School of Nursing, University of British Columbia, Vancouver, Canada.
School of Nursing, Trinity Western University, Langley, Canada.
Qual Life Res. 2019 Mar;28(3):629-636. doi: 10.1007/s11136-018-2051-9. Epub 2018 Nov 19.
As patient-reported outcome measures (PROMs) increasingly become key outcome indicators in health care, there has been growing concern about the potential negative consequences that could result when interpretations are being made to inform clinical and policy decisions. Therefore, we explored theoretical issues, assumptions, and consequences of using PROMs from a philosophical point of view.
Our analysis of the literature was informed by Gadamerian hermeneutics, which emphasizes the dialectical processes that occur during interpretation, to provide insights as to how different users interpret and use standardized questions about health and quality of life.
We structured our consideration according to three tenets of using PROMs: (1) the use of PROMs involves the interpretation of contextual elements; (2) interpretation of PROMs is an ongoing dialectical interaction; and (3) the use of PROMs involves openness and reflexivity. These findings suggest that hermeneutics provides a useful approach to examining the complexities of measuring patient-reported outcomes by attending to the perspectives of different users (e.g., patients, clinicians, administrators, and policy-makers) at the micro-, meso-, and macro-levels and the broader socio-historical and economic situation.
Because PROMs can have different meanings and are used for different purposes, we propose that hermeneutics be used as a lens to ask reflexive questions about the problems of measurement and open a pluralistic dialogue with respect to the way we use PROMs and the interpretations we make of the findings that derive from our studies.
随着患者报告的结果测量（PROMs）在医疗保健中越来越成为关键的结果指标，人们越来越担心在进行解释以告知临床和政策决策时可能产生的潜在负面影响。因此，我们从哲学的角度探讨了使用 PROMs 的理论问题、假设和后果。
我们的文献分析受到伽达默尔解释学的启发，该方法强调在解释过程中发生的辩证过程，以深入了解不同的用户如何解释和使用关于健康和生活质量的标准化问题。
我们根据使用 PROMs 的三个原则来组织我们的考虑：（1）使用 PROMs 涉及对上下文元素的解释；（2）对 PROMs 的解释是一个持续的辩证互动；（3）使用 PROMs 涉及开放性和反思性。这些发现表明，解释学通过关注不同用户（例如患者、临床医生、管理人员和政策制定者）在微观、中观和宏观层面以及更广泛的社会历史和经济环境中的观点，为检查测量患者报告结果的复杂性提供了一种有用的方法。
由于 PROMs 可能具有不同的含义并用于不同的目的，我们建议将解释学作为一个视角，提出关于测量问题的反思性问题，并就我们使用 PROMs 的方式以及我们对研究结果的解释展开多元化对话。
