​This webinar will review clinical implications and solutions for addressing response shift (RS) and differential item functioning (DIF) with emphasis on interpretation of PROs for assessing change and diverse people.

Participants will engage in discussion to learn about the concepts of DIF and RS, implications of DIF and RS for their practice, and solutions for addressing DIF and RS using case studies. The discussion will be facilitated via a panel and with interactive use of polls and survey questions.

The webinar has been co-developed via a series of online workshops with clinicians and analysts. Corresponding resources, including an independent online learning module, will be made available for further learning about statistical methods for detecting DIF and RS in PRO data. An online introductory whiteboard video is available at:


Tools for measuring patients’ perceived health and quality of life such as patient-reported outcomes (or PROs) are increasingly used in clinical practice and decision-making. However, patients may not be consistent in how they interpret and respond to these questions.

Differences in the meaning of PROs across patients or over time are known as differential item functioning (DIF) and response shift (RS), respectively. Studies have shown that ignoring DIF and RS could lead to erroneous healthcare decisions.

Learning Outcomes/Objectives

At the end of the webinar, participants will be able to:

  • Explain the concepts of DIF and RS and their implications for clinical decision-making
  • Critically evaluate and consider different ways to assess for DIF and RS in clinical practice
  • Identify practical solutions when using PROs to assess change and diverse people


  • Richard Sawatzky, PhD RN, Professor, School of Nursing, Trinity Western University
  • Jae-Yung Kwon, PhD RN, Assistant Professor, University of Victoria

Panel Discussion Members:

  • Theresa Coles, PhD, Assistant Professor, Duke University
  • Robert Klaassen, MD, Professor, University of Ottawa
  • Kara Schick-Makaroff, PhD RN, Associate Professor, University of Alberta

Organized By:
QOL in Clinical Practice SIG

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