Distinguishing appraisal and personality influences on quality of life in chronic illness: introducing the quality-of-life Appraisal Profile version 2 Bruce D. Rapkin 1 • Iliana Garcia 1 • Wesley Michael 2 • Jie Zhang 3 • Carolyn E. Schwartz 3,4 Accepted: 22 May 2017 Ó Springer International Publishing Switzerland 2017 Abstract Background Cognitive appraisal of quality of life (QOL) differs across individuals in ways that explain otherwise paradoxical findings, such as similar QOL ratings among individuals in highly divergent health states. Although warranted by a growing body of evidence, routine assess- ment of appraisal in QOL research has been impeded by measurement challenges. This study describes the QOL Appraisal Profile-version 2 (QOLAPv2), a new measure that addresses these challenges. Methods A heterogeneous, on-line cohort of chronic dis- ease patients and caregivers completed the QOLAPv2, along with demographics, PROMIS10 and Brief NEO Personality Inventory (NEO-PI). Analyses address the psychometric properties and construct validity of this new measure using principal components, bivariate, canonical correlation, and linear regression analyses. Results Analysis including 4173 respondents yielded 12 second-order QOLAPv2 principal components. Appraisal components varied with age and disease duration. Appraisals involving ‘‘Wellness,’’ ‘‘Health,’’ and ‘‘Recent Challenges’’ were correlated with QOL and with NEO-PI scales of ‘‘Agreeableness’’ and ‘‘Conscientiousness.’’ Canonical cor- relation analysis revealed that QOL scales were associated with appraisals involving ‘‘Spirituality,’’ ‘‘Anticipating Decline,’’ and ‘‘Lightness of Being.’’ Appraisal dimensions of ‘‘Relationships,’’ ‘‘Maintaining Roles,’’ ‘‘Independence,’’ ‘‘Pursuing Dreams,’’ and ‘‘Lightness of Being’’ were also associated with personality scales. Appraisal measures accounted for significantly more variance in QOL than per- sonality and demographics alone. Conclusions Findings corroborate the Rapkin and Schwartz QOL appraisal theory. QOL appraisal measures correlate as expected with personality scales, and explain more variance in QOL than does personality. The QOLAPv2 can be used across populations to provide insight into patients’ concerns, salient experiences, and comparators. Keywords Appraisal Á Cognitive processes Á Quality of life Á Personality Á Patient-reported outcomes Á Rare disease Á Chronic disease Á Response shift Introduction Recent advances in the conceptualization of health have reconsidered the World Health Organization definition that underlies most quality of life (QOL) measurement, i.e., ‘‘a state of complete physical, emotional, and social well-being, and not merely the absence of disease or infirmity’’ [1]. Huber and colleagues propose that the concept of health concerns a strengthened capability to adapt and manage oneself, thereby emphasizing social and personal resources as well as physical capacity [2]. From this perspective, QOL Electronic supplementary material The online version of this article (doi:10.1007/s11136-017-1600-y) contains supplementary material, which is available to authorized users. & Carolyn E. Schwartz carolyn.schwartz@deltaquest.org 1 Division of Community Collaboration & Implementation Science, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA 2 Rare Patient Voice, LLC, Towson, MD, USA 3 DeltaQuest Foundation Inc., 31 Mitchell Road, Concord, MA 01742, USA 4 Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA, USA 123 Qual Life Res DOI 10.1007/s11136-017-1600-y