Quality of Life & Response Shift Flashcards
What is QoL?
Individuals perception of their position in life in context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.
Why measure HRQoL?
Compare to the general population
Associations between treatments received and HRQoL
Understand associations of HRQoL with demographic, medical and Psychological variables.
How do we measure QoL?
Questionnaires
Systematic reviews
Qualitative studies.
Response Shift
An important mediator of this adaptation process is ‘response shift’ which involves changing internal standards, values and the conceptualization of quality of life (QOL).
Integrating response shift into QOL research would allow a better understanding of how QOL is affected by changes in health status and would direct the development of reliable and valid measures for assessing changes in QOL.
A theoretical model is proposed to clarify and predict changes in QOL as a result of the interaction of: (a) a catalyst, referring to changes in the respondent’s health status;
(b) antecedents, pertaining to stable or dispositional characteristics of the individual (e.g. personality);
(c) mechanisms, encompassing behavioral, cognitive, or affective processes to accommodate the changes in health status (e.g. initiating social comparisons, reordering goals); and
(d) response shift, defined as changes in the meaning of one’s self-evaluation of QOL resulting from changes in internal standards, values, or conceptualization.
Response Shift: Catalyst SCT
Catalyst: SCT
Optimism – important to feel hopeful about life and positive that treatment would help, believe you can survive
Social support – physical and emotional aid, acted as distraction
Changing expectations – important to accept th at lifespan may be shorter than normal, illness incurable, cancer part of identity
Social comparisons – downward comparisons (to people who are worse off) (upsetting for some, made some accept situation), upward comparisons (gave some hope, but made some feel worse)
Avoidant coping – distracting themselves, keeping busy
Setting goals – smaller, realistic and achievable goals important
How QoL measurement in predicting effectiveness of treatment
- Existing QoL measures as reliable as most other clinical outcomes - measure of tumour size over time no more relaible than QoL measures.
2) QoL have strong prognostic value for survival
- Self related health predicts survival duration (Idler & Benvamini 1997)
- Review of 39 cancers clinical trials: Global QoL and physical functioning predictive of survival (Gotav et al 2008)
Why might patient report be a better predictor of survial than objective measures (Sprangers 2010)
QoL may highlight early perception by pateints of signs of disease progression
Reflects changes in health, life style and life circumstances (response shift)
May induce changes in physiological processes - suggestions of interventions to improve QoL to enhance survival (controversial)
What might be difficulties in assessing HRQoL? (AndryKowski et al 1993)
Different things to different people
People witrh severe chronic illness report similar QoL to those who are less severly ill/healthy controls (AndryKowski et al 1993)
Would your life still be meaningful paralysed.
Components of Response Shift (Faller et al 2016)
Reconceptualisation - Qualitative change in structure of concept of QoL, so concepts added/omitted
Reprioritization - change in the structure of QoL, some concepts (focus on social aspect)
Recalibration - change of scaling when assessing level of the concept
Testing Response Shift (Gerlich et al 2006)
402 men prostate cancer
82% had surgery
Followed up for 3 months
- Deteriorations in physical, social and cognitive functioning.
Results
Reprioritization - Physical and role functioning
Change due to both true change and reprioritization
Recalibration (aspirations reduced) Emotional functioning (overall positive Cognitive functioning (small postitive reduced negative true change
Patients may be more distressed than they reveal in self report questionnaires
Response Shift: Qualitative Study (Beeken, Eiser & Dalley 2011).
28 Survivors of HSCT
Antecedents: Optimism & Social Support
Optimism
Mechanisms Changing expectations Social comparisons Avoidant coping Setting goals
Changing standards and values
Standards: evaluate QoL in relation to low expectations (good for my age, considering the illness)
Values: family and friends became more important,
Work, money & physical appearance, tidying the house became less important
Women with breast cancer: (Tessier et al 2017)
Greater weight over time to social HRQoL (Tessier et al 2017)
Response shift useful theoretical model for assessing HRQoL
Questionnaires PvC
Generic
Enable comparison with general population
Do not assess the specific problems experienced by patients on treatment
Disease Specific
Applicable to patients on treatment
Do not enable comparison with general population
Beyond Survival: How does cancer treatment affect longer-term HRQoL?
Late effects of treatment can occur decades after treatment completion (Blaauwbroek et al 2007)
Late effects reported by survivors of childhood cancer significantly greater than number recorded on notes (Taylor et al 2010)
Important to assess as likely to compromise HRQoL if not treated.
LTH problems as a consequence of original tumour - can be physical and psychological
Predictors of poor HRQoL
Mental Health HRQoL
Non-white ethnicity
Mental and Physical HRQoL
High school education (opposed to college education)
Physical HRQoL Female sex Older current age Low household income Obesity Walking with a limp Disfigurement.
