Evaluating the quality of life of cancer patients: assessments by patients, significant others, physicians and nurses

Abstract

Summary This study examined the usefulness of caregiver ratings of cancer patients' quality of life (QOL), an issue of relevance to bot h adequate patient care and to the possible use of proxy QOL raters in clinical studies.We compared QOL ratings of 90 cancer pat ients receiving inpatient chemotherapy with those provided by their significant others (most often the spouse), physicians and nurses . During patients' scheduled appointment for receiving chemotherapy on a clinical ward, all raters completed independently the Dartmouth COOP Functional Health Assessment charts/WONCA, an instrument developed by a cooperative group of primary care physicians to briefly assess a core set of seven QOL domains (physical fitness, feelings, daily and social activities, overall health, pain and quality of l ife) by single items with five response options. With few exceptions, mean scores of the proxy raters were equivalent or similar to those of the pat ients. Most patient-proxy correlations varied between 0.40 and 0.60, indicating a moderate level of agreement at the individual level. Of a ll comparisons made, 41% were in exact agreement and 43% agreed within one response categor y, leaving 17% more profound patient-proxy discrepancies. Disagreement was not dependent on the type of proxy rate r, or on raters' background characteristics, but was inf luenced by the QOL dimension under consideration and the clinical status of the patient. Better patient-proxy agreement was observed for m ore concrete questions (daily activities, pain) and for patients with either a very good (ECOG 0) or poor (ECOG 3) performance status. The r esults indicate that both significant others and health care providers can be useful sources of information about cancer patients' QOL.

Proxy ratings of patient quality of life Factors related to patient–proxy agreement

“…This position has been supported by some studies (21) showing slightly higher levels of patient Á/proxy agreement for significant others as compared with either physicians or nurses. However, results from recent studies, performed within inpatient care, indicate that the level of patient Á/physician agreement may only be slightly lower than that of patients and spouses or other close companions (17,22,23). The findings indicate that both significant others and healthcare providers can be useful sources of information about patients' QL.…”

“…When responses from patients, significant others, physicians, and nurses were compared (17), deviant scores of more than one response category appeared to be caused most often by the patients themselves. This might be interpreted as indicating that all proxy raters were unaware of the patients' QL.…”

Análisis económico de la neuromonitoría rutinaria del nervio laríngeo recurrente en tiroidectomía total

“…However, the lack of information about measurements with specific QOL instruments in this type of patients impeded its use in the model. Therefore, we believe that utilities values used in this model could be even lower and that results of cost-utility ratios could be even greater than those calculated here (22,23). Finally, costs were calculated using the SOAT manual, that could overestimate them over other costs sources as the ISS manual, but we believe conclusions will not change because the greater cost comes from a device not included in any manual, with similar values for both costs calculation systems.…”

Symptoms, Symptom Distress and Health-related Quality of Life in Patients with Polycythaemia Vera or Essential Thrombocythaemia during Treatment with Interferon-alpha

“…It has been found that the level of agreement between healthcare providers and patients appears to be dependent on clear questions with a high degree of concreteness and a minimum of subjectivity in the quality of life dimensions assessment. For example, patients' functional status tends to be more accurately rated than patients' level of psychological distress (18)(19)(20).…”