Proxy assessment of health-related quality of life in african american and white respondents with prostate cancer: perspective matters.
Proxy assessment of health-related quality of life in african american and white respondents with prostate cancer: perspective matters.
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DOI：
10.1097/mlr.0b013e31818475f4
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发表时间：
2009-02
期刊：
影响因子：
3
通讯作者：
Bennett CL
中科院分区：
文献类型：
--
作者：
Pickard AS;Lin HW;Knight SJ;Sharifi R;Wu Z;Hung SY;Witt WP;Chang CH;Bennett CL
代理文献中一个新出现的问题是，指定不同的代理观点是否有助于不同的健康相关生活质量（HRQL）评估，如果是这样的话，每个角度如何在医疗决策中提供信息。本研究的目的是确定非正式护理人员评估前列腺癌患者时，提示从患者的角度（代理-患者）和自己的观点（代理-代理），并确定与代理观点（即，代理内差距）的差异相关的因素。采用横断面设计，前列腺癌患者和他们的非正式护理人员从芝加哥杰西布朗退伍军人事务医疗保健系统的泌尿科诊所招募。Dyads使用EQ-5D视觉模拟量表（VAS）和EORTC QLQ-C30评估HRQL。在87对夫妇中，大多数照顾者是女性（83%）和配偶/伴侣（58%）。在QLQ-C30身体和情绪功能以及VAS方面，代理-患者和代理-代理观点之间的平均差异评分具有统计学意义（均P < 0.05），代理-患者观点更接近患者自我报告。情绪功能的差异最大，平均值为6.0（SD 12.8），效应量= 0.47。与代理内差距弱相关的因素包括角色功能的关系（配偶）和代理性别，以及身体功能的健康素养（有限/功能）（均P < 0.05，0.20 < r < 0.35）。有意义的代理-病人和代理-代理的角度对心理健康的差异是一致的理解代理的观点的概念框架。对患者健康的不同代理观点可以帮助临床医生识别可能从临床干预中受益的患者。
An emerging issue in the proxy literature is whether specifying different proxy viewpoints contributes to different health-related quality of life (HRQL) assessments, and if so, how might each perspective be informative in medical decision making. The aims of this study were to determine if informal caregiver assessments of patients with prostate cancer differed when prompted from both the patient perspective (proxy-patient) and their own viewpoint (proxy-proxy), and to identify factors associated with differences in proxy perspectives (ie, the intraproxy gap). Using a cross-sectional design, prostate cancer patients and their informal caregivers were recruited from urology clinics in the Jesse Brown Veterans Affairs Healthcare System in Chicago. Dyads assessed HRQL using the EQ-5D visual analog scale (VAS) and EORTC QLQ-C30. Of 87 dyads, most caregivers were female (83%) and were spouses/partners (58%). Mean difference scores between proxy-patient and proxy-proxy perspectives were statistically significant for QLQ-C30 physical and emotional functioning, and VAS (all P < 0.05), with the proxy-patient perspective closer to patient self-report. Emotional functioning had the largest difference, mean 6.0 (SD 12.8), an effect size = 0.47. Factors weakly correlated with the intraproxy gap included relationship (spouse) and proxy gender for role functioning, and health literacy (limited/functional) for physical functioning (all P < 0.05, 0.20 < r < 0.35). Meaningful differences between proxy-patient and proxy-proxy perspectives on mental health were consistent with a conceptual framework for understanding proxy perspectives. Prompting different proxy viewpoints on patient health could help clinicians identify patients who may benefit from clinical intervention.