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Quality of Life Research

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01-03-2019 | Commentary

Interpretation and use of patient-reported outcome measures through a philosophical lens

Authors: Jae Yung Kwon, Sally Thorne, Richard Sawatzky

Published in: Quality of Life Research | Issue 3/2019

Abstract

Purpose

As patient-reported outcome measures (PROMs) increasingly become key outcome indicators in health care, there has been growing concern about the potential negative consequences that could result when interpretations are being made to inform clinical and policy decisions. Therefore, we explored theoretical issues, assumptions, and consequences of using PROMs from a philosophical point of view.

Methods

Our analysis of the literature was informed by Gadamerian hermeneutics, which emphasizes the dialectical processes that occur during interpretation, to provide insights as to how different users interpret and use standardized questions about health and quality of life.

Results

We structured our consideration according to three tenets of using PROMs: (1) the use of PROMs involves the interpretation of contextual elements; (2) interpretation of PROMs is an ongoing dialectical interaction; and (3) the use of PROMs involves openness and reflexivity. These findings suggest that hermeneutics provides a useful approach to examining the complexities of measuring patient-reported outcomes by attending to the perspectives of different users (e.g., patients, clinicians, administrators, and policy-makers) at the micro-, meso-, and macro-levels and the broader socio-historical and economic situation.

Conclusion

Because PROMs can have different meanings and are used for different purposes, we propose that hermeneutics be used as a lens to ask reflexive questions about the problems of measurement and open a pluralistic dialogue with respect to the way we use PROMs and the interpretations we make of the findings that derive from our studies.

Messick, S. (1989). Validity. In R. Linn (Ed.), Educational measurement (3rd ed., pp. 13–103). Washington (DC): American Council on Education.

Sawatzky, R., Chan, E. K. H., Zumbo, B. D., Ahmed, S., Bartlett, S. J., Bingham, C. O., … Lix, L. M. (2017). Montreal accord on patient-reported outcomes (PROs) use series-paper 7: Modern perspectives of measurement validation emphasize justification of inferences based on patient reported outcome scores. Journal of Clinical Epidemiology, 89, 154–159. https://doi.org/10.1016/j.jclinepi.2016.12.002.CrossRefPubMed

Greenhalgh, J., Dalkin, S., Gibbons, E., Wright, J., Valderas, J. M., Meads, D., & Black, N. (2018). How do aggregated patient-reported outcome measures data stimulate health care improvement? A realist synthesis. Journal of Health Services Research & Policy, 23(1), 57–65. https://doi.org/10.1177/1355819617740925.CrossRef

Laverty, S. M. (2003). Hermeneutic phenomenology and phenomenology: A comparison of historical and methodological considerations. International Journal of Qualitative Methods, 2(3), 21–35. https://doi.org/10.1177/160940690300200303.CrossRef

Schwandt, T. A. (1994). Constructivist, interpretivist approaches to human inquiry. In Handbook of qualitative research (pp. 118–137). Thousand Oaks: Sage

Debesay, J., Nåden, D., & Slettebø, A. (2008). How do we close the hermeneutic circle? A Gadamerian approach to justification in interpretation in qualitative studies. Nursing Inquiry, 15(1), 57–66. https://doi.org/10.1111/j.1440-1800.2008.00390.x.CrossRefPubMed

Austgard, K. (2012). Doing it the Gadamerian way—Using philosophical hermeneutics as a methodological approach in nursing science. Scandinavian Journal of Caring Sciences, 26(4), 829–834. https://doi.org/10.1111/j.1471-6712.2012.00993.x.CrossRefPubMed

Gadamer, H. G. (1998). Truth and method (2nd ed.). New York: Continuum.

Lix, L. M., Wu, X., Hopman, W., Mayo, N., Sajobi, T. T., Liu, J., … Sawatzky, R. (2016). Differential item functioning in the SF-36 physical functioning and mental health sub-scales: A population-based investigation in the Canadian Multicentre Osteoporosis study. PLoS ONE, 11(3), e0151519. https://doi.org/10.1371/journal.pone.0151519.CrossRefPubMedPubMedCentral

10.

Krawczyk, M., Sawatzky, R., Schick-Makaroff, K., Stajduhar, K., Öhlen, J., Reimer-Kirkham, S., … Cohen, R. (2018). Micro-meso-macro practice tensions in using patient-reported outcome and experience measures in hospital palliative care. Qualitative Health Research. https://doi.org/10.1177/1049732318761366.PubMedCrossRef

11.

Sutherland, H. J., & Till, J. E. (1993). Quality of life assessments and levels of decision making: differentiating objectives. Quality of Life Research, 2(4), 297–303. https://doi.org/10.1007/BF00434801.CrossRefPubMed

12.

Wolpert, M. (2014). Uses and abuses of patient reported outcome measures (PROMs): Potential iatrogenic impact of proms implementation and how it can be mitigated. Administration and Policy in Mental Health, 41(2), 141–145. https://doi.org/10.1007/s10488-013-0509-1.CrossRefPubMed

13.

Sawatzky, R., Sajobi, T. T., Brahmbhatt, R., Chan, E. K. H., Lix, L. M., & Zumbo, B. D. (2017). Longitudinal change in response processes: a response shift perspective. In Understanding and Investigating Response Processes in Validation Research (pp. 251–276). Cham: Springer. https://doi.org/10.1007/978-3-319-56129-5_14.CrossRef

14.

