Kroenke Kurt, Stump Timothy E, Monahan Patrick O
Indiana University School of Medicine, Indianapolis, IN, USA.
Regenstrief Institute, Inc, 1101 West 10th St, Indianapolis, IN, 46202, USA.
J Patient Rep Outcomes. 2022 May 14;6(1):50. doi: 10.1186/s41687-022-00457-8.
Proxy report is essential for patients unable to complete patient-reported outcome (PRO) measures themselves and potentially beneficial when the caregiver perspective can complement patient report. In this study, we examine agreement between self-report by older adults and proxy report by their caregivers when completing PROs for pain, anxiety, depression, and other symptoms/impairments.
Four PROs were administered by telephone to older adults and their caregivers followed by re-administration within 24 h in a random subgroup. The PROs included the PHQ-9 depression, GAD-7 anxiety, PEG pain, and SymTrak multi-dimensional symptom and functional status scales.
The sample consisted of 576 older adult and caregiver participants (188 patient-caregiver dyads, 200 patients without identified caregiver). The four measures had good internal (Cronbach's alpha, 0.76 to 0.92) and test-retest (ICC, 0.63 to 0.92) reliability whether completed by patients or caregivers. Total score and item-level means were relatively similar for both patient and caregiver reports. Agreement for total score as measured by intraclass correlation coefficient (ICC) was better for SymTrak-23 (0.48) and pain (0.58) than for anxiety (0.28) and depression (0.25). Multinomial modeling showed higher (worse) patient-reported scale scores were associated with caregiver underreporting, whereas higher caregiver task difficulty was associated with overreporting.
When averaged over individuals at the group level, proxy reports of PRO scores by caregivers tend to approximate patient reports. For individual patients, proxy report should be interpreted more cautiously for psychological symptoms as well as when patient-reported symptoms are more severe, or caregiver task difficulty is high.
代理报告对于无法自行完成患者报告结局（PRO）测量的患者至关重要，并且当照顾者的观点能够补充患者报告时可能有益。在本研究中，我们考察了老年人的自我报告与他们的照顾者在完成有关疼痛、焦虑、抑郁及其他症状/损伤的PRO时的代理报告之间的一致性。
通过电话向老年人及其照顾者发放四项PRO，随后在一个随机子组中于24小时内再次发放。这些PRO包括PHQ-9抑郁量表、GAD-7焦虑量表、PEG疼痛量表以及SymTrak多维症状和功能状态量表。
样本包括576名老年参与者及其照顾者（188对患者-照顾者二元组，200名未确定照顾者的患者）。无论由患者还是照顾者完成，这四项测量都具有良好的内部信度（Cronbach's α系数，0.76至0.92）和重测信度（组内相关系数，ICC，0.63至0.92）。患者和照顾者报告的总分及项目水平均值相对相似。组内相关系数（ICC）测量的总分一致性在SymTrak-23量表（0.48）和疼痛量表（0.58）方面优于焦虑量表（0.28）和抑郁量表（0.25）。多项模型显示，患者报告的较高（较差）量表分数与照顾者报告不足相关，而照顾者任务难度较高与报告过度相关。
在群体水平上对个体进行平均时，照顾者对PRO分数的代理报告往往接近患者报告。对于个体患者，在涉及心理症状以及患者报告的症状更严重或照顾者任务难度较高时，对代理报告的解读应更加谨慎。
