For many couples, the interaction goes awry when one partner becomes angry at having to ask for attention or care. And one or both of them “puts on the armor,” as Blum calls it. Instead of discussing their concerns and needs, they lash out. If patients withdraw from a study for a reason unrelated to their disease or treatment (for example, because they have moved overseas) their data are probably missing completely at random, because systematic differences between them and the patients who remained in the study are unlikely. If patients withdraw from the study for reasons related to their disease or treatment (such as progression or toxicity) the missing data are either missing at random or missing not at random; their quality of life measures would have been, on average, worse than those of patients who remained in the study. One can distinguish between missing at random and missing completely at random by testing, for example, whether baseline quality of life or progression rates differ between dropouts and completers or by using a graphical approach.4 The figure shows quality of life plotted against time for the renal cell trial, stratified by dropout time.
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