Sprangers, M. A., & Schwartz, C. E. (1999). Integrating response shift into health-related quality of life research: A theoretical model. Social Science & Medicine (1982), 48(11), 1507–1515.CrossRef

15.

Ring, L., Höfer, S., Heuston, F., Harris, D., & O’Boyle, C. A. (2005). Response shift masks the treatment impact on patient reported outcomes (PROs): The example of individual quality of life in edentulous patients. Health and Quality of Life Outcomes, 3(1), 55. https://doi.org/10.1186/1477-7525-3-55.CrossRefPubMedPubMedCentral

16.

Ahmed, S., & Ring, L. (2008). Influence of response shift on evaluations of change in patient-reported outcomes. Expert Review of Pharmacoeconomics & Outcomes Research; London, 8(5), 479–489. https://doi.org/10.1586/14737167.8.5.479.CrossRef

17.

Albrecht, G. L., & Devlieger, P. J. (1999). The disability paradox: High quality of life against all odds. Social Science & Medicine (1982), 48(8), 977–988.CrossRef

18.

McClimans, L., Bickenbach, J., Westerman, M., Carlson, L., Wasserman, D., & Schwartz, C. (2013). Philosophical perspectives on response shift. Quality of Life Research, 22(7), 1871–1878. https://doi.org/10.1007/s11136-012-0300-x.CrossRefPubMed

19.

Padilla, J.-L., & Benítez, I. (2017). A rationale for and demonstration of the use of dif and mixed methods. In B. D. Zumbo & A. M. Hubley (Eds.), Understanding and investigating response processes in validation research (pp. 193–209). Cham: Springer. https://doi.org/10.1007/978-3-319-56129-5_11.CrossRef

20.

Yagata, K. (2018). Bildung as an essential disposition in becoming a reflective practitioner: Practical application of philosophical hermeneutics to second language teacher education. Reflective Practice, 19(3), 322–332. https://doi.org/10.1080/14623943.2018.1437409.CrossRef

21.

Saver, B. G., Martin, S. A., Adler, R. N., Candib, L. M., Deligiannidis, K. E., Golding, J., … Topolski, S. (2015). Care that matters: Quality measurement and health care. PLoS Medicine. https://doi.org/10.1371/journal.pmed.1001902.PubMedPubMedCentralCrossRef

22.

Weldring, T., & Smith, S. M. S. (2013). Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs). Health Services Insights, 6, 61–68. https://doi.org/10.4137/HSI.S11093.CrossRefPubMedPubMedCentral

23.

McClimans, L. (2011). Interpretability, validity, and the minimum important difference. Theoretical Medicine and Bioethics, 32(6), 389–401. https://doi.org/10.1007/s11017-011-9186-9.CrossRefPubMed

24.

Krawczyk, M., & Sawatzky, R. (2018). Relational use of an electronic quality of life and practice support system in hospital palliative consult care: A pilot study. Palliative & Supportive Care, https://doi.org/10.1017/S1478951518000020.CrossRef

25.

Haywood, K., Marshall, S., & Fitzpatrick, R. (2006). Patient participation in the consultation process: A structured review of intervention strategies. Patient Education and Counseling, 63(1–2), 12–23. https://doi.org/10.1016/j.pec.2005.10.005.CrossRefPubMed

26.

McClimans, L. (2013). The role of measurement in establishing evidence. Journal of Medicine and Philosophy, 38(5), 520–538.CrossRefPubMed

27.

American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (2014). Standards for educational and psychological testing. Washington, DC: American Educational Research Association. Retrieved from http://www.apa.org/science/programs/testing/standards.aspx.

28.

DeLuca, C. (2011). Interpretive validity theory: Mapping a methodology for validating educational assessments. Educational Research, 53(3), 303–320. https://doi.org/10.1080/00131881.2011.598659.CrossRef

29.

Moss, P. A. (2005). The role of consequences in validity theory. Educational Measurement: Issues and Practice, 17(2), 6–12. https://doi.org/10.1111/j.1745-3992.1998.tb00826.x.CrossRef

30.

Hawkins, M., Elsworth, G. R., & Osborne, R. H. (2018). Application of validity theory and methodology to patient-reported outcome measures (PROMs): Building an argument for validity. Quality of Life Research, 27(7), 1695–1710. https://doi.org/10.1007/s11136-018-1815-6.CrossRefPubMedPubMedCentral

31.

Kane, M. (2013). The argument-based approach to validation. School Psychology Review, 42(4), 448–457.

32.

Dostal, R. (2010). The science of philology and the discipline of hermeneutics: Gadamer’s understanding. Internationales Jahrbuch für Hermeneutik, 53–62.

Title: Interpretation and use of patient-reported outcome measures through a philosophical lens
Authors: Jae Yung Kwon
Sally Thorne
Richard Sawatzky
Publication date: 01-03-2019
Publisher: Springer International Publishing
Published in: Quality of Life Research / Issue 3/2019
Print ISSN: 0962-9343
Electronic ISSN: 1573-2649
DOI: https://doi.org/10.1007/s11136-018-2051-9

At a glance: The STEP trials

Springer Medicine

Interpretation and use of patient-reported outcome measures through a philosophical lens

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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