Content of review 1, reviewed on April 22, 2015

The paper discusses the problems associated with current methods of quality of life measurement when applied to individuals without capacity, such as those with severe dementia. The purpose of the paper is to justify the need for a new (QALY-compatible) measure for use in dementia, and to offer a framework for its development.

Here are my thoughts on the article.

I agree with the authors’ proposals, but I am not convinced by their arguments. The paper argues that current measures – those based on functioning, capabilities or subjective well-being – lack content, face and construct validity. This may be true, but I don't think it’s quite that simple. The authors argue that because functioning and capabilities measures might invariably be at the lower bound for individuals with severe dementia, and because there may be no possibility of improvement, the measures are not valid. This is not the case; such people may be in the worst possible state of functioning and capability and the measures may be capturing this perfectly well. Furthermore, the authors argue that capabilities are not relevant to such a population because it is necessary that they receive almost constant care and assistance. On the contrary, the loss of capabilities is surely a key factor in the undesirability of dementia.

The paper drops in words like ‘unethical’, ‘immoral’ and ‘need’ without much justification. Given the purpose of the paper, justification is necessary. For example, if ‘need’ were dependent on capacity to benefit, and an improvement in a patient’s health is impossible, how can we say they are in need? Furthermore, if they cannot benefit, why is it immoral to withhold care? These issues need addressing. Of course, it may be that they have been addressed elsewhere and I just don’t know about it…

For me, the authors are more on the money when they consider subjective well-being. They state that:

"SWB has at its core the notion that the individual is the best judge of their wellbeing, yet it is clear that the method is inappropriate for people without the cognitive capacity to evaluate their life."

I agree. But the same surely applies to utility measures. Of any sort. Preference-based measures require, to be valid, that patients can actually have preferences. Yet the authors still argue that a preference-based utility measure is the way forward. An apparent contradiction. I agree with the authors that processes become more important than outcomes, but whether this is process ‘utility’ I’m not so sure.

I would be comfortable with the care of individuals with severe dementia being valued based on people’s expected preferences (largely related to processes) regarding a possible future with dementia. The preferences of the individual with dementia need not be considered as they do not have preferences. In practice this is actually similar to the way we currently use QALYs anyway, but the dismissal of experienced utility is only implicit. It isn’t that we use preferences because we don’t care what people experience in a given health state, it’s that preferences are a useful (and practical) way of estimating the value that people attach to this experience. In the case of severe dementia, I’m not sure it’s possible (logically) for preferences to be indicative of experiences. Therefore, I think there is a subtle (but important) difference; between the process of eliciting people’s preferences for a hypothetical health state (defined by generic functioning or capabilities measures) and the process of eliciting people’s preferences for a possible future health state (defined by a ‘capacity-adapted’ measure) in which they would not be capable of valuing their own experiences. This distinction needs more investigation.

Despite my reservations, I would still conclude that there is a need for a new measure, which would be valued by the public; the same conclusion as the authors! The authors’ proposed framework could be extremely valuable in developing better measures. In terms of the implementation of such a measure, should the authors get around to creating it, there will be a few difficulties. It will be necessary to identify which individuals ‘lack capacity’ because of their disease. This would require a ‘cut-off’ point in some cases. This cut-off would presumably be defined by some existing measure, which raises obvious challenges to the validity of the approach. Given the necessity of proxy questionnaires, the valuation process could be set-up to account for this (e.g. “your carer judges you to be…”).

So, I agree with the need for a new measure, and that it should probably look something like that proposed by the authors, but others may disagree. A better justification for the approach will be necessary for it to be seen as credible.


    © 2015 the Reviewer (CC BY 4.0).

Comments   (Guidelines)

Felix Jose Gonzalez Gonzalez

4:06 a.m., 8 Jul 18 (UTC) | Link

Nice example to illustrate lack of arguments and absence of important definitions and clarifications. Yet, it was a polite review.

