Pearcy R, Waldron D, O'Boyle C, MacDonagh R
Department of Urology, Bristol Royal Infirmary Marlborough Street, Bristol, UK.
J R Soc Med. 2008 Mar;101(3):133-8. doi: 10.1258/jrsm.2008.081002.
To assess the ability of partners and clinicians to make proxy judgements on behalf of patients with prostate cancer relating to selection of life priorities and quality of life (QoL).
47 consecutive patients with histologically proven adenocarcinoma, and their partners, were recruited. The partners were asked to assess, by proxy, the QoL of the patient by completion of a series of interview-led questionnaires assessing global QoL (SEIQoL-DW), health-related QoL (FACT-P) and overall QoL (visual analogue score [VAS]). The patients' clinicians were asked to complete the SEIQoL-DW and VAS by proxy as soon as possible after a consultation with the patient.
Patients with histologically proven adenocarcinoma, their partners and their clinicians.
Proxy scores for SEIQoL-DW, FACT-P and VAS, as provided by partners and clinicians.
25 partners made a proxy assessment of the patients. The results showed that partners were able to select similar QoL cues to those of the patients (Spearman-Rank correlation 0.89). Comparison of the QoL scores obtained from patients and partners in proxy using the questionnaires showed no statistically significant difference (paired t-test). Urologists were poor predictors of areas of life (cues) that were important to their patients. The doctors overemphasized the importance of survival, postoperative complications, urinary symptoms, sexual ability, activities of daily living and finance, but underestimated the importance of wife, family, home and religion. Comparison of the QoL scores obtained from patients and urologists by proxy showed a significantly lower score when assessed by urologists using the SEIQoL-DW questionnaire.
Partners are able to accurately assess, by proxy, the areas of life that are of importance to patients. Clinicians, however, who are charged with making decisions on behalf of patients, are very poor judges of their patients' life priorities and QoL. This illustrates that conventional views held by most doctors regarding the priorities patients set themselves when planning treatment should be called into question and consequently suggests that the way in which doctors and patients arrive at treatment decisions must be reviewed.
评估伴侣和临床医生代表前列腺癌患者对生活优先级选择和生活质量（QoL）做出代理判断的能力。
招募了47例经组织学证实为腺癌的连续患者及其伴侣。要求伴侣通过完成一系列以访谈为主的问卷来代理评估患者的生活质量，这些问卷评估总体生活质量（SEIQoL-DW）、健康相关生活质量（FACT-P）和总体生活质量（视觉模拟评分[VAS]）。要求患者的临床医生在与患者会诊后尽快通过代理完成SEIQoL-DW和VAS。
经组织学证实为腺癌的患者、其伴侣及其临床医生。
伴侣和临床医生提供的SEIQoL-DW、FACT-P和VAS的代理评分。
25名伴侣对患者进行了代理评估。结果表明，伴侣能够选择与患者相似的生活质量提示因素（斯皮尔曼等级相关系数为0.89）。使用问卷对患者及其伴侣代理获得的生活质量评分进行比较，未发现统计学上的显著差异（配对t检验）。泌尿科医生对患者生活中重要领域（提示因素）的预测能力较差。医生过度强调生存、术后并发症、泌尿症状、性功能、日常生活活动和财务的重要性，但低估了妻子、家庭、家庭和宗教的重要性。通过代理对患者和泌尿科医生获得的生活质量评分进行比较，发现泌尿科医生使用SEIQoL-DW问卷评估时得分显著较低。
伴侣能够准确地代理评估对患者重要的生活领域。然而，负责代表患者做出决策的临床医生对患者的生活优先级和生活质量判断很差。这表明大多数医生关于患者在规划治疗时自行设定的优先级的传统观点应受到质疑，因此建议必须重新审视医生和患者做出治疗决策的方式。
