Barata Anna, Martino Rodrigo, Gich Ignasi, García-Cadenas Irene, Abella Eugenia, Barba Pere, Briones Javier, Brunet Salut, Esquirol Albert, García-Pallarols Francesc, Garrido Ana, Granell Miguel, Martinez Jaume, Mensa Irene, Novelli Silvana, Sánchez-González Blanca, Valcárcel David, Sierra Jordi
Hematology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; IIB-Sant Pau, Jose Carreras Leukemia Research Institute, Barcelona, Spain.
Hematology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; IIB-Sant Pau, Jose Carreras Leukemia Research Institute, Barcelona, Spain.
Biol Blood Marrow Transplant. 2017 Jun;23(6):1005-1010. doi: 10.1016/j.bbmt.2017.03.015. Epub 2017 Mar 10.
Patient and physician agreement on the most significant symptoms is associated with treatment outcomes and satisfaction with care. Thus, we sought to assess patient and physician agreement on patient-reported quality of life (QoL), and whether patient-related variables predict disagreement. In this cross-sectional, multisite study, patients and physicians completed the FACT-BMT at day 90. Agreement was analyzed with the intraclass coefficient correlation (ICC). Rates of underestimation and overestimation were calculated. Logistic regression models identified predictors of disagreement. We analyzed 96 pairs of questionnaires completed by 96 patients and 11 physicians. The patients' median age was 54 years, 52% were men, and 52% had undergone allogeneic hematopoietic cell transplantation (HCT). The physicians' median age was 42, 64% were men, and they had worked in the HCT field for an average of 12 years. Agreement on QoL was moderate (ICC = .436). Exploratory analyses revealed poor agreement for emotional (ICC = .092) and social (ICC = .270) well-being and moderate agreement for physical (ICC = .457), functional (ICC = .451), and BMT concerns (ICC = .445). Patients' well-being was underestimated by physicians in 41% to 59% of the categories of well-being parameters, and overestimated in 10% to 24%. Patient's anxiety predicted less disagreement in all scales except in social well-being, for which nonsignificant associations were observed. Patient-related variables explained 12% to 19% of the variance in disagreement across well-being scales. Patient and physician agreement on QoL was suboptimal, particularly in emotional and social well-being. The implementation of patient-reported outcomes in the daily care of HCT recipients may contribute to improving patient-centered care.
患者与医生就最重要症状达成的一致意见与治疗结果及护理满意度相关。因此，我们试图评估患者与医生在患者报告的生活质量（QoL）方面的一致性，以及与患者相关的变量是否可预测不一致性。在这项横断面、多中心研究中，患者和医生在第90天完成了FACT - BMT。采用组内相关系数（ICC）分析一致性。计算低估和高估率。逻辑回归模型确定不一致性的预测因素。我们分析了96名患者和11名医生完成的96对问卷。患者的中位年龄为54岁，52%为男性，52%接受了异基因造血细胞移植（HCT）。医生的中位年龄为42岁，64%为男性，他们在HCT领域平均工作了12年。在QoL方面的一致性为中等（ICC = 0.436）。探索性分析显示，在情感（ICC = 0.092）和社会（ICC = 0.270）幸福感方面一致性较差，在身体（ICC = 0.457）、功能（ICC = 0.451）和BMT相关问题（ICC = 0.445）方面一致性为中等。在幸福感参数的41%至59%类别中，医生低估了患者的幸福感，在10%至24%类别中高估了患者的幸福感。除社会幸福感外，患者的焦虑在所有量表中均预测不一致性较少，而在社会幸福感方面未观察到显著关联。与患者相关的变量解释了幸福感量表中不一致性方差的12%至19%。患者与医生在QoL方面的一致性未达最佳，尤其是在情感和社会幸福感方面。在HCT受者的日常护理中采用患者报告结局可能有助于改善以患者为中心的护理。
