Discrepancies between proxy estimates and patient reported, health related, quality of life: minding the gap between patient and clinician perceptions in heart failure.

Prichard, RA; Zhao, F-L; Mcdonagh, J; Goodall, S; Davidson, PM; Newton, PJ; Farr-Wharton, B; Hayward, CS

Discrepancies between proxy estimates and patient reported, health related, quality of life: minding the gap between patient and clinician perceptions in heart failure.

Prichard, RA Zhao, F-L Mcdonagh, J Goodall, S

Davidson, PM Newton, PJ Farr-Wharton, B Hayward, CS

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Publisher:: SPRINGER
Publication Type:: Journal Article
Citation:: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2021, 30, (4), pp. 1049-1059
Issue Date:: 2021-04

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Field	Value	Language
dc.contributor.author	Prichard, RA
dc.contributor.author	Zhao, F-L
dc.contributor.author	Mcdonagh, J
dc.contributor.author	Goodall, S https://orcid.org/0000-0001-6611-6565
dc.contributor.author	Davidson, PM
dc.contributor.author	Newton, PJ
dc.contributor.author	Farr-Wharton, B
dc.contributor.author	Hayward, CS
dc.date.accessioned	2021-08-20T07:45:07Z
dc.date.available	2020-11-23
dc.date.available	2021-08-20T07:45:07Z
dc.date.issued	2021-04
dc.identifier.citation	Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2021, 30, (4), pp. 1049-1059
dc.identifier.issn	0962-9343
dc.identifier.issn	1573-2649
dc.identifier.uri	http://hdl.handle.net/10453/150188
dc.description.abstract	<h4>Purpose</h4>Health related quality of life (HRQoL) is rarely routinely measured in the clinical setting. In the absence of patient reported data, clinicians rely on proxy and informal estimates to support clinical decisions. This study compares clinician estimates (proxy) with patient reported HRQoL in patients with advanced heart failure and examines factors influencing discrepancies.<h4>Methods</h4>Seventy-five patients with heart failure, (22 females, 53 males) completed the EQ-5D-5L questionnaire. Thirty-nine clinicians (11 medical, 23 nursing, 5 allied health) completed the proxy version (V1) producing 194 dyads. Correlation was assessed using Spearman's rank tests, systematic bias was examined with Bland-Altman analyses. Inter-rater agreement at the domain level, was investigated using linear weighted Kappa statistics while factors influencing the IRG were explored using independent student t-tests, analysis of variance and regression.<h4>Results</h4>There was a moderate positive correlation between clinician HRQoL estimates and patient reported utility (r = 0.38; p < .0005). Mean clinician estimates were higher than patient reported utility (0.60 vs 0.54; p = 0.008), with significant underestimation of reported problems apparent in three of the five EQ-5D-5L domains. Patient sex (female), depressed mood and frailty were all associated with an increased inter-rater gap.<h4>Conclusion</h4>Clinicians in this sample overestimated HRQoL. Factors affecting the inter-rater gap, including sex and depression, support formal HRQoL screening to enhance clinical conversations and decision making. The discrepancy also supports regulatory restriction on the use of expert opinion in the development of QALYs in health economic analysis.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	SPRINGER
dc.relation	http://purl.org/au-research/grants/nhmrc/APP1133337
dc.relation.ispartof	Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
dc.relation.isbasedon	10.1007/s11136-020-02722-z
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1117 Public Health and Health Services, 1701 Psychology
dc.subject.classification	Health Policy & Services
dc.subject.mesh	Humans
dc.subject.mesh	Quality of Life
dc.subject.mesh	Middle Aged
dc.subject.mesh	Proxy
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Heart Failure
dc.subject.mesh	Surveys and Questionnaires
dc.subject.mesh	Patient Reported Outcome Measures
dc.subject.mesh	Female
dc.subject.mesh	Heart Failure
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Middle Aged
dc.subject.mesh	Patient Reported Outcome Measures
dc.subject.mesh	Proxy
dc.subject.mesh	Quality of Life
dc.subject.mesh	Surveys and Questionnaires
dc.title	Discrepancies between proxy estimates and patient reported, health related, quality of life: minding the gap between patient and clinician perceptions in heart failure.
dc.type	Journal Article
utslib.citation.volume	30
utslib.location.activity	Netherlands
utslib.for	1117 Public Health and Health Services
utslib.for	1701 Psychology
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access	*
dc.date.updated	2021-08-20T07:45:06Z
pubs.issue	4
pubs.publication-status	Published
pubs.volume	30
utslib.citation.issue	4

Abstract:

Purpose

Health related quality of life (HRQoL) is rarely routinely measured in the clinical setting. In the absence of patient reported data, clinicians rely on proxy and informal estimates to support clinical decisions. This study compares clinician estimates (proxy) with patient reported HRQoL in patients with advanced heart failure and examines factors influencing discrepancies.

Methods

Seventy-five patients with heart failure, (22 females, 53 males) completed the EQ-5D-5L questionnaire. Thirty-nine clinicians (11 medical, 23 nursing, 5 allied health) completed the proxy version (V1) producing 194 dyads. Correlation was assessed using Spearman's rank tests, systematic bias was examined with Bland-Altman analyses. Inter-rater agreement at the domain level, was investigated using linear weighted Kappa statistics while factors influencing the IRG were explored using independent student t-tests, analysis of variance and regression.

Results

There was a moderate positive correlation between clinician HRQoL estimates and patient reported utility (r = 0.38; p < .0005). Mean clinician estimates were higher than patient reported utility (0.60 vs 0.54; p = 0.008), with significant underestimation of reported problems apparent in three of the five EQ-5D-5L domains. Patient sex (female), depressed mood and frailty were all associated with an increased inter-rater gap.

Conclusion

Clinicians in this sample overestimated HRQoL. Factors affecting the inter-rater gap, including sex and depression, support formal HRQoL screening to enhance clinical conversations and decision making. The discrepancy also supports regulatory restriction on the use of expert opinion in the development of QALYs in health economic analysis.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/150188