Abstract
BackgroundIn methodological studies and outcomes research, questionnaires often comprise several health-related quality of life (HRQoL) measures. Previous psychological studies have suggested that changing the sequential order of measurement scales within a questionnaire could alter the pattern of responses. Yet, information on the presence or absence of order effects on the assessment of HRQoL in cancer patients is limited.MethodsAn incomplete block design was used in this study of 1277 cancer patients. Each patient filled out a questionnaire package that contained two of the three major cancer-specific HRQoL instruments, namely the Functional Assessment of Cancer Therapy – General, the European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire and the Functional Living Index – Cancer. Within a questionnaire package the sequential order of the instruments contained were randomised. Measurement properties of the instruments, including the number of missing values, mean HRQoL scores, known-groups validity and internal consistency were compared between samples of different presentation orders.ResultsNo effect of presentation order on the four properties aforementioned was found.ConclusionPresentation order is unlikely to alter the responses to these HRQoL instruments administered in cancer patients when any two of them are used together.
Highlights
In methodological studies and outcomes research, questionnaires often comprise several health-related quality of life (HRQoL) measures
A recent experimental study of 190 cancer patients suggested that the Functional Assessment of Cancer Therapy – General (FACT-G) and Quick-FLIC were free from such effects [11]
In the present study of a substantially larger sample, we examined three HRQoL instruments commonly used in cancer research
Summary
In methodological studies and outcomes research, questionnaires often comprise several health-related quality of life (HRQoL) measures. Previous psychological studies have suggested that changing the sequential order of measurement scales within a questionnaire could alter the pattern of responses. There has been limited information in the area of quality of life research to confirm if the presentation ordering of composite measurement scales within a questionnaire would alter the results. Respondents may experience fatigue or lose concentration towards the end of a questionnaire and as a result, the probability of misinterpretation and omission of items may increase. According to this view, the strength of order effects is related to the length of the questionnaire. Respondents may produce different patterns of responses as the previous questionnaires desensitise or familiarize them with a topic
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