Leontjevas Ruslan, Teerenstra Steven, Smalbrugge Martin, Koopmans Raymond T C M, Gerritsen Debby L
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands; Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P.O. Box 2960, 6401 DL Heerlen, The Netherlands; Radboud Alzheimer Centre, Nijmegen, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Section Biostatistics, Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
J Clin Epidemiol. 2016 Dec;80:123-133. doi: 10.1016/j.jclinepi.2016.07.009. Epub 2016 Jul 27.
Research into different patient populations suggests that, on average, proxies report poorer health-related quality of life (HRQoL) compared to self-reports. We aimed to investigate whether the difference between proxy reports and self-reports (interrater gap) varies across the whole range of self-reports from low to high HRQoL scores.
A cross-sectional study in 16 Dutch nursing home (NH) dementia special care (DSC) units (n = 256) and 17 somatic units (n = 326). Professional carers, blinded to self-reports, provided EuroQol-5D scores from two perspectives: their own perspective (proxy-proxy) of the patients' HRQoL and the estimation of the patient's view (proxy-patient).
The interrater gap varied linearly in both DSC and somatic patients from proxy scores overestimating low self-reports to proxy scores underestimating high self-reports. This attenuation tendency existed for both proxy-proxy and proxy-patient perspectives. The interrater gap tended to be smaller for the proxy-patient perspective.
Proxies (professional carers) tend to attenuate self-reports in NH patients with and without dementia toward moderate scores rather than report systematically poorer HRQoL. A proxy-patient perspective may be preferable to a proxy-proxy perspective for the purpose of estimating self-reports. Further research into other populations is needed to understand whether the attenuation tendency is a general phenomenon.
针对不同患者群体的研究表明，平均而言，与自我报告相比，代理人报告的健康相关生活质量（HRQoL）较差。我们旨在调查代理人报告与自我报告之间的差异（评分者间差距）在从低到高HRQoL分数的整个自我报告范围内是否有所不同。
在荷兰的16个养老院（NH）痴呆症特殊护理（DSC）单元（n = 256）和17个躯体病单元（n = 326）进行的一项横断面研究。对自我报告不知情的专业护理人员从两个角度提供了欧洲五维健康量表（EuroQol-5D）评分：他们自己对患者HRQoL的看法（代理人-代理人）以及对患者看法的估计（代理人-患者）。
在DSC患者和躯体病患者中，评分者间差距呈线性变化，从代理人评分高估低自我报告到代理人评分低估高自我报告。这种衰减趋势在代理人-代理人视角和代理人-患者视角中均存在。代理人-患者视角的评分者间差距往往较小。
代理人（专业护理人员）倾向于将患有和未患痴呆症的NH患者的自我报告向中等分数衰减，而不是系统性地报告较差的HRQoL。为了估计自我报告，代理人-患者视角可能比代理人-代理人视角更可取。需要对其他人群进行进一步研究，以了解这种衰减趋势是否是一种普遍现象。
