Joshua A. McGrane

Psychological morbidity and quality of life of ethnic minority patients with cancer: a systematic review and meta-analysis

BACKGROUND Ethnic minority is associated with higher cancer incidence and poorer survival than is being in the majority group. We did a systematic review and meta-analysis to assess whether psychological morbidity and health-related quality of life (HRQoL) were affected by minority status. METHODS We searched Medline, AMED, PsycINFO, Embase, CENTRAL, CINAHL, PubMed, Sociological Abstracts, and Web of Science for English-language articles published between Jan 1, 1995, and October, 2009. Articles were eligible if they reported original data on anxiety, depression, distress (for psychological morbidity), or HRQoL in minority and majority cancer patients or survivors. Minority status was defined as being an immigrant or having an ethnic, linguistic, or religious background different to the majority of the population in the country where the research was done. We excluded African Americans and indigenous groups. Eligible articles were rated for quality of reporting, external validity, internal validity, sample size, and power. Each quality criterion was rated independently by two reviewers until inter-rater reliability was achieved. In a meta-analysis we compared mean scores adjusted for socioeconomic status and other sociodemographic and clinical variables, where available. Effect sizes greater than 0·5 and 95% CI that included 0·5 or -0·5 were deemed clinically important, with negative values indicating worse outcomes in minority patients. We assessed publication bias by estimating the number of potential unpublished studies and the number of non-signficant studies with p=0·05 required to produce a non-significant overall result. FINDINGS We identified 21 eligible articles that included 18 datasets collected in the USA and one in each of Canada, Romania, and the UK. Ethnic minority groups were Hispanic, Asian or Pacific Islander, or Hungarian (one dataset). Overall, we found minority versus majority groups to have significantly worse distress (mean difference -0·37, 95% CI -0·46 to -0·28; p<0·0001), depression (-0·23, -0·36 to -0·11; p=0·0003), and overall HRQoL (-0·33, -0·58 to -0·07; p=0·013). Further analyses found disparities to be specific to Hispanic patients in the USA, in whom poorer outcomes were consistent with potentially clinically important differences for distress (effect size -0·37, 95% CI -0·54 to -0·20; p<0·0001), social HRQoL (-0·45, -0·87 to -0·03; p=0·035), and overall HRQoL (-0·49, -0·78 to -0.20; p=0·0008). Results were significantly heterogeneous for overall HRQoL and all domains. Tests for interaction, for adjusted versus unadjusted and comparisons of high-quality, medium-quality, and low-quality articles, were generally non-significant, which suggests no bias. We found no evidence of any substantive publication bias. INTERPRETATION Hispanic cancer patients in the USA, but not other ethnic minority groups, report significantly worse distress, depression, social HRQoL, and overall HRQoL than do majority patients, of which all but depression might be clinically important. Heterogeneous results might, however, have limited the interpretation. Data for other minority groups and for anxiety are scarce. More studies are needed from outside the USA. Future reports should more clearly describe their minority group samples and analyses should control for clinical and sociodemographic variables known to predict outcomes. Understanding of why outcomes are poor in US Hispanic patients is needed to inform the targeting of interventions. FUNDING Prince of Wales Hospital, Sydney, Australia.

Stevens’ forgotten crossroads: the divergent measurement traditions in the physical and psychological sciences from the mid-twentieth century

The late 19th and early 20th Centuries saw the consolidation in physics of the three main traditions that predominate in discussions of measurement theory. These are: (i) the systematic tradition pioneered by Maxwell; (ii) the representational tradition pioneered by Campbell; and (iii) the operational tradition pioneered by Bridgman (1927). These divergent approaches created uncertainty about the nature of measurement in the physical sciences and provided Stevens (1946) with an opportunity and rationale to, in effect, reinvent the definition of scientific measurement. Stevens appropriated the representational and operational traditions as the sole basis for his definition of measurement, excluding any place for the systematic approach. In committing to Stevens’ path, the psychological sciences were blinded to the advances made in metrology, the establishment of the International System (SI) and the standard units contained within this system. These advances were only possible due to the deep conceptual and instrumental connections between the system of physical units and the body of physical theory and laws developed over the preceding centuries. It is argued that if the psychological sciences are to ever achieve equivalent methodological advances, they must bridge this ‘metrological gap’ created by Stevens’ measurement crossroads and understand the ways in which the systematic approach advanced measurement. This means that psychological measurement needs to be de-abstracted, rid of operational rules for numerical assignment and set upon a foundation of quantitative theory, definition and law. In the absence of such theoretical foundations, claims of measurement in the psychological sciences remain a methodological chimera.

