Department of Methodology and Statistics, Institute of Psychology, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands.
Department of Medical Psychology, Amsterdam University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Qual Life Res. 2021 May;30(5):1293-1304. doi: 10.1007/s11136-020-02742-9. Epub 2021 Feb 7.
Patient-reported outcomes (PROs) are of increasing importance for health-care evaluations. However, the interpretation of change in PROs may be obfuscated due to changes in the meaning of the self-evaluation, i.e., response shift. Structural equation modeling (SEM) is the most widely used statistical approach for the investigation of response shift. Yet, non-technical descriptions of SEM for response shift investigation are lacking. Moreover, application of SEM is not straightforward and requires sequential decision-making practices that have not received much attention in the literature.
To stimulate appropriate applications and interpretations of SEM for the investigation of response shift, the current paper aims to (1) provide an accessible description of the SEM operationalizations of change that are relevant for response shift investigation; (2) discuss practical considerations in applying SEM; and (3) provide guidelines and recommendations for researchers who want to use SEM for the investigation and interpretation of change and response shift in PROs.
Appropriate applications and interpretations of SEM for the detection of response shift will help to improve our understanding of response shift phenomena and thus change in PROs. Better understanding of patients' perceived health trajectories will ultimately help to adopt more effective treatments and thus enhance patients' wellbeing.
患者报告的结局（PROs）对于医疗保健评估越来越重要。然而，由于自我评估的含义发生变化，即反应转移，PRO 变化的解释可能会变得模糊。结构方程模型（SEM）是用于研究反应转移的最广泛使用的统计方法。然而，缺乏用于研究反应转移的 SEM 的非技术描述。此外，SEM 的应用并不简单，需要连续的决策实践，而这些实践在文献中并没有得到太多关注。
为了促进 SEM 在反应转移研究中的适当应用和解释，本文旨在（1）提供一个可访问的描述，说明与反应转移研究相关的 SEM 操作化变化；（2）讨论应用 SEM 的实际考虑因素；（3）为希望使用 SEM 研究和解释 PRO 中变化和反应转移的研究人员提供指南和建议。
适当应用和解释 SEM 以检测反应转移将有助于我们更好地理解反应转移现象，从而更好地理解 PRO 的变化。更好地了解患者感知的健康轨迹最终将有助于采用更有效的治疗方法，从而提高患者的幸福感。
