Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St. Kilda Road, Melbourne, VIC, 3004, Australia.
School of Health and Social Development, Deakin University, Burwood, VIC, Australia.
Qual Life Res. 2024 Aug;33(8):2055-2066. doi: 10.1007/s11136-024-03660-w. Epub 2024 Apr 24.
Proxy assessment can be elicited via the proxy-patient perspective (i.e., asking proxies to assess the patient's quality of life (QoL) as they think the patient would respond) or proxy-proxy perspective (i.e., asking proxies to provide their own perspective on the patient's QoL). This review aimed to identify the role of the proxy perspective in explaining the differences between self-rated and proxy-rated QoL in people living with dementia.
A systematic literate review was conducted by sourcing articles from a previously published review, supplemented by an update of the review in four bibliographic databases. Peer-reviewed studies that reported both self-reported and proxy-reported mean QoL estimates using the same standardized QoL instrument, published in English, and focused on the QoL of people with dementia were included. A meta-analysis was conducted to synthesize the mean differences between self- and proxy-report across different proxy perspectives.
The review included 96 articles from which 635 observations were extracted. Most observations extracted used the proxy-proxy perspective (79%) compared with the proxy-patient perspective (10%); with 11% of the studies not stating the perspective. The QOL-AD was the most commonly used measure, followed by the EQ-5D and DEMQOL. The standardized mean difference (SMD) between the self- and proxy-report was lower for the proxy-patient perspective (SMD: 0.250; 95% CI 0.116; 0.384) compared to the proxy-proxy perspective (SMD: 0.532; 95% CI 0.456; 0.609).
Different proxy perspectives affect the ratings of QoL, whereby adopting a proxy-proxy QoL perspective has a higher inter-rater gap in comparison with the proxy-patient perspective.
代理评估可以通过代理-患者视角（即，询问代理人根据他们认为患者会如何回答来评估患者的生活质量（QoL））或代理-代理视角（即，询问代理人提供他们自己对患者 QoL 的看法）来获得。本综述旨在确定代理视角在解释痴呆患者自我报告和代理报告的生活质量之间差异中的作用。
通过对之前发表的综述中的文章进行系统文献回顾，并对四个文献数据库中的综述进行更新，从而获取文章。纳入的研究报告了使用相同标准化 QoL 工具的自我报告和代理报告的平均 QoL 估计值，并使用英语发表，且重点关注痴呆患者的生活质量。对不同代理视角下自我报告和代理报告之间的平均差异进行了荟萃分析。
综述共纳入 96 篇文章，从中提取了 635 个观测值。大多数提取的观测值使用代理-代理视角（79%），而不是代理-患者视角（10%）；11%的研究未说明视角。最常用的测量方法是 QOL-AD，其次是 EQ-5D 和 DEMQOL。与代理-代理视角相比，代理-患者视角的自我报告和代理报告之间的标准化平均差异（SMD）更低（SMD：0.250；95%CI 0.116；0.384），而代理-代理视角的 SMD 更高（SMD：0.532；95%CI 0.456；0.609）。
不同的代理视角会影响 QoL 的评分，与代理-患者视角相比，采用代理-代理 QoL 视角的评分差异更大。