Inferior health-related quality of life and psychological well-being in immigrant cancer survivors: A population-based study

This study compared health-related quality of life (QOL) and psychological morbidity in a population-based sample of first generation immigrant and Anglo-Australian cancer survivors. Eligible participants, recruited via three State Cancer Registries, included those: with a new diagnosis of one of 12 most incident cancers (all stages) 1-6years earlier; aged 18-80 at diagnosis; born in a Chinese, Arabic, or Greek speaking country and able to speak one of these languages. A random sample of English-speaking Anglo-Australian-born controls frequency matched for cancer diagnosis was recruited. 596 patients (277 of whom were immigrants) participated (a 26% response rate). In multiple linear regression models adjusted for age, sex, education, marital status, socio-economic status, time since diagnosis and type of cancer, immigrants had clinically significantly worse QOL (5.4-8.5 points on Functional Assessment of Cancer Therapy - General (FACT-G), P<0·0001), higher depression (P<0·0001) and higher incidence of clinical depression (P<0·01) than Anglo-Australians. Understanding the health system partially mediated this relationship for depression (P=0·0004) and QOL (P=0·001). Immigrant survivors of cancer have worse psychological and QOL outcomes than Anglo-Australians. Potential targets for intervention include assistance in navigating the health system, translated information and cultural competency training for health professionals.

Migrant Health in Cancer: Outcome Disparities and the Determinant Role of Migrant-Specific Variables

BACKGROUND Multiethnic societies face challenges in delivering evidence-based culturally competent health care. This study compared health-related quality of life and psychological morbidity in a hospital-based sample of first-generation migrants and Australian-born Anglo cancer patients, controlling for potential confounders related to migrant status. Further, it explored the relative contribution of ethnicity versus migrant-related variables. METHODS Eligible participants, recruited via 16 oncology clinics in Australia, included those over the age of 18, diagnosed with cancer (any type or stage) within the previous 12 months and having commenced treatment at least 1 month previously. RESULTS In total, 571 migrant patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated. In multiple linear regression models adjusted for age, sex, education, marital status, socioeconomic status, time since diagnosis, and type of cancer, migrants had clinically significantly worse health-related quality of life (HRQL; 3.6-7.3 points on FACT-G, p < .0001), higher depression and anxiety (both p < .0001), and higher incidence of clinical depression (p < .0001) and anxiety (p = .003) than Anglo-Australians. Understanding the health system (p < .0001 for each outcome) and difficulty communicating with the doctor (p = .04 to .0001) partially mediated the impact of migrancy. In migrant-only analyses, migrant-related variables (language difficulty and poor understanding of the health system), not ethnicity, predicted outcomes. CONCLUSION Migrants who develop cancer have worse psychological and HRQL outcomes than Anglo-Australians. Potential targets for intervention include assistance in navigating the health system, translated information, and cultural competency training for health professionals.

As Pragmatic as Theft Over Honest Toil: Disentangling Pragmatism From Operationalism

“The uniformity of weights and measures cannot displease anyone but those lawyers who fear a diminution in the number of trials, and those merchants who fear anything that renders the operations of commerce easy and simple” (Condorcet, as cited in Hand, 2016, p. 6) The concept of pragmatism has come to garner widespread appeal over the past century, particularly in the context of methodological innovations in the social and psychological sciences. In addition to connoting an orientation toward practicality and real-world usefulness—and who among us would not want to claim such things—pragmatism is often used to suggest freedom from slavish devotion to abstract principles or theoretical concerns. The assumption of this freedom has led to a diversification of activities being referred to as measurement across different scientific disciplines and other areas of human activity. Many of these activities bear little resemblance to canonical instances of measurement in the physical sciences (e.g., the measurement of length or temperature). Pragmatism, then, may seem to offer an alternative method of justification for the dependability and usefulness of the knowledge acquired as a result of these more liberally–defined measurement activities. Of course, whether pragmatism actually succeeds in offering such a justification is another matter. As a philosophical approach to truth and knowledge, the Pragmatist school may have much to offer to measurement theorists. However, in many contexts the idea of pragmatism is invoked but not carefully defined. One obvious danger resulting from this is that different users of the term will have different intuitions about what it means, raising the possibility that the term is used in a manner that is explanatorily soothing but semantically and scientifically vacuous. This vacuum may be easily filled by anti-realist positions that ultimately serve no pragmatic purpose other than to render the operations of measurement deceptively easy and simplistic.

