Quality of life assessments in nursing homes revealed a tendency of proxies to moderate patients' self-reports
SourceJournal of Clinical Epidemiology, 80, (2016), pp. 123-133
Article / Letter to editor
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Primary and Community Care
Journal of Clinical Epidemiology
SubjectRadboudumc 18: Healthcare improvement science RIHS: Radboud Institute for Health Sciences; Radboudumc 1: Alzheimer`s disease DCMN: Donders Center for Medical Neuroscience
OBJECTIVE: Research into different patient populations suggests that, on average, proxies report poorer health-related quality of life (HRQoL) compared to self-reports. We aimed to investigate whether the difference between proxy reports and self-reports (interrater gap) varies across the whole range of self-reports from low to high HRQoL scores. STUDY DESIGN AND SETTING: A cross-sectional study in 16 Dutch nursing home (NH) dementia special care (DSC) units (n = 256) and 17 somatic units (n = 326). Professional carers, blinded to self-reports, provided EuroQol-5D scores from two perspectives: their own perspective (proxy-proxy) of the patients' HRQoL and the estimation of the patient's view (proxy-patient). RESULTS: The interrater gap varied linearly in both DSC and somatic patients from proxy scores overestimating low self-reports to proxy scores underestimating high self-reports. This attenuation tendency existed for both proxy-proxy and proxy-patient perspectives. The interrater gap tended to be smaller for the proxy-patient perspective. CONCLUSIONS: Proxies (professional carers) tend to attenuate self-reports in NH patients with and without dementia toward moderate scores rather than report systematically poorer HRQoL. A proxy-patient perspective may be preferable to a proxy-proxy perspective for the purpose of estimating self-reports. Further research into other populations is needed to understand whether the attenuation tendency is a general phenomenon.
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