Using a retrospective pretest instead of a conventional pretest is replacing biases: a qualitative study of cognitive processes underlying responses to thentest items

doi:10.1007/s11136-015-1175-4

. 2016 Jun;25(6):1327-37.

doi: 10.1007/s11136-015-1175-4. Epub 2015 Nov 16.

Using a retrospective pretest instead of a conventional pretest is replacing biases: a qualitative study of cognitive processes underlying responses to thentest items

Elsbeth F Taminiau-Bloem¹, Carolyn E Schwartz^{2

3}, Florence J van Zuuren⁴, Margot A Koeneman¹, Mechteld R M Visser⁵, Carol Tishelman^{6

7}, Caro C E Koning⁸, Mirjam A G Sprangers⁹

Affiliations

¹ Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
² DeltaQuest Foundation, Inc., Concord, MA, USA.
³ Departments of Medicine and Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA, USA.
⁴ Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
⁵ Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁶ Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet, Stockholm, Sweden.
⁷ The Innovation Center, Karolinska University Hospital, Stockholm, Sweden.
⁸ Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁹ Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.a.sprangers@amc.uva.nl.

PMID: 26573019
PMCID: PMC4870298
DOI: 10.1007/s11136-015-1175-4

Using a retrospective pretest instead of a conventional pretest is replacing biases: a qualitative study of cognitive processes underlying responses to thentest items

Elsbeth F Taminiau-Bloem et al. Qual Life Res. 2016 Jun.

. 2016 Jun;25(6):1327-37.

doi: 10.1007/s11136-015-1175-4. Epub 2015 Nov 16.

Authors

Elsbeth F Taminiau-Bloem¹, Carolyn E Schwartz^{2

3}, Florence J van Zuuren⁴, Margot A Koeneman¹, Mechteld R M Visser⁵, Carol Tishelman^{6

7}, Caro C E Koning⁸, Mirjam A G Sprangers⁹

Affiliations

¹ Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
² DeltaQuest Foundation, Inc., Concord, MA, USA.
³ Departments of Medicine and Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA, USA.
⁴ Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
⁵ Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁶ Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet, Stockholm, Sweden.
⁷ The Innovation Center, Karolinska University Hospital, Stockholm, Sweden.
⁸ Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
⁹ Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.a.sprangers@amc.uva.nl.

PMID: 26573019
PMCID: PMC4870298
DOI: 10.1007/s11136-015-1175-4

Abstract

Background: The thentest design aims to detect and control for recalibration response shift. This design assumes (1) more consistency in the content of the cognitive processes underlying patients' quality of life (QoL) between posttest and thentest assessments than between posttest and pretest assessments; and (2) consistency in the time frame and description of functioning referenced at pretest and thentest. Our objective is to utilize cognitive interviewing to qualitatively examine both assumptions.

Methods: We conducted think-aloud interviews with 24 patients with cancer prior to and after radiotherapy to elicit cognitive processes underlying their assessment of seven EORTC QLQ-C30 items at pretest, posttest and thentest. We used an analytic scheme based on the cognitive process models of Tourangeau et al. and Rapkin and Schwartz that yielded five cognitive processes. We subsequently used this input for quantitative analysis of count data.

Results: Contrary to expectation, the number of dissimilar cognitive processes between posttest and thentest was generally larger than between pretest and posttest across patients. Further, patients considered a range of time frames when answering the thentest questions. Moreover, patients' description at the thentest of their pretest functioning was often not similar to that which was noted at pretest. Items referring to trouble taking a short walk, overall health and QoL were most often violating the assumptions.

Conclusions: Both assumptions underlying the thentest design appear not to be supported by the patients' cognitive processes. Replacing the conventional pretest-posttest design with the thentest design may simply be replacing one set of biases with another.

Keywords: Cancer; Cognitive processes; Item level; Patient-reported outcomes; Quality of life; Response shift; Thentest.

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Figures

**Fig. 1**
Flowchart of the data analysis process: posttest and thentest. *Note* the same process was used for analyzing the pretest and comparing the posttest with the pretest

**Fig. 2**
Scatterplot of pretest–posttest versus posttest–thentest disparity counts for all five cognitive processes combined (*regression line*)

