Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Cologne, Germany.
Department of Internal Medicine, Section: Clinical Psycho-Oncology, Working Group Psycho-Oncological Health Services Research, University Hospital of Cologne, Cologne, Germany.
Int J Methods Psychiatr Res. 2020 Jun;29(2):e1821. doi: 10.1002/mpr.1821. Epub 2020 Feb 23.
Considering the heterogeneity of cancer entities and the associated disease progression, personalized care of patients is increasingly emphasized in psycho-oncology. This individualization makes the use of measurements of individual clinically significant change important when studying the efficacy and effectiveness of psycho-oncological care. Two conceptualizations for the measurement of clinical significance are critically contrasted in this study: the Reliable Change Index (RCI) and the Minimal Important Difference (MID) method.
In total, 2,121 cancer patients participated in the study and a subsample of 708 patients was reassessed about 4 months later. Psychological distress was measured using the Hospital Anxiety and Depression Scale. We evaluated two measures of clinical significance (RCI, MID) by comparing the respective numbers of improved, unimproved, and deteriorated patients.
Individually significant changes were observed with both methods; however, determined rates of improvement differed substantially: MID (66.67%) and RCI (48.23%). Most importantly, according to MID, 17.93% of patients were identified as being improved, although their respective improvements were not statistically significant and thus unreliable.
The benefits of RCI outweigh MID, and therefore, the RCI is recommended as a measure to assess change.
考虑到癌症实体的异质性和相关疾病进展，心理肿瘤学越来越强调患者的个性化护理。这种个体化使得在研究心理肿瘤学护理的疗效和有效性时，测量个体临床显著变化变得尤为重要。本研究批判性地对比了两种临床意义测量的概念化：可靠变化指数（RCI）和最小有意义差异（MID）方法。
共有 2121 名癌症患者参与了这项研究，其中 708 名患者的亚组在大约 4 个月后再次接受评估。使用医院焦虑和抑郁量表测量心理困扰。我们通过比较各自改善、未改善和恶化的患者数量来评估两种临床意义的测量（RCI、MID）。
两种方法都观察到了个体显著的变化；然而，改善的确定率有很大差异：MID（66.67%）和 RCI（48.23%）。最重要的是，根据 MID，有 17.93%的患者被认为是改善的，尽管他们的各自改善没有统计学意义，因此不可靠。
RCI 的优势超过 MID，因此建议将 RCI 作为评估变化的测量方法。
