Survey tools for measuring patients’ perceived health and quality of life, called patient-reported outcome measures (PROMs), are increasingly used in clinical practice and decision-making. Although PROMs have proven effective in capturing the patient’s perspective, one challenge is that patients may not be consistent in how they interpret and respond to survey questions.
Dr. Rick Sawatzky’s newest research focuses on how to take into consideration the inconsistencies in patient responses, in order to provide more accurate assessment and quality care.
Dr. Rick Sawatzky’s current research focuses on how to accurately measure a patient’s health while incorporating input from the patient’s own perspective. As Professor in TWU’s School of Nursing and Canada Research Chair in Person-Centred Outcomes, his work supports healthcare professionals in delivering more holistic, person-centered care.
Listening to the patient’s assessment of their own health and wellness provides useful information for healthcare professionals beyond the data that traditional medical assessments provide.
“Traditionally, we have assigned numbers to things, such as weight and blood pressure, and used these numbers to capture differences in health between patients, or changes in health for a patient over time. But the patient’s perspectives of their health have often been overlooked,” Dr. Sawatzky explained
Tools to measure patients’ perspectives about their health are called Patient-Reported Outcome Measures or PROMs.
PROMs are like questionnaires that can be used to guide conversations people have with their healthcare providers. They provide the opportunity for a patient’s voice to be heard and recorded as part of their health assessment, alongside other medical data. The result is that the care provided focuses on what matters to the person, and is better-suited to each person’s needs.
“Traditionally, we have assigned numbers to things, such as weight and blood pressure, and used these numbers to capture differences in health between patients, or changes in health for a patient over time. But the patient’s perspectives of their health have often been overlooked.”
Listening to what matters to people
Within recent years, use of PROMs among healthcare providers has been growing. Along with increased usage comes the opportunity to evaluate and to improve how to measure those aspects of life that are important to patients.
Two key opportunities for improvement have been identified. The first is addressing how patients perceive their health differently over time, due to contextual reasons, including life experiences and developmental factors. This change in perception is known as response shift.
It is important to understand response shift, as it influences the interpretation of PROMs. As Dr. Sawatzky indicates, “Ignoring the impact of response shift can lead to errors in healthcare measurement, and subsequent care and treatment for patients.”
“Humans have factors such as emotional well-being, physical well-being, culture and more, that affect their responses to questions about their health. Sometimes, these factors can also introduce bias into the findings, or lead to false conclusions that overlook the true overall wellbeing of an individual.”
Measuring health for diverse populations
The second challenge to overcome is in addressing how diverse populations perceive health differently. This variation is called differential item functioning.
“As much as we would like to apply a one-size-fits-all questionnaire asking about people’s health, everyone is different,” said Dr. Sawatzky.
He explains that factors such as culture, experiences, personal characteristics and beliefs can affect someone’s responses to questions about their health.
In some cases, these factors can cause some groups to consistently score higher or lower on PROMs responses than others who have the same level of health. This can lead to inaccurate conclusions by caregivers and other important decision makers.
“In the end there must be a change in how we look at health, and the modes of gathering information on patients’ health, as there is no one-size-fits-all for measuring what matters."
Overcoming bias to gain more accurate measurements of health
“Humans have factors such as emotional well-being, physical well-being, culture and more, that affect their responses to questions about their health,” Dr. Sawatzky said, alluding to the challenges of response shift and differential item functioning.
“Sometimes, these factors can also introduce bias into the findings, or lead to false conclusions that overlook the true overall wellbeing of an individual,” he continued.
One example is the variation in the perceived significance and meaning of crying. Several PROMs focus on depressive symptoms and include a question about “crying”. However, proneness to crying is influenced by personal, societal, and situational factors.
As Dr. Sawatzky explains, “People may cry for many reasons besides depression, and many people with depression do not report crying when they are depressed. This can lead to under- or over-estimation of depression for some individuals, and it is just one illustrative example of how measurement biases can drive health inequities.”
