Agreement between older adult patient and caregiver proxy symptom reports.
Agreement between older adult patient and caregiver proxy symptom reports.
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DOI：
10.1186/s41687-022-00457-8
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发表时间：
2022-05-14
影响因子：
2.7
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中科院分区：
文献类型：
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对于无法自己完成患者报告结果(PRO)测量的患者，代理报告是必不可少的，并且当护理者的视角可以补充患者报告时，代理报告可能是有益的。在这项研究中，我们检查了老年人在完成疼痛、焦虑、抑郁和其他症状/损害的专业报告时，老年人的自我报告和他们的照顾者的代理报告之间的一致性。四名专业人员通过电话给老年人和他们的照顾者注射，然后在24小时内随机分组重新给药。优点包括PHQ-9抑郁，GAD-7焦虑，聚乙二醇痛，以及SymTrak多维症状和功能状态量表。样本包括576名老年人和照顾者参与者(188名患者-照顾者二人组，200名没有确定照顾者的患者)。无论是由患者还是照顾者完成，这四个量表都具有良好的内部信度(Cronbach‘s Alpha，0.76~0.92)和重测信度(ICC，0.63~0.92)。患者和照顾者报告的总分和条目水平的平均值相对相似。以组内相关系数(ICC)衡量的总分，SymTrak-23(0.48)和疼痛(0.58)的一致性好于焦虑(0.28)和抑郁(0.25)。多项模型显示，患者报告的量表得分较高(较差)与照顾者报告不足有关，而照顾者任务难度较高与报告过多有关。当在群体水平上对个人进行平均时，照顾者的PRO评分的代理报告往往与患者报告相似。对于个别患者，代理报告应更谨慎地解释心理症状，以及当患者报告的症状更严重时，或护理人员的任务难度较高时。当患者自我报告不可能或补充视角可能为护理提供信息时，由代理代表患者评估患者报告的结果(例如，症状、功能状态和其他生活质量领域)是有帮助的。确定老年患者和他们的照顾者对患者的疼痛、抑郁、焦虑和功能的一致程度，对于调查和管理这些核心临床领域非常重要。在这项研究中，患者-照顾者的协议被评估了四个常用的量表，评估抑郁(PHQ-9)，焦虑(GAD-7)，疼痛(PEG)，以及多维症状和功能障碍(SymTrak)。当在团体水平上平均时，患者和照顾者之间的总分和项目级得分是相似的。在更多面向身体的领域(疼痛和SymTrak)比心理状况(抑郁和焦虑)的一致性更高。患者报告的量表得分较高(较差)与照顾者报告不足有关，而照顾者任务难度较高与报告过多有关。在研究群体差异时，代理报告在研究中可能足够准确。然而，对于有心理症状或症状严重程度较高的个别患者，或存在照顾者困难的情况，应更加谨慎地解释代理报告。
Proxy report is essential for patients unable to complete patient-reported outcome (PRO) measures themselves and potentially beneficial when the caregiver perspective can complement patient report. In this study, we examine agreement between self-report by older adults and proxy report by their caregivers when completing PROs for pain, anxiety, depression, and other symptoms/impairments. Four PROs were administered by telephone to older adults and their caregivers followed by re-administration within 24 h in a random subgroup. The PROs included the PHQ-9 depression, GAD-7 anxiety, PEG pain, and SymTrak multi-dimensional symptom and functional status scales. The sample consisted of 576 older adult and caregiver participants (188 patient-caregiver dyads, 200 patients without identified caregiver). The four measures had good internal (Cronbach’s alpha, 0.76 to 0.92) and test–retest (ICC, 0.63 to 0.92) reliability whether completed by patients or caregivers. Total score and item-level means were relatively similar for both patient and caregiver reports. Agreement for total score as measured by intraclass correlation coefficient (ICC) was better for SymTrak-23 (0.48) and pain (0.58) than for anxiety (0.28) and depression (0.25). Multinomial modeling showed higher (worse) patient-reported scale scores were associated with caregiver underreporting, whereas higher caregiver task difficulty was associated with overreporting. When averaged over individuals at the group level, proxy reports of PRO scores by caregivers tend to approximate patient reports. For individual patients, proxy report should be interpreted more cautiously for psychological symptoms as well as when patient-reported symptoms are more severe, or caregiver task difficulty is high. Assessment of patient-reported outcomes (e.g., symptoms, functional status, and other quality of life domains) by a proxy on behalf of the patient is helpful when patient self-report is not possible or when a complementary perspective may inform care. Determining how well older adult patients and their caregivers agree on the patient’s pain, depression, anxiety, and functioning is important in investigating and managing these core clinical domains. In this study, patient-caregiver agreement was evaluated for four commonly-used scales that assess depression (PHQ-9), anxiety (GAD-7), pain (PEG), and multi-dimensional symptom and functional impairment (SymTrak). Total score and item-level scores were similar between patients and caregivers when averaged at the group level. Agreement was higher for more physically oriented domains (pain and SymTrak) than psychological conditions (depression and anxiety). Higher (worse) patient-reported scale scores were associated with caregiver underreporting, whereas higher caregiver task difficulty was associated with overreporting. Proxy report may be sufficiently accurate in research when studying group differences. However, proxy reports should be interpreted more cautiously in individual patients with psychological symptoms or higher symptom severity, or where there is caregiver diffficulty.