Hawraa Natiq Kabroot AL-Fatlawy

2:11 p.m., 16 Sep 18 (UTC) | Link

I would like to become reviewer

Arjun Mani Guragain

9:15 a.m., 24 Sep 18 (UTC) | Link

Very interesting, I learn that a reviewer should have a patient to critic a paper.

Deepak Verma

6:46 p.m., 10 Oct 18 (UTC) | Link

The reviewer covered all aspects of the article.

Dr.mufeed alzaidi

6:16 a.m., 23 Oct 18 (UTC) | Link

مقال متميز ومثير للاهتمام

Radeep Krishna Radhakrishnan Nair

1:43 p.m., 28 Nov 18 (UTC) | Link

Thanks for the sample and very informative and gives different ways of approaching the thought behind the writing


2:05 p.m., 10 Dec 18 (UTC) | Link

Thanks for sharing the review. The reviewer was polite even though he or she disagreed with the authors

Ramesh Desikan

4 p.m., 15 Dec 18 (UTC) | Link

Nice comments and I learned new things from this review Thanks for sharing this valuable review

Dr. Wael R. Abdulmajeed

11:22 p.m., 17 Dec 18 (UTC) | Link

Nice example for post-publication review. Thanks

Adamkolo Mohammed Ibrahim

10:01 a.m., 18 Dec 18 (UTC) | Link

Wow. Beautiful.

abdusalam alrmali

10:54 a.m., 1 Jan 19 (UTC) | Link

nice review for interesting topic without cutoff definitions . great thanks

Prem Kumar Seelam

10 a.m., 2 Jan 19 (UTC) | Link

Perfect illustration to demonstrate the peer-review work. I got some useful tips to improve the quality of the manuscript.

Noreen Mirza

9:55 a.m., 1 Mar 19 (UTC) | Link

Great job, I think the reviewer covered most of the points. I like his convincing argumentation, though he/she was polite.

Joshua O. Ighalo

8:20 a.m., 25 Mar 19 (UTC) | Link

Honest, objective and precise

Andrew Afton Lawrence

5:06 a.m., 5 Apr 19 (UTC) | Link

Excellent example for a model review.

Dr. Muhammad Ujudud Musa

5:38 p.m., 2 May 19 (UTC) | Link

An excellent review which is highly objective, I am indeed inspired

Teymur Zulfugarzade

9:45 p.m., 2 May 19 (UTC) | Link

The work was done at a very high level, is relevant, independent research

Emmanuel Udo

10:23 p.m., 2 May 19 (UTC) | Link

Excellent review

Usman Atique

2:37 a.m., 3 May 19 (UTC) | Link

The reviewer has politely yet convincingly pin-pointed the significant aspects of this paper by conveying his thoughts. One of the best examples to argue objectively. Thanks.

Fabricio Ramos

3:03 p.m., 3 May 19 (UTC) | Link

With education and consistency the reviewer pointed out the flaws and indicated improvements to make the article adequate

Md. Monjurul Hasan

10:33 a.m., 4 May 19 (UTC) | Link

Nice review of a quality article to understand the view & mode of how to review. I have learnt a lot.

Nataliya Yuzikova

8:54 p.m., 5 May 19 (UTC) | Link

Детальный обзор статьи. Мне понравилась аргументация рецензента. Представляет интерес спорные вопросы, которые предлагаются к дальнейшей дискуссии. Рецензент дает рекомендации к статье, которые могут быть учтены и другими авторами при написании научного обзора. Благодарю за научный пример

Nzooma Shimaponda-Mataa

2:12 p.m., 10 May 19 (UTC) | Link

The reviewer was objective. He/she show that the topic is still important in spite of differing arguments

Dr. Marwan Jawad Msarah

10:18 a.m., 18 Jun 19 (UTC) | Link

Nice example, Thanks !

