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Quality of Life Research

, Volume 17, Issue 4, pp 549–558

First Online: 04 April 2008Received: 06 July 2007Accepted: 13 March 2008


BackgroundQuality of life QoL is considered to be an indispensable outcome measure of curative and palliative treatment. However, QoL research often yields findings that raise questions about what QoL measurement instruments actually assess and how the scores should be interpreted.

ObjectiveTo investigate how patients interpret and respond to questions on the EORTC-QLQ-C30 over time and to find explanations to account for counterintuitive findings in QoL measurement.

MethodsQualitative investigation was made of the response behaviour of small-cell lung cancer patients n = 23 in the measurement of QoL with the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire EORTC QLQ-C30. Focus was on physical functioning PF, items 1 to 5, role functioning RF, items 6 and 7, global health and QoL rating GH-QOL, items 29 and 30. Interviews were held at four points: at the start of the chemotherapy, 4 weeks later, at the end, and 6 weeks after the end of chemotherapy. Patients were asked to ‘think aloud’ when filling in the questionnaire.

ResultsPatients used various response strategies when answering questions about problems and limitations in functioning, which impacted the accuracy of the scale. Patients had scores suggesting they were less limited than they actually were by taking the wording of questions literally, by guessing their functioning in activities that they did not perform, and by ignoring or excluding certain activities that they could not perform.

ConclusionTerminally ill patients evaluate their functioning in terms of what they perceive to be normal under the circumstances. Their answers can be interpreted in terms of change in the appraisal process Rapkin and Schwartz 2004; Health and Quality of Life Outcomes, 2, 14. More care should be taken in assessing the quality of a set of questions about physical and role functioning.

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Autor: Marjan J. Westerman - Tony Hak - Mirjam A. G. Sprangers - Harry J. M. Groen - Gerrit van der Wal - Anne-Mei The


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