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. 2021 Dec;30(12):3343-3357.
doi: 10.1007/s11136-021-02766-9. Epub 2021 Mar 2.

Implications of response shift for micro-, meso-, and macro-level healthcare decision-making using results of patient-reported outcome measures

Richard Sawatzky  1   2   3 , Jae-Yung Kwon  4   5   6 , Ruth Barclay  7 , Cynthia Chauhan  8 , Lori Frank  9 , Wilbert B van den Hout  10 , Lene Kongsgaard Nielsen  11   12 , Sandra Nolte  13   14 , Mirjam A G Sprangers  15 ; Response Shift – in Sync Working Group
Affiliations

Implications of response shift for micro-, meso-, and macro-level healthcare decision-making using results of patient-reported outcome measures

Richard Sawatzky et al. Qual Life Res. 2021 Dec.

Abstract

Purpose: Results of patient-reported outcome measures (PROMs) are increasingly used to inform healthcare decision-making. Research has shown that response shift can impact PROM results. As part of an international collaboration, our goal is to provide a framework regarding the implications of response shift at the level of patient care (micro), healthcare institute (meso), and healthcare policy (macro).

Methods: Empirical evidence of response shift that can influence patients' self-reported health and preferences provided the foundation for development of the framework. Measurement validity theory, hermeneutic philosophy, and micro-, meso-, and macro-level healthcare decision-making informed our theoretical analysis.

Results: At the micro-level, patients' self-reported health needs to be interpreted via dialogue with the clinician to avoid misinterpretation of PROM data due to response shift. It is also important to consider the potential impact of response shift on study results, when these are used to support decisions. At the meso-level, individual-level data should be examined for response shift before aggregating PROM data for decision-making related to quality improvement, performance monitoring, and accreditation. At the macro-level, critical reflection on the conceptualization of health is required to know whether response shift needs to be controlled for when PROM data are used to inform healthcare coverage.

Conclusion: Given empirical evidence of response shift, there is a critical need for guidelines and knowledge translation to avoid potential misinterpretations of PROM results and consequential biases in decision-making. Our framework with guiding questions provides a structure for developing strategies to address potential impacts of response shift at micro-, meso-, and macro-levels.

Keywords: Health policy; Healthcare decision-making; Organization; Patient; Patient-reported outcomes; Response shift.

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Conflict of interest statement

All authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Potential response shift implications for use of PROM data at micro-, meso-, and macro-levels of healthcare decision-making
See this image and copyright information in PMC

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