Reply to K.P. Weinfurt et al

I find little to disagree with in a letter to the editor from Weinfurt and Flynn¹ in response to my recent article in Journal of Clinical Oncology titled “Validation of patient-reported outcomes: A low bar.”² The target of the critique in my editorial was a narrow view of questionnaire validation and implementation. In brief, show that a questionnaire correlates well with something that it should, and less well with something it should not, and you are done: the questionnaire is ready for use in research and the clinic, and even the most trivial change would render it invalid.

It is apparent that Weinfurt and Flynn¹ share my skepticism of this view. For instance, they describe how, when they developed the sexual function measures for the Patient-Reported Outcome Measurement Information System (PROMIS), they interviewed an appropriately diverse group of individuals. As a result, they modified the measures to avoid some of the problematic issues with prior measures, such as the use of the term “erection” or evaluation of patients who did not have sex with a partner. This is a far more important reason to favor the PROMIS measures than, say, the statistically significant differences in score between patients who received different degrees of nerve sparing reported by Agochukwu et al.³ To make it doubly clear, I was not criticizing the PROMIS measures at all; the target of my editorial was the methodology.

I agree with Weinfurt and Flynn¹ that it is important to take a “nuanced view of the progress being made in PRO [patient-reported outcome] research.” I apologize if a critique of a common approach to patient-reported outcomes, written as a response to a single article, was misinterpreted as a global attack on a whole field; we need to do more psychometrics, not less, expanding our research beyond narrow correlative studies so that we can indeed, “better reflect patients’ perspectives in comprehensive, inclusive, and efficient ways.”¹

AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Reply to K.P. Weinfurt et al

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/journal/jco/site/ifc.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Andrew J. Vickers

Stock and Other Ownership Interests: OPKO Health

Consulting or Advisory Role: OPKO Diagnostics

Patents, Royalties, Other Intellectual Property: I am named on a patent for a statistical method to detect prostate cancer. This method has been commercialized by Opko as the “4Kscore.” I receive royalties from sales of the 4Kscore.

Travel, Accommodations, Expenses: OPKO Health

No other potential conflicts of interest were reported.