Dildora Ruzmetova

5:27 a.m., 30 Jun 19 (UTC) | Link

Thanks for sharing this nice example

Jack Harry Peralta Cáceres

3:03 a.m., 1 Jul 19 (UTC) | Link

Gracias por el buen ejemplo y compartir

Polinpapilinho F. Katina

4:39 p.m., 3 Jul 19 (UTC) | Link

Thanks for sharing

Iman Muwafaq Muslim Muwafaq Al-Ghabra

11:34 p.m., 5 Jul 19 (UTC) | Link

Thanks a lot. It is an interesting and useful example.

Koro Stephen

4:32 a.m., 7 Jul 19 (UTC) | Link

Insightful and objective. I Would even want to be superior than that in future

Ronaldo da Silva Cruz

11:33 a.m., 22 Jul 19 (UTC) | Link

Excelente exemplo!

María Elena Torrens Pérez

3:46 a.m., 1 Aug 19 (UTC) | Link

María Elena Torens Es un ejemplointeresante, y muy completo

Olha Nesterova

11:39 a.m., 4 Aug 19 (UTC) | Link

The reviewer uncovered a lot of contradictions associated with the paper. I think this is useful for author's further research activity

Aissa Boulmerka

3:49 p.m., 5 Aug 19 (UTC) | Link

Thank you!

Dr. Haider Alshawi

10:58 a.m., 18 Aug 19 (UTC) | Link

I benefited from this wonderful and very useful article

Muhammad Sher Baz Ali

5:28 p.m., 18 Aug 19 (UTC) | Link

I amazed to see that a review could be this much long and detailed. Too much to learn but not in a single sitting.

Silvia Regina Machado de Campos

11:20 a.m., 3 Sep 19 (UTC) | Link

Thanks for the example. Besides the comments on clarification, which the authors will have to deal with, the approach adopted by the reviewer provides some insights and contributes to the improvement of the paper.

Jack Harry Peralta Cáceres

7:02 a.m., 10 Sep 19 (UTC) | Link

Considero ante todo buenos dias o buenas noches, el revisar un articulo es interiorizarse bastante en el tema a investigar se es consiente que se aprende cada vez mas cuando uno revisa con rectitud y se cocientiza la veracidad de los sucesos con su información en todo el articulo, agradezco al consciente de su conciencia.

Ammcise Apply

1:01 a.m., 19 Sep 19 (UTC) | Link

Very good example of peer review. It is very inspiring and useful for future reviewers: objectivity, clarity, precision, respect. Thank you for sharing this good example.

Oluwafunke O Akinbule

12:51 p.m., 19 Sep 19 (UTC) | Link

Wow! Very detailed and critically reviewed. Thanks for sharing

Ali H A Alwaeli

10:02 a.m., 25 Sep 19 (UTC) | Link

Thank you for this good example to performing a post-publication review.

Maria Jesús Alonso

9:54 p.m., 29 Sep 19 (UTC) | Link

Sincero y justificado pero para mi gusto excesivamente extenso.


4:02 a.m., 1 Oct 19 (UTC) | Link

Very good job. Excellent post-publication review.

Adarshlata Singh

1:52 p.m., 12 Oct 19 (UTC) | Link

A very good example of post publication review. Very categorically the respected reviewer has explained about the positive and negative points on the paper. Critical appraisal of the article will be helpful for further research on the same disease.

Henry Eric Magezi

10:19 a.m., 19 Oct 19 (UTC) | Link

Thanks for this good example. I like the attention to detail by the reviewer.

Aditya Vedam

7:05 a.m., 14 Nov 19 (UTC) | Link

Some of the comments posted by others below the sample review were poorly scripted in grammatical sense, which, with some care---could have been avoided.


7:29 a.m., 29 Nov 19 (UTC) | Link

Well done.

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    Jeff, R., L., S. E., Louise, J. 2014. A framework for understanding quality of life in individuals without capacity. Quality of Life Research.