Quality of Life Research

, Volume 19, Issue 4, pp 465–471 | Cite as

Abandoning the language of “response shift”: a plea for conceptual clarity in distinguishing scale recalibration from true changes in quality of life

  • Peter A. Ubel
  • Yvette Peeters
  • Dylan Smith


Quality of life researchers have been studying “response shift” for a decade now, in an effort to clarify how best to measure QoL over time and across changing circumstances. However, we contend that this line of research has been impeded by conceptual confusion created by the term “response shift”, that lumps together sources of measurement error (e.g., scale recalibration) with true causes of changing QoL (e.g., hedonic adaptation). We propose abandoning the term response shift, in favor of less ambiguous terms, like scale recalibration and adaptation.


Response shift Hedonic adaptation Scale recalibration Validity 



Dr. Ubel is supported by a Robert Wood Johnson Health Policy Investigators Award.


  1. 1.
    Schwartz, C. E., & Sprangers, M. A. (1999). Introduction to symposium on the challenge of response shift in social science and medicine. Social Science and Medicine, 48, 1505–1507.CrossRefGoogle Scholar
  2. 2.
    Sprangers, M. A., & Schwartz, C. E. (1999). Integrating response shift into health-related quality of life research: A theoretical model. Social Science and Medicine, 48(11), 1507–1515.CrossRefPubMedGoogle Scholar
  3. 3.
    Gibbons, F. X. (1999). Social comparison as a mediator of response shift. Social Science and Medicine, 48(11), 1517–1530.CrossRefPubMedGoogle Scholar
  4. 4.
    Schwartz, C. E., & Sprangers, M. A. (1999). Methodological approaches for assessing response shift in longitudinal health-related quality-of-life research. Social Science and Medicine, 48(11), 1531–1548.CrossRefPubMedGoogle Scholar
  5. 5.
    Daltroy, L., Larson, M., Eaton, H., Phillips, C., & Liang, M. (1999). Discrepancies between self-reported and observed physical function in the elderly: The influence of response shift and other factors. Social Science and Medicine, 48, 1549–1561.CrossRefPubMedGoogle Scholar
  6. 6.
    Schwartz, C., & Sendor, R. (1999). Helping others helps oneself: Response shift effects in peer support. Social Science and Medicine, 48, 1563–1575.CrossRefPubMedGoogle Scholar
  7. 7.
    Wilson, I. B. (1999). Clinical understanding and clinical implications of response shift. Social Science and Medicine, 48(11), 1577–1588.CrossRefPubMedGoogle Scholar
  8. 8.
    Schwartz, C., Bode, R., Repucci, N., Becker, J., Sprangers, M., & Fayers, P. (2006). The clinical significance of adaptation to changing health: A meta-analysis of response shift. Quality of Life Research, 15, 1533–1550.CrossRefPubMedGoogle Scholar
  9. 9.
    Albrecht, G. L., & Devlieger, P. J. (1999). The disability paradox: High quality of life against all odds. Social Science and Medicine, 48(8), 977–988.CrossRefPubMedGoogle Scholar
  10. 10.
    Ubel, P. A., Loewenstein, G., & Jepson, C. (2003). Whose quality of life? A commentary exploring discrepancies between health state evaluations of patients and the general public. Quality of Life Research, 12(6), 599–607.CrossRefPubMedGoogle Scholar
  11. 11.
    Ekman, P. (2003). Emotions revealed: Recognizing faces and feelings to improve communication and emotional life. New York: Times Books.Google Scholar
  12. 12.
    Ubel, P. A. (2006). You’re stronger than you think: Tapping into the secrets of emotionally resilient people. New York: McGraw-Hill.Google Scholar
  13. 13.
    Ubel, P. A., Jankovic, A., Smith, D., Langa, K. M., & Fagerlin, A. (2005). What is perfect health to an 85-year-old?: Evidence for scale recalibration in subjective health ratings. Medical Care, 43(10), 1054–1057.CrossRefPubMedGoogle Scholar
  14. 14.
    Brunstein, J. C. (1993). Personal goals and subjective well-being: A longitudinal study. Journal of Personality and Social Psychology, 65(5), 1061–1070.CrossRefGoogle Scholar
  15. 15.
    Lepore, S. J., & Eton, D. T. (2000). Response shifts in prostate cancer patients: An evaluation of suppressor and buffer modes. In C. E. Schwartz & M. A. Sprangers (Eds.), Adaptation to changing health: Response shift in quality-of-life research (1st ed., pp. 37–51). Washington, D.C.: American Psychological Association.Google Scholar
  16. 16.
    Kahneman, D., Wakker, P. P., & Sarin, R. (1997). Back to Bentham? Explorations of experienced utility. The Quarterly Journal of Economics, 112(2), 375–405.CrossRefGoogle Scholar
  17. 17.
    Loewenstein, G., & Ubel, P. (2008). Hedonic adaptation and the role of decision and experience utility in public policy. Journal of Public Economics, 92(8–9), 1795–1810.CrossRefGoogle Scholar
  18. 18.
    Brossart, D., Clay, D., & Willson, V. (2002). Methodological and statistical considerations for threats to internal validity in pediatric outcome data: Response shift in self-report outcomes. Journal of Pediatric Psychology, 27(1), 97–107.CrossRefPubMedGoogle Scholar
  19. 19.
    Schwartz, C., Sprangers, M., Carey, A., & Reed, G. (2004). Exploring response shift in longitudinal data. Psychology & Health, 19(1), 51–69.CrossRefGoogle Scholar
  20. 20.
    Norman, G. (2003). Hi! How are you? Response shift, implicit theories and differing epistemologies. Quality of Life Research, 12, 239–249.CrossRefPubMedGoogle Scholar
  21. 21.
    Ross, M. (1989). Relation of implicit theories to the construction of personal histories. Psychological Review, 96(2), 341–357.CrossRefGoogle Scholar
  22. 22.
    Lacey, H. P., Smith, D. M., & Ubel, P. A. (2006). Hope I die before I get old: Mispredicting happiness across the lifespan. Journal of Happiness Studies, 7(2), 167–182.CrossRefGoogle Scholar
  23. 23.
    Smith, D., Loewenstein, G., Jankovich, S., Jepson, C., Feldman, H., & Ubel, P. (2008). Mispredicting and misremembering: patients with renal failure overestimate improvements in quality of life after a kidney transplant. Health Psychology, 27(5), 653–658.CrossRefPubMedGoogle Scholar
  24. 24.
    Frederick, S., & Loewenstein, G. (1999). Hedonic adaptation. In D. Kahneman, E. Diener, & N. Schwarz (Eds.), Well-being: The foundations of hedonic psychology. New York: Russell Sage Foundation Press.Google Scholar
  25. 25.
    Smith, D., Schwarz, N., Roberts, T., & Ubel, P. (2006). Why are you calling me? How survey introductions change response patterns. Quality of Life Research, 15, 621–630.CrossRefPubMedGoogle Scholar

Copyright information

© US Government 2010

Authors and Affiliations

  • Peter A. Ubel
    • 1
    • 2
    • 3
  • Yvette Peeters
    • 1
    • 4
  • Dylan Smith
    • 1
    • 3
  1. 1.Center for Behavioral and Decision Sciences in MedicineUniversity of MichiganAnn ArborUSA
  2. 2.Department of PsychologyUniversity of MichiganAnn ArborUSA
  3. 3.VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare SystemAnn ArborUSA
  4. 4.Department of Medical Decision MakingLeiden University Medical CentreLeidenThe Netherlands

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