title: Exploring the response shift phenomenon in childhood patients with cancer and its effect on health-related quality of life.
abstract: OBJECTIVE
  To explore the response shift phenomenon in pediatric patients with cancer and to determine its effects on ratings of health-related quality of life (HRQOL).
  
  
  METHODS
  Retrospective pre- and post-test design.
  
  
  METHODS
  Pediatric oncology department in the northern part of the Netherlands.
  
  
  METHODS
  37 children newly diagnosed with cancer and 80 parents.
  
  
  METHODS
  The then-test method was used to determine response shift. HRQOL was assessed within two weeks postdiagnosis (pretest) and three months later (post-test) using both child and parent reports of PedsQL and Cantril's ladder. The post-test and then-test were administered concurrently.
  
  
  METHODS
  Overall and multidimensional HRQOL.
  
  
  RESULTS
  Scores on Cantril's then-test were lower than the pretest in both child and parent reports, indicating response shift in the assessment of overall HRQOL. Children experienced a greater response shift than parents. No differences were found between the PedsQL then- and pretests.
  
  
  CONCLUSIONS
  Both child- and parent-report ratings of overall HRQOL were affected by response shift, resulting in an underestimation of the improvement in overall HRQOL between diagnosis and three months postdiagnosis. No response shift was demonstrated in the more specific domains of HRQOL (PedsQL).
  
  
  CONCLUSIONS
  Knowledge of the response shift phenomenon helps nurses to better interpret the outcomes of HRQOL. The use of the PedsQL instrument is recommended in future studies that aim to demonstrate changes in HRQOL.
authors.affiliation: School of Nursing and Health, Department of Pediatric Oncology and Hematology, Beatrix Children's Hospital in Groningen.
authors.forename: Aeltsje
authors.initials: A
authors.lastname: Brinksma
authors.affiliation: School of Nursing and Health, Department of Pediatric Oncology and Hematology, Beatrix Children's Hospital in Groningen.
authors.forename: Wim J E
authors.initials: WJ
authors.lastname: Tissing
authors.affiliation: School of Nursing and Health, Department of Pediatric Oncology and Hematology, Beatrix Children's Hospital in Groningen.
authors.forename: Esther
authors.initials: E
authors.lastname: Sulkers
authors.affiliation: School of Nursing and Health, Department of Pediatric Oncology and Hematology, Beatrix Children's Hospital in Groningen.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Kamps
authors.affiliation: School of Nursing and Health, University of Groningen, the Netherlands.
authors.forename: Petrie F
authors.initials: PF
authors.lastname: Roodbol
authors.affiliation: School of Nursing and Health, University Medical Center Groningen, the Netherlands.
authors.forename: Robbert
authors.initials: R
authors.lastname: Sanderman
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000451:nursing / Q000523:psychology*; D009426:Netherlands; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology; D010361:Patients / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D015983:Selection Bias; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D013997:Time Factors; D064232:Visual Analog Scale
keywords: adolescent; cancer; child; parents; quality of life; self-report