. 2008 May.

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.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
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
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '2776397', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/2776397/'}]}
    2. Llewellyn-Thomas, H. A., Thiel, E. C., & Clark, R. M. (1989). Patients versus surrogates: Whose opinion counts on the ethics review panels? Clinical Research, 37, 51–55. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/0895-4356(89)90085-1', 'is_inner': False, 'url': 'https://doi.org/10.1016/0895-4356(89)90085-1'}, {'type': 'PubMed', 'value': '2918321', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/2918321/'}]}
    2. O’Connor, A. M. (1989). Effects of framing and level of probability on patients’ preferences for cancer chemotherapy. Journal of Clinical Epidemiology, 42(2), 119–126. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/0959-8049(95)00513-7', 'is_inner': False, 'url': 'https://doi.org/10.1016/0959-8049(95)00513-7'}, {'type': 'PubMed', 'value': '8562147', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/8562147/'}]}
    2. Bremnes, R. M., Andersen, K., & Wist, E. A. (1995). Cancer patients, doctors and nurses vary in their willingness to undertake cancer chemotherapy. European Journal of Cancer, 31A, 1955–1959. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PMC', 'value': 'PMC1663147', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC1663147/'}, {'type': 'PubMed', 'value': '2379006', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/2379006/'}]}
    2. Slevin, M. L., Stubbs, L., Plant, H. J., Wilson, P., Gregory, W. M., & Armes, P. J., et al. (1990). Attitudes to chemotherapy: Comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ, 300, 1458–1460. - PMC - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1634/theoncologist.9-90006-14', 'is_inner': False, 'url': 'https://doi.org/10.1634/theoncologist.9-90006-14'}, {'type': 'PubMed', 'value': '15616146', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/15616146/'}]}
    2. Gralla, R. J. (2004). Quality-of-life considerations in patients with advanced lung cancer: Effect of topotecan on symptom palliation and quality of life. Oncologist, 9(Suppl. 6), 14–24. - PubMed

Publication types

MeSH terms

Substances