Caregiver assessment of patients with advanced cancer: concordance with patients, effect of burden and positivity.
Caregiver assessment of patients with advanced cancer: concordance with patients, effect of burden and positivity.
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DOI：
10.1186/1477-7525-6-42
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发表时间：
2008-06-02
影响因子：
3.6
通讯作者：
Gao W
中科院分区：
文献类型：
--
作者：
Higginson IJ;Gao W
临床医生和研究人员经常不得不依赖护理人员提供的信息来评估晚期癌症患者。本研究旨在评估护理者对患者关注的报告的有效性(以患者评估为金标准)，以及护理者负担和积极性的作用。从区域姑息关怀服务机构招募晚期癌症患者和非正式照顾者二人组并进行访谈。患者的结果用患者和照顾者版本的姑息结果量表(POS)进行评估；照顾者的负担和积极程度通过Zarit负担访谈(ZBI)和三个关于成就和关系的问题来收集。患者和照顾者评分的POS之间的一致性通过加权kappa统计来衡量。采用Logistic回归控制潜在的混杂因素，研究照顾者负担和积极程度在POS协议中的作用；根据模型估计调整后的优势比。对于疼痛，协议是实质性的，对于四个项目是中等的，对于三个项目是一般的，对于两个项目是轻微的。与患者自我评级相比，护理者在提供信息和分享感受方面描述了更多的问题，而且不太可能评估患者是否觉得自己的生活值得或对自己感觉良好。对三个POS项目的不一致与较高的照顾者负担显著相关：“感觉焦虑”(OR：4.5；95%CI：1.3至15.6)、“生命有价值”(OR：12.4；95%CI：2.9至54.3)和“感觉良好”(OR：7.7；95%CI：2.0至29.6)。积极得分越高的照顾者更有可能同意患者对“感觉良好”的评价(OR：0.3；95%CI：0.1-0.9)，但对患者的“实际问题”持不同意见的风险增加(OR：4.2；95%CI：1.1-16.6)。照顾者的负担和积极性影响他们的评估，特别是对心理患者领域的评估，以及患者是否评估他们的生活是值得的。意识到这一点可能有助于临床医生和研究人员更好地解释护理者评估。
Clinicians and researchers often have to rely on information from caregivers to assess patients with advanced cancer. This study aims to assess the validity (using patients' assessment as the gold standard) of caregiver reports of patient concerns and the roles of caregiver burden and positivity. A total of 64 advanced cancer patient and informal caregiver dyads were recruited from regional palliative care services and interviewed. Patients' outcomes were assessed with both the patient and the caregiver version of the Palliative Outcome Scale (POS); caregiver burden and positivity were collected with the Zarit Burden interview (ZBI) and three questions on achievements and relationships. The agreement between patient- and caregiver-rated POS was measured with weighted kappa statistics. The roles of caregiver burden and positivity in POS agreement were studied with logistic regression controlling for potential confounders; adjusted odds ratios were estimated from the models. Agreement was substantial for pain, moderate for four items, fair for three items and slight for two items. Compared with patients self-ratings, caregivers described more problems with information given and sharing feelings and were less likely to assess the patient felt their life was worthwhile or felt good about themselves. Disagreement for three POS item ratings was significantly associated with higher caregiver burden: "feeling anxious"(OR: 4.5; 95%CI: 1.3 to 15.6), "life worthwhile"(OR: 12.4; 95%CI: 2.9 to 54.3) and "felt good" (OR: 7.7; 95%CI: 2.0 to 29.6). Caregivers with higher positivity scores were more likely to agree patients' rating of "felt good"(OR: 0.3; 95%CI: 0.1–0.9) but at increased risk of disagreeing about patient's "practical problems"(OR: 4.2; 95%CI: 1.1 to 16.6). Caregiver burden and positivity affect their assessments, especially of psychological patient domains and whether patients assess their life as worthwhile. Awareness of this might help clinicians and researchers better interpret caregiver assessments.
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影响因子：
3.4
作者：
Hunt, CK
通讯作者：
Hunt, CK
DOI：
10.1093/geronj/44.3.p61
发表时间：
1989-05-01
期刊：
JOURNALS OF GERONTOLOGY
影响因子：
--
作者：
LAWTON, MP;KLEBAN, MH;GLICKSMAN, A
通讯作者：
GLICKSMAN, A
影响因子：
2.1
作者：
Ingleton, C;Faulkner, A
通讯作者：
Faulkner, A
影响因子：
105.7
作者：
Kind, P;Dolan, P;Williams, A
通讯作者：
Williams, A
影响因子：
2.4
作者：
Coen, RF;O'Boyle, CA;Lawlor, BA
通讯作者：
Lawlor, BA