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Advancing quality-of-life research by deepening our understanding of response shift: a unifying theory of appraisal

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Abstract

Studies of response-shift phenomena in quality-of-life (QOL) research have grown steadily in the more than two decades of research. As a field, we have been calling a lot of different approaches “response shift” over the years, but the only approach that fully embodies the foundational (Sprangers and Schwartz, Soc Sci Med 48(11):1507–1515, 1999) theoretical model is appraisal. According to the definition proposed in this model, response shift is about individual cognitive change. This paper presents the argument that all response-shift research models need to be grounded in an understanding of cognitive appraisal. We present a reasoned argument for why appraisal is fundamental to QOL response-shift research. We describe current measurement and analytic methods for working with appraisal, and how these methods can be integrated into the current response-shift statistical ‘tool box.’ We propose future research directions on theory, methods, and cross-calibration of group- and individual-level methods. There are currently three tools available in multiple languages for assessing QOL appraisal processes. They have been tested and used to assess response shift in empirical studies of ~ 7000 people with chronic illness. The study findings illustrate how appraisal theory and methods can facilitate methodological investigations of and to enhance other response-shift detection methods. Future research directions are proposed to enrich QOL theory, response-shift methods, and interpretation of QOL change over time. Appraisal theory and methods are the closest approximation to a response-shift ‘gold standard.’ They provide the foundation for understanding response shift and point to a unified theory of QOL.

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Acknowledgements

The authors are grateful to the ISOQOL Response Shift Special Interest Group (SIG) for the ongoing collaborations over the past two decades that have enriched the field of response-shift research.

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Authors and Affiliations

  1. Division of Community Collaboration & Implementation Science, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Bruce D. Rapkin

  2. DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, USA

    Carolyn E. Schwartz

  3. Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA, USA

    Carolyn E. Schwartz

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  1. Bruce D. Rapkin
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Correspondence to Carolyn E. Schwartz.

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Rapkin, B.D., Schwartz, C.E. Advancing quality-of-life research by deepening our understanding of response shift: a unifying theory of appraisal. Qual Life Res 28, 2623–2630 (2019). https://doi.org/10.1007/s11136-019-02248-z

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