Discrepancies between proxy estimates and patient reported, health related, quality of life: minding the gap between patient and clinician perceptions in heart failure.

Autor: Prichard RA; Faculty of Health, University of Technology, Ultimo, NSW, Australia. Roslyn.Prichard@uts.edu.au., Zhao FL; School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, Australia., Mcdonagh J; Faculty of Health, University of Technology, Ultimo, NSW, Australia., Goodall S; Centre for Health Economic Research and Evaluation, University of Technology Sydney, Ultimo, Australia., Davidson PM; Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, USA., Newton PJ; School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia., Farr-Wharton B; School of Business and Law, Edith Cowan University, Joondalup, WA, Australia., Hayward CS; Faculty of Health, University of Technology, Ultimo, NSW, Australia.; Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia.; St Vincent's Hospital Heart and Lung Clinic, St Vincent's Hospital Sydney, Darlinghurst, Australia.
Jazyk: angličtina
Zdroj: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation [Qual Life Res] 2021 Apr; Vol. 30 (4), pp. 1049-1059. Date of Electronic Publication: 2021 Jan 02.
DOI: 10.1007/s11136-020-02722-z
Abstrakt: Purpose: Health related quality of life (HRQoL) is rarely routinely measured in the clinical setting. In the absence of patient reported data, clinicians rely on proxy and informal estimates to support clinical decisions. This study compares clinician estimates (proxy) with patient reported HRQoL in patients with advanced heart failure and examines factors influencing discrepancies.
Methods: Seventy-five patients with heart failure, (22 females, 53 males) completed the EQ-5D-5L questionnaire. Thirty-nine clinicians (11 medical, 23 nursing, 5 allied health) completed the proxy version (V1) producing 194 dyads. Correlation was assessed using Spearman's rank tests, systematic bias was examined with Bland-Altman analyses. Inter-rater agreement at the domain level, was investigated using linear weighted Kappa statistics while factors influencing the IRG were explored using independent student t-tests, analysis of variance and regression.
Results: There was a moderate positive correlation between clinician HRQoL estimates and patient reported utility (r = 0.38; p < .0005). Mean clinician estimates were higher than patient reported utility (0.60 vs 0.54; p = 0.008), with significant underestimation of reported problems apparent in three of the five EQ-5D-5L domains. Patient sex (female), depressed mood and frailty were all associated with an increased inter-rater gap.
Conclusion: Clinicians in this sample overestimated HRQoL. Factors affecting the inter-rater gap, including sex and depression, support formal HRQoL screening to enhance clinical conversations and decision making. The discrepancy also supports regulatory restriction on the use of expert opinion in the development of QALYs in health economic analysis.
Databáze: MEDLINE
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