title: Philosophical perspectives on response shift.
abstract: OBJECTIVE
  This paper brings a philosophical perspective to response shift research with the aim of raising new critical questions, clarifying some of the concepts employed, and providing a philosophical context within which to critically examine the assumptions that shape the field.
  
  
  METHODS
  This critical analysis aims to reveal assumptions and clarify concepts and/or definitions that undergird methodological practice and theory.
  
  
  RESULTS
  We bring attention to the distinction of weak and strong evaluations, and the implications and consequences for construct validity and for designing patient-reported outcome measures (PROMs). We then consider the epistemology of PROMs, suggesting that they are better suited to a social constructivist approach than a scientific realist one. Finally, we examine the relationship between disability and response shift, arguing that in at least some cases, response shifts should not be understood as 'measurement bias'.
  
  
  CONCLUSIONS
  Our analysis reveals various concerns and further questions related to the role that substantive values play in the assessment of QoL. It also draws response shift into a wider arena, with broader issues of interpretation, self-evaluation, the meaning of the 'good life', and the status and legitimacy we accord to various scientific methods.
authors.affiliation: Department of Philosophy, University of South Carolina, Columbia, SC 29208, USA. mccliman@mailbox.sc.edu
authors.forename: Leah
authors.initials: L
authors.lastname: McClimans
authors.forename: Jerome
authors.initials: J
authors.lastname: Bickenbach
authors.forename: Marjan
authors.initials: M
authors.lastname: Westerman
authors.forename: Licia
authors.initials: L
authors.lastname: Carlson
authors.forename: David
authors.initials: D
authors.lastname: Wasserman
authors.forename: Carolyn
authors.initials: C
authors.lastname: Schwartz
mesh_terms: D000223:Adaptation, Psychological; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology; D006801:Humans; D019359:Knowledge; D017063:Outcome Assessment, Health Care; D010684:Philosophy; D011788:Quality of Life; D057566:Self Report