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Patient-reported outcomes are increasingly used as dependent variables in studies regarding the effectiveness of clinical interventions. But patient-reported outcome measures (PROMs) do not provide intuitively meaningful data. For instance, it is not clear what a five point increase or decrease on a particular scale signifies. Establishing ‘interpretability’ involves making changes in outcomes meaningful. Attempts to interpret PROMs have led to the development of methods for identifying a minimum important difference (MID). In this paper, however, I draw on Charles Taylor’s distinction (...) |
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The philosophy of measurement studies the conceptual, ontological, epistemic, and technological conditions that make measurement possible and reliable. A new wave of philosophical scholarship has emerged in the last decade that emphasizes the material and historical dimensions of measurement and the relationships between measurement and theoretical modeling. This essay surveys these developments and contrasts them with earlier work on the semantics of quantity terms and the representational character of measurement. The conclusions highlight four characteristics of the emerging research program in (...) |
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I examine the dynamics of measure development using two case studies: temperature, and health-related quality of life. I argue, following Bas van Fraassen and Leah McClimans that in each case these dynamics have a hermeneutic structure. Measure development is plagued by epistemic circularity, as is the task of interpreting a text, and similar strategies can be used in both measure development and hermeneutics to overcome that circularity. I show that Hans Georg Gadamer’s philosophical hermeneutics in particular are an effective lens (...) |
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This article develops a model-based account of the standardization of physical measurement, taking the contemporary standardization of time as its central case study. To standardize the measurement of a quantity, I argue, is to legislate the mode of application of a quantity concept to a collection of exemplary artefacts. Legislation involves an iterative exchange between top-down adjustments to theoretical and statistical models regulating the application of a concept, and bottom-up adjustments to material artefacts in light of remaining gaps. The model-based (...) |
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This article is a mutual introduction of the science of well-being to philosophy of science and an explanation of how the two disciplines can benefit each other. In the process, I argue that the science of well-being is not helpfully viewed as a social or a natural, but rather as a mixed, science. Hence, its methodology will have to attend to its specific features. I discuss two of its methodological problems: justifying the role of values, and validating measures. I suggest (...) |
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This article develops a model-based account of the standardization of physical measurement, taking the contemporary standardization of time as its central case-study. To standardize the measurement of a quantity, I argue, is to legislate the mode of application of a quantity-concept to a collection of exemplary artefacts. Legislation involves an iterative exchange between top-down adjustments to theoretical and statistical models regulating the application of a concept, and bottom-up adjustments to material artefacts in light of remaining gaps. The model-based account clarifies (...) |
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Machine Learning (ML) is on the rise in medicine, promising improved diagnostic, therapeutic and prognostic clinical tools. While these technological innovations are bound to transform health care, they also bring new ethical concerns to the forefront. One particularly elusive challenge regards discriminatory algorithmic judgements based on biases inherent in the training data. A common line of reasoning distinguishes between justified differential treatments that mirror true disparities between socially salient groups, and unjustified biases which do not, leading to misdiagnosis and erroneous (...) |
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Since the 1970’s epidemiological measures focusing on “health-related quality of life” or simply “quality of life” have figured increasingly as endpoints in clinical trials. Before the 1970’s these measures were known, generically, as performance measures or health status measures. Relabeled as “quality of life measures” they were first used in cancer trials. In the early 2000’s they were relabeled again as “patient-reported outcome measures” or PROMs, in their service to the FDA to support drug labeling claims. To the limited degree (...) |
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Quality improvement mechanisms increasingly use outcome measures to evaluate health care providers. This move toward outcome measures is a radical departure from the traditional focus on process measures. More radical still is the proposal to shift from relatively simple and proximal measures of outcome, such as mortality, to complex outcomes, such as quality of life. While the practical, scientific, and ethical issues associated with the use of outcomes such as mortality and morbidity to compare health care providers have been well (...) |
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Measurement outcomes are frequently used as evidence in favor of or against medical and surgical interventions, health policies, and system designs. Indeed, in the medical and health services research literature, outcomes are the currency of policy debate and decision making. Yet in the philosophy of science and philosophy of medicine, the measures used in evidence-based medicine (EBM) are rarely discussed. Rather, the focus here is almost exclusively on study design and hierarchies of evidence. This concentration on the methodology of study (...) |
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There has been much philosophical interest regarding the ‘hierarchy of evidence’ used to determine which study designs are of most value for reporting on questions of effectiveness, prognosis, and so on. There has been much less philosophical interest in the choice of outcome measures with which the results of, say, an RCT or a cohort study are presented. In this paper, we examine the FDA’s recently published guidelines for assessing the psychometric adequacy of patient-reported outcome measures. We focus on their (...) |
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Psychotherapy research is known for its pursuit of evidence-based treatment. Psychotherapeutic efficacy is assessed by calculation of aggregated differences between pre treatment- and post treatment symptom levels. As this ‘gold standard methodology’ is regarded as ‘procedurally objective’, the efficacy number that results from the procedure is taken as a valid indicator of treatment efficacy. However, I argue that the assumption of procedural objectivity is not justified, as the methodology is build upon a problematic numerical basis. I use an empirical case (...) |
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The use of quality of life (QOL) outcomes in clinical trials is increasing as a number of practical, ethical, methodological, and regulatory reasons for their use have become apparent. It is important, then, that QOL measurements and differences between QOL scores be readily interpretable. We study interpretation in two contexts: when determining QOL and when basing decisions on QOL differences. We consider both clinical situations involving individual patients and research contexts, e.g., randomized clinical trials, involving groups of patients. We note (...) |
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Engagement with the historical and theoretical underpinnings of measuring quality of life (QoL) and patient‐reported outcomes (PROs) in healthcare is important. Ideas and values that shape such practices—and in the endgame, people's lives—might otherwise remain unexamined, be taken for granted or even essentialized. Our aim is to explicate and theoretically discuss the philosophical tenets underlying the practices of QoL assessment and PRO measurement in relation to the notion of person‐centredness. First, we engage with the late‐modern history of the concept of (...) |
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The aim of this study was to explore patients’ experiences of using the Integrated Palliative care Outcome Scale (IPOS) during specialized palliative home care. The study adopted a qualitative approach with an interpretive descriptive design. Interviews were performed with 10 patients, of whom a majority were diagnosed with incurable cancer. Our findings suggest that the use of IPOS as a basis for conversation promotes safe care by making the patients feel confident that the care provided was adapted to them which (...) |
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