Deschler Daniel G, Walsh Kathleen, Hayden Richard E
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02420, USA.
ORL Head Neck Nurs. 2004 Winter;22(1):26-32.
OBJECTIVE/HYPOTHESIS: As rehabilitation after head and neck surgery is increasingly dependent upon caregivers with no formal training (lay caregivers), the lay caregiver's assessment of the patient's quality of life (QOL) status may be critical to successful rehabilitative efforts. This study evaluates lay caregiver QOL assessment at six and 12 months post-operatively and compares the findings to pre-operative assessments.
Twenty-five patients undergoing head and neck surgery and their primary lay caregivers completed the Medical Outcomes Survey Short Form 36 (SF-36) pre-operatively and were followed. Six and 12-month post-operative forms were completed and compared for available patient/lay caregiver pairs. Pair assessment was considered congruent if the lay caregiver's assessment of each domain of the SF-36 fell within the 90th % confidence interval of the patient's score. High congruence was defined as congruence between the pairs for six or more of the eight domains. Results were also related to previously published preoperative data.
Fourteen and six patient/lay caregiver pairs completed the six and 12-month follow-up forms, respectively. Overall congruence was 55% and 45% at six and 12 months, respectively, down from 70% found pre-operatively. Forty-two percent and 17% of the patient/lay caregiver pairs were highly congruent at six and 12 months, respectively. Both values were below the 60% high congruence value noted pre-operatively. The trend toward lay caregivers underrating general health was maintained, while overrating of bodily pain leveled at six months and returned at 12 months. Same generation pairs demonstrated a steady decrease in high congruence levels at six and 12 months. Recurrent disease status no longer predicted high congruence at six or 12 months.
Trends predicting high congruence in patient/lay caregiver QOL assessment identified preoperatively were not maintained in the post-operative evaluations, except the underrating of patients' general health status. Lay caregiver ability to accurately assess patient QOL status did not improve and, in fact, appeared to worsen. Further study into lay caregiver assessment of patients' quality of life status following head and neck surgery is warranted. Efforts should be directed toward the use of standardized assessment tools and anticipation of subject dropout with greater subject recruitment.
目的/假设：由于头颈外科手术后的康复越来越依赖于没有接受过正规培训的照料者（非专业照料者），非专业照料者对患者生活质量（QOL）状况的评估对于成功的康复努力可能至关重要。本研究评估非专业照料者在术后6个月和12个月时对生活质量的评估，并将结果与术前评估进行比较。
25例接受头颈外科手术的患者及其主要非专业照料者在术前完成了医学结局调查简表36（SF - 36），并进行随访。完成术后6个月和12个月的表格，并对可获得的患者/非专业照料者配对进行比较。如果非专业照料者对SF - 36各领域得分的评估落在患者得分的第90%置信区间内，则认为配对评估一致。高一致性定义为在八个领域中的六个或更多领域中配对之间的一致性。结果也与先前发表的术前数据相关。
分别有14对和6对患者/非专业照料者完成了术后6个月和12个月的随访表格。总体一致性在6个月和12个月时分别为55%和45%，低于术前的70%。在6个月和12个月时，分别有42%和17%的患者/非专业照料者配对具有高一致性。这两个值均低于术前记录的60%的高一致性值。非专业照料者低估总体健康状况的趋势持续存在，而对身体疼痛的高估在6个月时趋于平稳，并在12个月时再次出现。同代配对在6个月和12个月时高一致性水平呈稳步下降。复发疾病状态在6个月或12个月时不再预测高一致性。
除了对患者总体健康状况的低估外，术前确定的预测患者/非专业照料者生活质量评估高一致性的趋势在术后评估中未得到维持。非专业照料者准确评估患者生活质量状况的能力没有提高，事实上，似乎还恶化了。有必要对头颈外科手术后非专业照料者对患者生活质量状况的评估进行进一步研究。应致力于使用标准化评估工具，并通过增加受试者招募来预期受试者退出情况。
