Centre for Functioning and Health Research, Buranda, Brisbane, Australia.
Health Qual Life Outcomes. 2012 Aug 17;10:94. doi: 10.1186/1477-7525-10-94.
Expectations held by patients and health professionals may affect treatment choices and participation (by both patients and health professionals) in therapeutic interventions in contemporary patient-centered healthcare environments. If patients in rehabilitation settings overestimate their discharge health-related quality of life, they may become despondent as their progress falls short of their expectations. On the other hand, underestimating their discharge health-related quality of life may lead to a lack of motivation to participate in therapies if they do not perceive likely benefit. There is a scarcity of empirical evidence evaluating whether patients' expectations of future health states are accurate. The purpose of this study is to evaluate the accuracy with which older patients admitted for subacute in-hospital rehabilitation can anticipate their discharge health-related quality of life.
A prospective longitudinal cohort investigation of agreement between patients' anticipated discharge health-related quality of life (as reported on the EQ-5D instrument at admission to a rehabilitation unit) and their actual self-reported health-related quality of life at the time of discharge from this unit was undertaken. The mini-mental state examination was used as an indicator of patients' cognitive ability.
Overall, 232(85%) patients had all assessment data completed and were included in analysis. Kappa scores ranged from 0.42-0.68 across the five EQ-5D domains and two patient cognition groups. The percentage of exact correct matches within each domain ranged from 69% to 85% across domains and cognition groups. Overall 40% of participants in each cognition group correctly anticipated all of their self-reported discharge EQ-5D domain responses.
Patients admitted for subacute in-hospital rehabilitation were able to anticipate their discharge health-related quality of life on the EQ-5D instrument with a moderate level of accuracy. This finding adds to the foundational empirical work supporting joint treatment decision making and patient-centered models of care during rehabilitation following acute illness or injury. Accurate patient expectations of the impact of treatment (or disease progression) on future health-related related quality of life is likely to allow patients and health professionals to successfully target interventions to priority areas where meaningful gains can be achieved.
在以患者为中心的当代医疗环境中，患者和医疗保健专业人员的期望可能会影响治疗选择以及他们对治疗干预的参与（包括患者和医疗保健专业人员）。如果康复环境中的患者高估了他们出院后的健康相关生活质量，那么当他们的康复进度不如预期时，他们可能会感到沮丧。另一方面，如果他们没有感觉到可能的益处，那么低估他们出院后的健康相关生活质量可能会导致他们缺乏参与治疗的动力。目前缺乏评估患者对未来健康状况的期望是否准确的实证证据。本研究旨在评估因亚急性住院康复而入院的老年患者对出院后健康相关生活质量的预期的准确性。
前瞻性纵向队列研究，比较患者入院康复单元时（使用 EQ-5D 工具报告）预期的出院健康相关生活质量和他们从该单元出院时实际自我报告的健康相关生活质量之间的一致性。采用简易精神状态检查作为患者认知能力的指标。
共有 232 名（85%）患者完成了所有评估数据，并纳入分析。在五个 EQ-5D 领域和两个患者认知组中，kappa 评分范围从 0.42 到 0.68。在每个领域和认知组中，完全正确匹配的百分比范围从 69%到 85%。在每个认知组中，有 40%的参与者正确预期了他们所有自我报告的出院 EQ-5D 域反应。
因亚急性住院康复而入院的患者能够以中等准确性预测他们在 EQ-5D 工具上的出院健康相关生活质量。这一发现为支持急性疾病或损伤后康复期间共同治疗决策和以患者为中心的护理模式提供了基础实证工作。患者对治疗（或疾病进展）对未来健康相关生活质量的影响的准确期望，可能使患者和医疗保健专业人员能够成功地将干预措施针对可以取得有意义收益的重点领域。