“In the end there must be a change in how we look at health, and the modes of gathering information on patients’ health, as there is no one-size-fits-all for measuring what matters,” Dr. Sawatzky concluded.
“The good news is that artificial intelligence methods can be applied to achieve ‘tailored’ measurements for comparing patient reported outcomes over time and between different people."
Placing patient perspectives at the forefront of care
Accordingly, Dr. Sawatzky’s latest research focuses on meaningful interpretation and analysis of patient-reported outcomes over time, and among different populations. His work seeks to place patient perspectives on health outcomes at the forefront of care.
“The good news is that artificial intelligence methods can be applied to achieve ‘tailored’ measurements for comparing patient reported outcomes over time and between different people,” he said.
This advancement towards more tailored healthcare measurement that is adaptable to diverse populations is becoming known as “equitable people-centred health measurement”.
Developing equitable people-centred health measurement
Dr. Sawatzky joins an international team of experts for this research to develop equitable people-centred health measurement, and their work has been published this year in the multidisciplinary health sciences journal, Quality of Life Research.
The first report, “Response shift in results of patient-reported outcome measures: a commentary to The Response Shift—in Sync Working Group initiative,” sets up a framework and rationale for response shift research. The second paper, “Critical examination of current response shift methods and proposal for advancing new methods,” examines various approaches to addressing response shift, while the third paper, “ Response shift in patient-reported outcomes: definition, theory, and a revised model,” proposes a new way of understanding response shift. The fourth paper, which is in progress, will explain differences in the magnitudes of response shift effects.
The work of Dr. Sawatzky and his colleagues will help prevent potential misinterpretations of PROMs and consequent biases in healthcare decision-making. Their research informs healthcare providers at the level of caring for the individual patient, as well as supports leaders and policy makers at the organizational and societal levels.
Working alongside the research team, Ben and Madison Stenner helped to develop and produce the above educational videos. Several TWU students participated in the research project as well.
About PROMs
To learn more about measuring the patient’s perspective through Patient-Reported Outcome Measurements (PROMs), visit HealthyQOL.
About Dr. Rick Sawatzky
Richard Sawatzky, Ph.D., RN, is Professor of Nursing at Trinity Western University. As Canada Research Chair in Person-Centred Outcomes, Sawatzky has become a leader in person-centred outcomes measurement and quality of life assessments in healthcare, with a particular emphasis on people who are living with chronic life-limiting illnesses and their family caregivers. Additionally, Sawatzky is provincial lead for the Patient-Centred Measurement – Methods Clusters of the BC SUPPORT Unit. He is program lead for Patient-Reported Outcomes at CHÉOS: Centre for Health Evaluation & Outcome Sciences at UBC, as well as scientific advisor for the BC Ministry of Health Office Patient-Centred Measurement.
About TWU Nursing
TWU Nursing is recognized as a leader in faith-integrated education and is accredited by the Canadian Association of Schools of Nursing. As a student in the TWU School of Nursing, you will experience transformative education that develops your intellectual, sociocultural, emotional, physical, and spiritual self. TWU offers studies in Bachelor of Science in Nursing (BSN), Master of Science in Nursing (MSN), and a newly-launched PhD in Nursing.
About Trinity Western University
Founded in 1962, Trinity Western University is Canada’s premier Christian liberal arts university dedicated to equipping students to establish meaningful connections between career, life, and the needs of the world. It is a fully accredited research institution offering liberal arts and sciences, as well as professional schools in business, nursing, education, human kinetics, graduate studies, and arts, media, and culture. It has four campuses: Langley, Richmond-Lansdowne, Richmond-Minoru, and Ottawa. TWU emphasizes academic excellence, research, and student engagement in a vital faith community committed to forming leaders to have a transformational impact on culture. Learn more at www.twu.ca or follow us on Twitter @TrinityWestern, on Facebook and LinkedIn.
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Photo by CDC via Unsplash.