Uncovering the story within the story: a scoping review of response shift in qualitative research.

Purpose: The role of qualitative research in response-shift research has not been well characterized. This scoping review summarizes the status of qualitative studies on response shift.

Methods: A scoping review of the medical literature was done using the keywords "response shift" and "qualitative" or "interview." After excluding ineligible works, each retained article was rated by two independent raters according to the modified Critical Appraisal Skill Program (CASP) criteria. A synthesis of adjudicated review results further characterized the articles.

Results: The search yielded 50 unique articles published from 1991 to 2023, 39 of which were retained after applying exclusion criteria. Most (69%) had the highest possible CASP score. Studies involved a broad range of patients by diagnosis or therapeutic context, caregivers, and healthcare professionals. While studies were often purely descriptive, many addressed components of response-shift theory or assumptions of response-shift methods. Study goals varied by design, time-focus (i.e., retrospective, present-focus or prospective), and by whether response-shift hypotheses were planned or post-hoc. The theoretical value added by the qualitative process involved examining the cognitive/emotional processes underlying quality-of-life ratings and response shifts. The methodological value added by the qualitative process facilitates understanding measurement error and non-responsiveness, and whether the methods used reflect the researchers' presumptions.

Conclusion: The use of qualitative methods in response-shift research yields a nuanced understanding of what response-shift "looks like" in different patient populations, thereby helping to translate results more directly to clinical experience. Studies contributed to response-shift theory or methods in ways not easily captured by purely quantitative research.