Relationships between patient and physician global assessments in anti-neutrophil cytoplasmic antibody-associated vasculitis.

INTRODUCTION/OBJECTIVES: Patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) experience reduced health-related quality of life (HRQoL). Global assessment tools use visual analogue scales to provide patients' and physicians' views on disease activity or the patient's overall health and well-being. The aim of this study was to examine the relationships between patient and physician global assessments (PtGA and PhGa) as they relate to overall health in people with AAV.

METHODS

Patients with AAV attending a tertiary vasculitis clinic participated in this prospective observational study. The primary outcome measured was PtGA and PhGA scores, with higher scores representing better health. SF-36 assessed HRQoL. Discordant scores were defined as an absolute difference of ≥ 20 between PhGA and PtGA.

RESULTS

Ninety-seven patients (mean age 58 years, 46% male) participated. Most were taking immunosuppressive therapy (88%) and had kidney involvement (79%). The mean PhGa and PtGA were similar (mean difference - 2.6, [CI] 0.5, 4.7). Physicians' global assessments were lower in the 43 (44%) patients with active disease, with a trend towards a lower PtGA in this group. Patients' global assessments were ≥ 20 points higher than PhGAs in 16 patients and ≥ 20 points lower in 10 patients. Negatively discordant patients (PtGA < PhGA) were older and less likely to have active disease than positively discordant patients.

CONCLUSIONS

Physicians did not systematically overestimate patients' global health when using the global assessment tool. Discordance rates were 26%, within which, physicians were more likely to assess the patient's health lower than patients themselves. Key Points • There remains an unmet need for patient-reported outcomes assessing quality of life in AAV and other diseases. • The global assessment tool correlates with SF-36 which is commonly used as a tool for assessing quality of life. • Physicians do not tend to overestimate patient's global health both overall and within the discordant sub-group. • Assessing PtGA/PhGA discordance could identify unmet priorities for patients and improve shared physician-patient decision-making.