International Journal of Innovative Research in Medical Science (IJIRMS) Volume 05, Issue 05, May 2020, https://doi.org/10.23958/ijirms/vol05-i05/880 www.ijirms.in 160 Original article Exploring the Innate Human Potential for Positive Adaptation in the Face of Impending Mortality: Is there a Response Shift in Subjective Quality of Life over Time in a Group of Patients with Lung Cancer Receiving Palliative Treatment? Dr. Eileen Mannion MD 1 , Professor JJ Gilmartin, MD 2,6 , Dr. Veronica McInerney 3 PhD , Ms Kate Molony 4 , Ms Emily Basquille 5 , Professor Dympna Waldron MD 1,6 1 Department of Palliative Medicine, Galway University Hospital, Galway, Ireland. 2 Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland. 3 HRB Clinical Research Facility and School of Nursing and Midwifery, National University of Ireland Galway, Ireland. 4 Department of Psychology, Graduate, National University of Ireland Galway, Ireland. 5 Department of Health Science, National University of Ireland Galway, Ireland. 6 Department of Medicine, National University of Ireland Galway, Ireland. *Corresponding Authors: Professor Dympna Waldron MD; dympnamwaldron@gmail.com Received 21 April 2020; Accepted 01 May 2020; Published 07 May 2020 Abstract Traditionally changes in quality of life (QoL) are assessed using self report questionnaires. They rely on the assumption th at the patient‘s point of reference does not change over time. However in reality patients with chronic and life threatening illness appear to undergo an adaptation to their disease or ―Response Shift‖ (RS). In this study of a population of patients with advanced lung cancer receiving palliative chemotherapy we examine for a RS in subjective QoL. Methods: 33 patients completed the Schedule for the Evaluation of Individual Quality of Life (SEIQoL), SEIQOL–DW and the EORTC-QLQ C-30 at diagnosis. At 1, 3 and 6 months patients completed SEIQoL/ SEIQOL–DW and retrospectively re- assessed their baseline QoL (the ―then‖ test) using SEIQoL-DW. Results: The initial mean SEIQoL-DW score was 67.48 changing to 66.71 at one month. Retrospectively, patients reassessed their initial mean SEIQoL-DW score as 59.61, suggesting a RS of 7.87 (p ≤0.0001) and an actual improvement in QoL of 7.1 points. At three months the mean SEIQoL-DW score was 65.13; retrospectively patients rated their QoL at one month much lower, mean SEIQoL-DW then – test‘ score was 59.92, suggesting a RS of 6.79 (p = 0.0013). At six months patients‘ mean SEIQoL-DW score was 61.86. Again, when retrospectively rating their QoL at three months they rated it lower, mean SEIQoL-DW score of 58.84, indicating a ‗positive‘ RS of 6.28 (p = 0.0007). Conclusion: Traditional pre/post SEIQOL–DW scores show little change in subjective QOL however by incorporating the ‗then-test‘ we can see that patients have undergone a RS and a significant positive change in subjective QOL. By explicitly measuring RS it may be possible to assess changes in QoL with greater validity and sensitivity. Keywords: Lung cancer, Palliative treatment, Quality of Life, SEIQoL/SEIQOL–DW, EORTC-QLQ C-30, Response Shift. Introduction Despite advances in treatments, many individuals with lung cancer present at an advanced stage of illness, the prognosis remains poor and time from diagnosis is often short [1,-5] . As the traditional outcome measures of survival and tumour response are so poor in this group, a patient based subjective quality of life (QoL) assessment may offer a more comprehensive approach to evaluating the relative risks and benefits associated with treatment. Research has demonstrated that QoL changes may be among the most important factors in a patient‘s decision whether to receive palliative treatment [6] . The dynamic and individual nature of QoL is difficult to capture when using questionnaires based on group data, in which the questions asked, the response format provided and the relative weights applied to the answers have all been predetermined. While such measures, which are generally referred to as Health Related QoL (HRQoL) measures [7] , provide important information regarding health status, their promulgation as measures of subjective QoL is more questionable [8] .