Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
PLoS One. 2020 Jul 28;15(7):e0236584. doi: 10.1371/journal.pone.0236584. eCollection 2020.
The ICECAP capability measures are increasingly being used to capture the impact of health and social care interventions on well-being. In cases where the recipient of an intervention is highly vulnerable, proxy completion may be necessary. This study adds to the limited existing evidence on proxy completion of ICECAP-A specifically and adopts the novel approach of investigating multiple proxy responses for the same four (hypothetical) individuals.
62 members of the public who were participating in a series of one day deliberative workshops on public health and social care completed ICECAP-A on behalf of four hypothetical individuals, described in vignettes. Quantitative analysis explored the range of proxy responses for each of the four hypothetical individuals, and any possible correlation between participants' own characteristics and their proxy responses. Participants discussed their proxy responses after completing the task; this discussion was audio recorded and analysed using Framework Analysis.
Wide variation in ICECAP-A scores was observed across proxy respondents for each hypothetical individual. Participants' demographic characteristics and own well-being do not appear to have systematically influenced proxy responses. Qualitative analysis suggests two principal approaches (or perspectives) were adopted by participants: Empathetic (adopting the perspective of the 'subject') and factual (a factual assessment of the subject's well-being). Participants also drew on their own experiences to varying degrees. There were differing interpretations of the Independence attribute on ICECAP-A and some evidence that participants' ideas of what constituted achievement were context (including life-stage and condition/health) specific.
The factual versus empathetic approaches identified from qualitative analysis in this study match to the concept of a proxy-proxy versus proxy-patient perspective, previously outlined in the literature. Researchers should consider specifying which perspective proxy raters should adopt. Findings also suggest proxy responses can be influenced by external points of reference and interpretation of measure attributes.
ICECAP 能力衡量标准越来越多地被用于捕捉健康和社会保健干预对幸福感的影响。在干预的接受者高度脆弱的情况下，可能需要代理完成。这项研究增加了关于 ICECAP-A 代理完成的有限的现有证据，并采用了一种新颖的方法，即调查同一四个（假设）个体的多个代理响应。
62 名参与公共卫生和社会保健系列为期一天的审议研讨会的公众代表四个假设个体完成了 ICECAP-A，这些个体在情景描述中进行了描述。定量分析探讨了每个假设个体的代理响应的范围，以及参与者自身特征与其代理响应之间的任何可能的相关性。参与者在完成任务后讨论了他们的代理响应；讨论内容被录音，并使用框架分析进行了分析。
每个假设个体的代理响应者的 ICECAP-A 评分差异很大。参与者的人口统计学特征和自身的幸福感似乎并没有系统地影响代理响应。定性分析表明，参与者采用了两种主要方法（或视角）：同理心（采用“主体”的视角）和事实（对主体幸福感的事实评估）。参与者还在不同程度上利用了自己的经验。对 ICECAP-A 中的独立性属性存在不同的解释，并且有证据表明，参与者对成就构成的看法是具体的（包括生活阶段和条件/健康）。
本研究中的定性分析确定的事实与同理心方法与文献中先前概述的代理代理与代理患者视角的概念相匹配。研究人员应考虑指定代理评分者应采用的视角。研究结果还表明，代理响应可能受到外部参考点和对度量属性的解释的影响。
