Response shift after coronary revascularization

Tom H Oreel,Michael Scherer-Rath,Justine E Netjes,Frans J Oort,Iris D Hartog,Alexander B A Vonk,Pythia T Nieuwkerk,José P S Henriques,Jorrit Lemkes,Mathilde G E Verdam,Hanneke W M Van Laarhoven,Mirjam A G Sprangers

doi:10.1007/s11136-021-02902-5

Abstract

PurposeThe aims of this study were to investigate (1) the extent to which response shift occurs among patients with coronary artery disease (CAD) after coronary revascularization, (2) whether the assessment of changes in health-related quality of life (HRQoL), controlled for response shift, yield more valid estimates of changes in HRQoL, as indicated by stronger associations with criterion measures of change, than without controlling for response shift, and (3) if occurrences of response shift are related to patient characteristics.MethodsPatients with CAD completed the SF-36 and the Seattle Angina Questionnaire (SAQ7) at baseline and 3 months after coronary revascularization. Sociodemographic, clinical and psychosocial variables were measured with the patient version of the New York Heart Association-class, Subjective Significance Questionnaire, Reconstruction of Life Events Questionnaire (RE-LIFE), and HEXACO personality inventory. Oort’s Structural Equation Modeling (SEM) approach was used to investigate response shift.Results191 patient completed questionnaires at baseline and at 3 months after treatment. The SF-36 showed recalibration and reprioritization response shift and the SAQ7 reconceptualization response shift. Controlling for these response shift effects did not result in more valid estimates of change. One significant association was found between reprioritization response shift and complete integration of having CAD into their life story, as indicated by the RE-LIFE.ConclusionResults indicate response shift in HRQoL following coronary revascularization. While we did not find an impact of response shift on the estimates of change, the SEM approach provides a more comprehensive insight into the different types of change in HRQoL following coronary revascularization.

Highlights

Patients with coronary artery disease (CAD) typically experience a number of symptoms, such as shortness of breath, chest pain, and fatigue, which impact their daily functioning and health-related quality of life (HRQoL) [1]
While we did not find an impact of response shift on the estimates of change, the study provides a more comprehensive insight into the different types of change in HRQoL following coronary revascularization
Such research is expected to improve the assessment of change in HRQoL and to obtain a more detailed account of that change

Summary

Introduction

Patients with coronary artery disease (CAD) typically experience a number of symptoms, such as shortness of breath, chest pain, and fatigue, which impact their daily functioning and health-related quality of life (HRQoL) [1]. The symptoms can become so severe that they require a coronary revascularization procedure to alleviate these symptoms and to improve their HRQoL [2, 3]. Such procedures typically consist of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Response shift may influence patients’ evaluations of HRQoL over time. Response shift can be defined as a change in the meaning of patients’ self-evaluation due to a change in internal standards (recalibration), a change in the relative importance of the components of HRQoL (reprioritization), and/or a change in the meaning of the target construct (reconceptualization) [8]. Changes in HRQoL are more sensitively assessed when these response shift effects are taken into account [9, 10]

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