PRISM, a Novel Visual Metaphor Measuring Personally Salient Appraisals, Attitudes and Decision-Making: Qualitative Evidence Synthesis

Background
PRISM (the Pictorial Representation of Illness and Self Measure) is a novel, simple visual instrument. Its utility was initially discovered serendipitously, but has been validated as a quantitative measure of suffering. Recently, new applications for different purposes, even in non-health settings, have encouraged further exploration of how PRISM works, and how it might be applied. This review will summarise the results to date from applications of PRISM and propose a generic conceptualisation of how PRISM works which is consistent with all these applications.
Methods
A systematic review, in the form of a qualitative evidence synthesis, was carried out of all available published data on PRISM.
Results
Fifty-two publications were identified, with a total of 8254 participants. Facilitated by simple instructions, PRISM has been used with patient groups in a variety of settings and cultures. As a measure of suffering, PRISM has, with few exceptions, behaved as expected according to Eric Cassell’s seminal conceptualisation of suffering. PRISM has also been used to assess beliefs about or attitudes to stressful working conditions, interpersonal relations, alcohol consumption, and suicide, amongst others.
Discussion
This review supports PRISM behaving as a visual metaphor of the relationship of objects (eg ‘my illness’) to a subject (eg ‘myself’) in a defined context (eg ‘my life at the moment’). As a visual metaphor, it is quick to complete and yields personally salient information. PRISM is likely to have wide applications in assessing beliefs, attitudes, and decision-making, because of its properties, and because it yields both quantitative and qualitative data. In medicine, it can serve as a generic patient-reported outcome measure. It can serve as a tool for representational guidance, can be applied to developing strategies visually, and is likely to have applications in coaching, psychological assessment and therapeutic interventions.

背景
疾病与自我图像表征量表（Pictorial Representation of Illness and Self Measure，PRISM）是一种新颖且简便的可视化工具。其应用价值最初偶然被发现，现已被验证为可量化的痛苦评估工具。近年来，其在不同场景下的全新应用（甚至包括非医疗场景）推动了学界对PRISM运作机制与应用潜力的进一步探索。本综述将梳理迄今为止PRISM各项应用的研究成果，并提出一套可兼容所有现有应用场景的PRISM通用运作概念框架。

方法
本研究采用定性证据综合的形式开展系统综述，对所有已公开的PRISM相关研究数据进行整合分析。

结果
本次综述共纳入52项已发表研究，涉及总样本量8254名参与者。仅需简单指导即可完成操作，PRISM已被应用于不同场景与文化背景下的患者群体评估。作为痛苦评估工具，除极少数例外情况外，PRISM的表现均符合埃里克·卡塞尔（Eric Cassell）关于痛苦的开创性概念框架。此外，PRISM还被用于评估人们对压力性工作环境、人际关系、饮酒行为以及自杀等议题的信念与态度。

讨论
本次综述的结果证实，PRISM本质上是一种可视化隐喻，用于表征特定情境（如"当下的生活"）中客体（如"我的疾病"）与主体（如"我自身"）之间的关系。作为可视化隐喻工具，PRISM填写便捷，且可获取具有个人显著性的有效信息。凭借其自身特性，且可同时提供定量与定性数据，PRISM在信念、态度与决策评估领域拥有广阔的应用前景。在医学领域，它可作为通用的患者报告结局量表。同时，它还可作为表征性指导工具，用于可视化策略制定，并有望在辅导、心理评估与治疗干预等场景中得到应用。