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Health and Quality of Life Outcomes BioMed Central Review Open Access Reconsidering the psychometrics of quality of life assessment in light of response shift and appraisal Carolyn E Schwartz*1,2,3,4 and Bruce D Rapkin5 Address: 1QualityMetric Incorporated, Waltham, MA, USA, 2Health Assessment Lab, Waltham, MA, USA, 3Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA, 4DeltaQuest Foundation, Inc., Concord, MA, USA and 5Department of Psychiatry and the Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA Email: Carolyn E Schwartz* - carolyn.schwartz@deltaquest.org; Bruce D Rapkin - rapkinb@mskcc.org * Corresponding author Published: 23 March 2004 Health and Quality of. | BioMed Central Health and Quality of Life Outcomes Review Open Access Reconsidering the psychometrics of quality of life assessment in light of response shift and appraisal Carolyn E Schwartz 1 2 3 4 and Bruce D Rapkin5 Address 1QualityMetric Incorporated Waltham MA USA 2Health Assessment Lab Waltham MA USA 3Division of Preventive and Behavioral Medicine Department of Medicine University of Massachusetts Medical School Worcester MA USA 4DeltaQuest Foundation Inc. Concord MA USA and 5Department of Psychiatry and the Behavioral Sciences Memorial Sloan Kettering Cancer Center New York NY USA Email Carolyn E Schwartz - carolyn.schwartz@deltaquest.org Bruce D Rapkin - rapkinb@mskcc.org Corresponding author Published 23 March 2004 Received 21 July 2003 Accepted 23 March 2004 Health and Quality of Life Outcomes 2004 2 16 r This article is available from http www.hqlo.cOm content 2 1 16 2004 Schwartz and Rapkin licensee BioMed Central Ltd. This is an Open Access article verbatim copying and redistribution of this article are permitted in all media for any purpose provided this notice is preserved along with the article s original URL. Abstract The increasing evidence for response shift phenomena in quality of life QOL assessment points to the necessity to reconsider both the measurement model and the application of psychometric analyses. The proposed psychometric model posits that the QOL true score is always contingent upon parameters of the appraisal process. This new model calls into question existing methods for establishing the reliability and validity of QOL assessment tools and suggests several new approaches for describing the psychometric properties of these scales. Recommendations for integrating the assessment of appraisal into QOL research and clinical practice are discussed. Studies examining response shift phenomena suggest that underlying processes of appraisal differ across people and over time and can greatly affect how people answer questions on QOL .