Educational Growth, Learning Progressions, and Metrological Simulacra: Putting the House in (Partial) Order

Briggs and Peck (this issue) bring insight and elucidation to a number of pressing matters in educational measurement. These include the divergent conceptualizations, assessments, and interpretations of educational growth; the need for theoretically substantiated vertical scales to inform interpretations of growth; and the prominent role that learning progressions may play in the development of these scales. I broadly agree with them on all of these points. However, another more implicit point in their discussion is the pervasive emulation of scientific measurement concepts and language throughout the descriptions and understanding of educational growth, particularly in the context of standardized assessment and teacher accountability. This will be the focus of my comment, as the same metrological concepts and language are used throughout Briggs and Peck’s discussion, which repeatedly refers to “magnitudes,” “scales,” “intervals,” “units,” and “measurement,” albeit with a deeper understanding than many psychometric discussions. In committing to these metrological simulacra, I believe Briggs and Peck perpetuate a number of common psychometric oversights regarding the logic and process of scientific measurement. Specifically, I will argue that Briggs and Peck do not explicitly acknowledge a fundamental hypothesis in their discussion of the measurement of educational growth. This is the hypothesis that students not only possess some cognitive attribute that develops over time as a result of schooling but also this attribute and its development are quantitative. Whilst the intuitive appeal of this hypothesis continues to drive the educational assessment and accountability industries, it remains almost entirely unsubstantiated by quantitative cognitive theory. Moreover, Briggs and Peck do not integrate any theoretical account of units of measurement into their learning progression approach to substantiate quantitative interpretations of educational growth. Finally, Briggs and Peck actually provide a theoretical account of growth in mathematical proficiency that is inconsistent with this quantity assumption irrespective of whether tests of double cancellation are carried out on data. When stripped of these oversights, Briggs and Peck’s learning progression approach alludes to a scientific and educational imperative to investigate students’ cognitive attributes and learning and teachers’ pedagogical effectiveness using theoretically substantiated methods rather than very loose metrological metaphors.

