The Effect of Response Shift on Quality of Life among Cancer Patients: A Systematic Review


Aims and Objectives: To scrutinize the evidence of response shift effect on published quality of life (QOL) studies investigating the patient-reported outcome to obtain accuracy data as evaluating clinical practice. Background: People may alter their internal standards, known as response shift, when they experience changes in their health status. This phenomenon can falsify patient-reported measures, and has gained increasing attention recently in explaining research paradoxical findings. Nevertheless a rigorous evidence-base about this effect on cancer patients QOL is lacking. Design: A systematic review was carried out under adhered to the guideline of the Quality of Reporting of Meta-Analyses. Methods: A comprehensive search was conducted on seven English and Chinese databases to identify and collect studies focus on cancer patients QOL. Methodological quality assessment was performed to assess the strength of evidence. Results: Using pre-determined keywords, 584 relevant titles were identified. Eventually 14 papers satisfied the inclusion criteria and entered the quality assessment stage. All the articles were written in English and published between 1996 and 2013. A majority of the studies used the then-test method, which is also known as the retrospective pretest-posttest design method. The weighted mean effect size (WMES) was 0.47 (95% CI 0.31 to 0.63). Using data from the six studies for assessing then-test/pre-test comparison on the outcome measure fatigue, the WMES was -0.21 (95% CI -0.32 to -0.10). Conclusion: The alternation of self-internal standard occurs when cancer patients evaluated their QOL over a period of time. Relevance to clinical practice: This review emphasizes the need for a more sensitive approach to inspect the clinical impact of response shift by measuring changes in QOL. Patients’ adaptation to the disease can then be more precisely acquired.

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Chao, L. , Fan, J. , Chung, F. and Lam, H. (2014) The Effect of Response Shift on Quality of Life among Cancer Patients: A Systematic Review. Open Access Library Journal, 1, 1-13. doi: 10.4236/oalib.1101099.

Conflicts of Interest

The authors declare no conflicts of interest.


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