Roslyn A Prichard1, Fei-Li Zhao2, Julee Mcdonagh3, Stephen Goodall4, Patricia M Davidson5, Phillip J Newton6, Ben Farr-Wharton7, Christopher S Hayward3,8,9. 1. Faculty of Health, University of Technology, Ultimo, NSW, Australia. Roslyn.Prichard@uts.edu.au. 2. School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, Australia. 3. Faculty of Health, University of Technology, Ultimo, NSW, Australia. 4. Centre for Health Economic Research and Evaluation, University of Technology Sydney, Ultimo, Australia. 5. Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, USA. 6. School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia. 7. School of Business and Law, Edith Cowan University, Joondalup, WA, Australia. 8. Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia. 9. St Vincent's Hospital Heart and Lung Clinic, St Vincent's Hospital Sydney, Darlinghurst, Australia.
Abstract
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.
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.
Entities:
Keywords:
Heart failure; Patient reported outcomes; Proxy; Quality of life; Sex difference
Authors: Lindsey M Philpot; Sunni A Barnes; Rachel M Brown; Jessica A Austin; Cameron S James; Richard H Stanford; Jon O Ebbert Journal: Am J Med Qual Date: 2017-12-19 Impact factor: 1.852