Coucill W, Bryan S, Bentham P, Buckley A, Laight A
Health Economics Facility, University of Birmingham, England, UK.
Med Care. 2001 Aug;39(8):760-71. doi: 10.1097/00005650-200108000-00003.
There are difficulties in obtaining health-related quality of life (HRQL) data from patients with dementia due to variation in their cognitive ability, degree of insight and capacity to make judgments. The use of proxies is one solution.
To examine the inter-rater agreement of patient and proxy completion of the EuroQol EQ-5D instrument (EQ-5D).
The EQ-5D instrument was completed separately by patients, their caregivers and a physician. Assessment of inter-rater agreement involved comparison of self-completed (patient) and proxy-completed (caregiver and physician) responses for each dimension of EQ-5D, using a weighted kappa score. Three key hypotheses were tested. (1) Interrater agreement would be stronger between patient and caregiver than between patient and physician. (2) Interrater agreement would be stronger on the 'observable' and objective dimensions of EQ-5D. (3) Interrater agreement between patient and proxies would be stronger for patients with earlier dementia.
The sample comprised 64 patients with a range of dementia severity.
The EQ-5D health state classification system and visual analogue scale were used to assess HRQL. Global severity of dementia was determined using the Clinical Dementia Rating Scale.
The principal finding of this study was that responses to EQ-5D questions were highly variable across the three raters such that none of the three hypotheses were strongly supported.
The data provide some support for the use of EQ-5D when interviewer administered. However, there are serious concerns regarding the validity of patient self-rated HRQL data obtained in this study and uncertainty exists regarding who the appropriate proxy should be, as different groups of proxies provide different results. It was not clear whether caregivers or physicians represent better proxies. Further research should focus on the comparison of caregivers and physicians as proxies.
由于痴呆患者认知能力、洞察力和判断能力存在差异，获取其健康相关生活质量（HRQL）数据存在困难。使用代理人是一种解决办法。
检验患者及其代理人完成欧洲五维健康量表（EQ-5D）的评分者间一致性。
EQ-5D量表由患者、其照护者和医生分别独立完成。评分者间一致性评估包括使用加权kappa分数比较EQ-5D各维度的自我完成（患者）和代理人完成（照护者和医生）的回答。检验了三个关键假设。（1）患者与照护者之间的评分者间一致性要强于患者与医生之间的。（2）在EQ-5D的“可观察”和客观维度上，评分者间一致性更强。（3）对于早期痴呆患者，患者与代理人之间的评分者间一致性更强。
样本包括64名痴呆严重程度各异的患者。
使用EQ-5D健康状态分类系统和视觉模拟量表评估HRQL。使用临床痴呆评定量表确定痴呆的总体严重程度。
本研究的主要发现是，三位评分者对EQ-5D问题的回答差异很大，因此三个假设均未得到有力支持。
数据为访谈者实施EQ-5D时的使用提供了一些支持。然而，对于本研究中获得的患者自评HRQL数据的有效性存在严重担忧，并且对于谁是合适的代理人存在不确定性，因为不同组的代理人提供不同的结果。不清楚照护者还是医生是更好的代理人。进一步的研究应侧重于比较照护者和医生作为代理人的情况。
