Nonresponse bias in survey research: Lessons from a prospective study of breast reconstruction Journal Article


Authors: Berlin, N. L.; Hamill, J. B.; Qi, J.; Kim, H. M.; Pusic, A. L.; Wilkins, E. G.
Article Title: Nonresponse bias in survey research: Lessons from a prospective study of breast reconstruction
Abstract: Background Survey-based research is essential for evaluating the outcomes of health care in an era of patient-centered care. However, many such studies are hampered by poor response rates in completion of study questionnaires, thus limiting the generalizability of any findings. The objectives of this analysis were to identify independent variables associated with nonresponse to surveys following breast reconstruction to improve future patient-reported outcomes research. Materials and methods The Mastectomy Reconstruction Outcomes Consortium is a prospective cohort study involving 11 leading medical centers from the United States and Canada. Nonresponse rates for surveys assessing satisfaction with breast, satisfaction with care (BREAST-Q), depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder-7) were measured at 1 y and 2 y postoperatively. Clinical complication rates were compared between responders and nonresponders, and multivariable models were used to assess predictors of nonresponse. Results Among 2856 women in the analytic cohort, 1882 (65.9%) underwent implant-based, 817 (28.6%) received autologous, and 157 (5.5%) underwent latissimus dorsi myocutaneous flap breast reconstructions. Nonresponse rates to surveys at 1 y and 2 y were 27.8% and 34.4%, respectively. Race, ethnicity, and annual household income were associated with nonresponse to surveys. Women who underwent implant-based procedures were less likely to complete long-term surveys. Conclusions As survey-based research plays an increasingly prominent role in evaluating the outcomes of breast reconstruction, we found socioeconomic and procedure-related differences in survey response rates. Investigators must consider systematic differences in response rates among particular groups of women on the generalizability and validity of findings and perform rigorous nonresponse bias analyses. © 2017 Elsevier Inc.
Keywords: adult; treatment outcome; middle aged; patient satisfaction; major clinical study; united states; prospective study; breast cancer; cohort analysis; breast reconstruction; latissimus dorsi flap; postoperative complication; patient care; depression; anxiety disorder; patient-reported outcomes; epidemiology; race difference; canada; ethnic group; ethnicity; longitudinal study; patient-reported outcome; independent variable; surgical outcomes; human; female; priority journal; article; patient health questionnaire 9; household income; study bias; anxiety assessment; nonresponse bias
Journal Title: Journal of Surgical Research
Volume: 224
ISSN: 0022-4804
Publisher: Academic Press Inc., Elsevier Science  
Date Published: 2018-04-01
Start Page: 112
End Page: 120
Language: English
DOI: 10.1016/j.jss.2017.11.058
PROVIDER: scopus
PMCID: PMC5844368
PUBMED: 29506826
DOI/URL:
Notes: Article -- Export Date: 2 January 2018 -- Source: Scopus
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  1. Andrea Pusic
    280 Pusic