Influence of response shift and disposition on patient-reported outcomes may lead to suboptimal medical decisions: a medical ethics perspective

• Published in: BMC medical ethics Vol. 20; no. 1; p. 61
• Main Authors: Hartog, Iris D, Willems, Dick L, van den Hout, Wilbert B, Scherer-Rath, Michael, Oreel, Tom H, Henriques, José P S, Nieuwkerk, Pythia T, van Laarhoven, Hanneke W M, Sprangers, Mirjam A G
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 11.09.2019; BioMed Central; BMC
• Subjects: Adaptation; Analysis; Bioethics; Chemotherapy; Clinical decision making; Clinical Decision-Making - ethics; Communication; Cost analysis; Cross-Sectional Studies; Cytotoxicity; Debate; Decision making; Emotions; Ethics; Ethics, Medical; Health care policy; Health insurance industry; Health policy; Humans; Influence; Insurance; Insurance companies; Medical ethics; Methods; Patient care; Patient Reported Outcome Measures; Patients; Planning; Quality of life; Quality standards; Self Report; Netherlands
• ISSN: 1472-6939; 1472-6939
• DOI: 10.1186/s12910-019-0397-3

Patient-reported outcomes (PROs) are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients' response shifts (changes in interpretation) and dispositions (stable characteristics). We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. If influences of response shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used.