Are Psychological Quantities and Measurement Relevant in the 21st Century

Osborne (2010, p. 1) argues that as quantitative psychologists we must “keep challenging ourselves…and…continue questioning and examining our tacit assumptions”. Whilst I wholeheartedly endorse the critical and optimistic spirit of his article, I find it alarming that he only implicitly directs quantitative psychologists to question and examine their most fundamental tacit assumption. This is the claim, or rather, inadequately tested hypothesis that continuous, psychological quantities exist. Unless we “shrug off the shackles of 20th century methodology and thinking” (Osborne, 2010, p. 3) and seriously address this hypothesis, the relevance of quantitative psychology, and the “measurements” it provides will remain obscure in this century and beyond. The desire to replicate the physical sciences model in psychology has a long history, as do criticisms of this desire, which I cannot do justice in the present commentary (see Michell, 1999). The culmination of this history took place when Stevens (1946)proposed a new definition of measurement, as numerical application according to rule, which would have a profound effect upon the practice of Psychology, including the “explosive progress” that Osborne (2010, p. 2) refers to. But, at what cost has this “progress” come? The fact that Stevens’ definition endures in the mainstream even today is testament to the schism between quantitative psychology and quantitative science more generally. There is only one rule for measurement in quantitative science. This is, the estimation of a magnitude of a quantity by its ratio to a unit of the same quantity (Michell, 1999). This is not a trivial matter, as even Stevens (1946) acknowledged that everything from the calculation of the humble mean and t-test through to the sophisticated multivariate analyses that Osborne (2010) refers to are contingent upon this “kind of” measurement1. Thus, even though our data may be “hard-earned” (p. 3), if they are not derived from defensible measurement practices, then our toil simply leads to questionable inferences and continued scepticism from outside the discipline (Cliff, 1996). Thankfully, a number of quantitative psychologists have eschewed Stevens’ definition and proposed ways to measure psychological attributes in a manner that is consistent with the physical sciences (Luce and Tukey, 1964; Rasch, 1980; Michell, 1990). Axiomatic Conjoint Measurement theory and the class of Rasch models stand out from the crowd as potential tools to be used by psychologists to test their quantitative assumptions, establish standard units of measurement, and bring about defensible methodological practices (see Humphry and Andrich, 2008; Kyngdon, 2008). However, the minimal impact that these approaches have had on mainstream psychology over the past half-century does raise the question of whether they are sufficient or even necessary for addressing the question of psychological quantities. A more fundamental cognitive shift seems to be required whereby the application of such mathematical models is not seen as an end unto itself, as measurement never takes place in a theoretical vacuum. One only needs to take a cursory look at measurement practices in the physical sciences to realize that they are intrinsically linked to what has been described as a “body of workable, quantitative theories and laws” (Michell, 1999, p. 217). This means a body of substantive, quantitative theories and laws and not algebraic ideals. Thus, before we may defensibly apply such models, the burden is upon us as quantitative psychologists to delve into the applied literature to establish and experimentally investigate strong, quantitative psychological theories (Borsboom, 2006). Michell (2009) and Trendler (2009) provide examples of the necessary theoretical analysis and their conclusions are alarming. Firstly, Michell argues that many psychological attributes are necessarily not quantitative, as unlike established physical quantities, the differences between levels of these attributes are not mutually homogeneous. Furthermore, Trendler argues that quantification and measurement will never be possible in psychology, as we will never possess the necessary control over our subject matter. Whilst their arguments are compelling, it is pertinent to note that the systems of measurement in the physical sciences were developed over centuries and necessarily required a large amount of qualitative work to substantiate them (Kuhn, 1961). Thus, it seems premature to conclude that quantification and measurement are, in principle, not possible in psychology. However, this possibility can only be realized (or not) if we stop begging the quantity and measurement questions. So I accept Osbornes (2010) challenges and I add my own (on behalf of the authors cited from whom this commentary is derived). If it is to be shown that Quantitative Psychology is relevant to the 21st century and beyond, then we must provide empirical evidence for the existence of psychological quantities and then establish units by which they can be measured. Hopefully, given Osbornes editorial directive, some of the pages of this new and exciting journal will be dedicated to this most fundamental challenge.

The Bipolarity of Attitudes: Unfolding the Implications of Ambivalence

Recently, some attitude researchers have argued that the traditional bipolar model of attitudes should be replaced, claiming that a bivariate model is superior in several ways, foremost of which is its ability to account for ambivalent attitudes. This study argues that ambivalence is not at odds with bipolarity per se, but rather the conventional view of bipolarity, and that the psychometric evidence supporting a bivariate interpretation has been flawed. To demonstrate this, a scale developed out of the bivariate approach was examined using a unidimensional unfolding item response theory model: general hyperbolic cosine model for polytomous responses. The results were consistent with a bipolar interpretation, providing support for the argument that ambivalent evaluations are the correct middle-point of a bipolar evaluative dimension. Thus, it is argued that attitudinal ambivalence does not necessitate moving beyond bipolarity, but rather, moving beyond the conventional conceptualization and assessment of attitudes.

Applying a Thurstonian, Two-Stage Method in the Standardized Assessment of Writing

ABSTRACT National standardized assessment programs have increasingly included extended written performances, amplifying the need for reliable, valid, and efficient methods of assessment. This article examines a two-stage method using comparative judgments and calibrated exemplars as a complement and alternative to existing methods of assessing writing. Written performances were taken from Australia’s National Assessment Program—Literacy and Numeracy, which included both narrative and persuasive performances from students aged 8 to 15. In Stage 1, assessors performed comparative judgments on 160 performances to form a scale of 36 calibrated exemplars. These comparative judgments showed a very high level of reliability and concurrent validity. In Stage 2, assessors scored 2,380 new performances by matching them to the most similar calibrated exemplar. These matching judgments showed a generally high level of reliability and concurrent validity and were reasonably efficient after a familiarization period. Further research is suggested to enhance Stage 2 by simplifying the exemplar scale and scaffolding it with detailed descriptors. Overall, the findings support the use of the method in standardized writing assessment and its application to various learning areas.

Likert or Not, Survey (In)validation Requires Explicit Theories and True Grit

From the time of Likert (1932) on, attitudes of expediency regarding both theory and methodology became apparent with reference to survey construction and validation practices. In place of theory a...