See this image and copyright information in PMC

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References

1. Taminiau-Bloem EF, van Zuuren FJ, Koeneman MA, Rapkin BD, Visser MRM, Koning CCE, Sprangers MAG. A ‘short walk’ is longer before radiotherapy than afterwards: A qualitative study questioning the baseline and follow-up design. Health and Quality of Life Outcomes. 2010;8:69. doi: 10.1186/1477-7525-8-69. - DOI - PMC - PubMed
1. Morak MJ, Pek CJ, Kompanje EJ, Hop WC, Kazemier G, van Eijck CH. Quality of life after adjuvant intra-arterial chemotherapy and radiotherapy versus surgery alone in resectable pancreatic and periampullary cancer: A prospective randomized controlled study. Cancer. 2010;116(4):830–836. doi: 10.1002/cncr.24809. - DOI - PubMed
1. Komblith AB, Huang HQ, Walker JL, Spirtos NM, Rotmensch J, Cella D. Quality of life of patients with endometrial cancer undergoing laparoscopic international federation of gynecology and obstetrics staging compared with laparotomy: A Gynecologic Oncology Group study. Journal of Clinical Oncology. 2009;27(32):5337–5342. doi: 10.1200/JCO.2009.22.3529. - DOI - PMC - PubMed
1. Groenvold M, Fayers PM, Petersen MA, Mouridsen HT. Chemotherapy versus ovarian ablation as adjuvant therapy for breast cancer: Impact on health-related quality of life in a randomized trial. Breast Cancer Research. 2006;98(3):275–284. doi: 10.1007/s10549-006-9160-9. - DOI - PubMed
1. Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G, for the Clinical Outcomes of Surgical Therapy (COST) Study Group Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer. JAMA. 2003;287(3):321–328. doi: 10.1001/jama.287.3.321. - DOI - PubMed

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[1] Taminiau-Bloem EF, van Zuuren FJ, Koeneman MA, Rapkin BD, Visser MRM, Koning CCE, Sprangers MAG. A ‘short walk’ is longer before radiotherapy than afterwards: A qualitative study questioning the baseline and follow-up design. Health and Quality of Life Outcomes. 2010;8:69. doi: 10.1186/1477-7525-8-69. - DOI - PMC - PubMed

[2] Taminiau-Bloem EF, van Zuuren FJ, Koeneman MA, Rapkin BD, Visser MRM, Koning CCE, Sprangers MAG. A ‘short walk’ is longer before radiotherapy than afterwards: A qualitative study questioning the baseline and follow-up design. Health and Quality of Life Outcomes. 2010;8:69. doi: 10.1186/1477-7525-8-69. - DOI - PMC - PubMed

[3] Morak MJ, Pek CJ, Kompanje EJ, Hop WC, Kazemier G, van Eijck CH. Quality of life after adjuvant intra-arterial chemotherapy and radiotherapy versus surgery alone in resectable pancreatic and periampullary cancer: A prospective randomized controlled study. Cancer. 2010;116(4):830–836. doi: 10.1002/cncr.24809. - DOI - PubMed

[4] Morak MJ, Pek CJ, Kompanje EJ, Hop WC, Kazemier G, van Eijck CH. Quality of life after adjuvant intra-arterial chemotherapy and radiotherapy versus surgery alone in resectable pancreatic and periampullary cancer: A prospective randomized controlled study. Cancer. 2010;116(4):830–836. doi: 10.1002/cncr.24809. - DOI - PubMed

[5] Komblith AB, Huang HQ, Walker JL, Spirtos NM, Rotmensch J, Cella D. Quality of life of patients with endometrial cancer undergoing laparoscopic international federation of gynecology and obstetrics staging compared with laparotomy: A Gynecologic Oncology Group study. Journal of Clinical Oncology. 2009;27(32):5337–5342. doi: 10.1200/JCO.2009.22.3529. - DOI - PMC - PubMed

[6] Komblith AB, Huang HQ, Walker JL, Spirtos NM, Rotmensch J, Cella D. Quality of life of patients with endometrial cancer undergoing laparoscopic international federation of gynecology and obstetrics staging compared with laparotomy: A Gynecologic Oncology Group study. Journal of Clinical Oncology. 2009;27(32):5337–5342. doi: 10.1200/JCO.2009.22.3529. - DOI - PMC - PubMed

[7] Groenvold M, Fayers PM, Petersen MA, Mouridsen HT. Chemotherapy versus ovarian ablation as adjuvant therapy for breast cancer: Impact on health-related quality of life in a randomized trial. Breast Cancer Research. 2006;98(3):275–284. doi: 10.1007/s10549-006-9160-9. - DOI - PubMed

[8] Groenvold M, Fayers PM, Petersen MA, Mouridsen HT. Chemotherapy versus ovarian ablation as adjuvant therapy for breast cancer: Impact on health-related quality of life in a randomized trial. Breast Cancer Research. 2006;98(3):275–284. doi: 10.1007/s10549-006-9160-9. - DOI - PubMed

[9] Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G, for the Clinical Outcomes of Surgical Therapy (COST) Study Group Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer. JAMA. 2003;287(3):321–328. doi: 10.1001/jama.287.3.321. - DOI - PubMed

[10] Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G, for the Clinical Outcomes of Surgical Therapy (COST) Study Group Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer. JAMA. 2003;287(3):321–328. doi: 10.1001/jama.287.3.321. - DOI - PubMed

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Using a retrospective pretest instead of a conventional pretest is replacing biases: a qualitative study of cognitive processes underlying responses to thentest items

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Using a retrospective pretest instead of a conventional pretest is replacing biases: a qualitative study of cognitive processes underlying responses to thentest items

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Abstract

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