Two perspectives of proxy reporting of health-related quality of life using the Euroqol-5D: An investigation of agreement

McPhail, Steven, Beller, Elaine and Haines, Terry (2008) Two perspectives of proxy reporting of health-related quality of life using the Euroqol-5D: An investigation of agreement. Medical Care, 46 11: 1140-1148. doi:10.1097/MLR.0b013e31817d69a6

Author McPhail, Steven
Beller, Elaine
Haines, Terry
Title Two perspectives of proxy reporting of health-related quality of life using the Euroqol-5D: An investigation of agreement
Journal name Medical Care   Check publisher's open access policy
ISSN 0025-7079
Publication date 2008-11-01
Year available 2008
Sub-type Article (original research)
DOI 10.1097/MLR.0b013e31817d69a6
Open Access Status
Volume 46
Issue 11
Start page 1140
End page 1148
Total pages 9
Editor Catarina Kiefe
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Subject C1
920408 Health Status (e.g. Indicators of Well-Being)
111799 Public Health and Health Services not elsewhere classified
Formatted abstract
Background: Proxy-reporting has been proposed as an alternative to self-report of health-related quality of life (HRQoL) for patients with poor cognition. There are 2 possible perspectives from which to complete a proxy-report, answer as the patient would (proxy-patient) or from the proxy's own perspective (proxy-proxy). Most research has not differentiated between perspectives. Agreement between patient and proxy-reports from either perspective has not been investigated using the Euroqol-5D (EQ-5D) among elderly hospital patients undergoing rehabilitation.

Objectives: Identify agreement levels between proxy-patient and patient self-report as well as proxy-proxy and patient self-report of the EQ-5D and investigate interaction effects of timing (admission vs. discharge) and basic cognition (intact vs. not intact).

Research Design: Repeated measures, inter-rater agreement investigation of clinician proxy-report, and patient self-report incorporating; proxy-patient reports (perspective A) and proxy-proxy reports (perspective B).

Subjects: Geriatric rehabilitation patients (n = 272) and their proxies (treating physiotherapists n = 29).

Measures: EQ-5D for HRQoL and Mini Mental State Examination for cognition.

Results: One hundred fifty (89%) proxy-patient and 130 (98%) proxy-proxy datasets were complete, 51 perspective A and 52 perspective B patients did not have basic cognition intact. Proxy-patient assessments had strong agreement with self-report at discharge across all cognition levels (kappa = 0.76–0.95), but at admission had stronger agreement among patients with better cognition (kappa = 0.70–0.86) than patients with lower cognition (kappa = 0.47–0.76). At admission and discharge proxy-proxy assessments generally had moderate agreement with self-report among patients with poor cognition on most domains with proxies giving lower scores than patients (kappa = 0.23–0.81), this is in contrast to proxy-proxy assessments and patients with better cognition (kappa = 0.55–0.95).

Conclusions: Clinician (physiotherapist) proxy-reports among this population generally had good agreement with patient self-report though this was affected by proxy perspective, patient cognition, and timing.
Keyword agreement
quality of life
Q-Index Code C1
Q-Index Status Confirmed Code

Document type: Journal Article
Sub-type: Article (original research)
Collections: Faculty of Health and Behavioural Sciences -- Publications
2009 Higher Education Research Data Collection
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Citation counts: TR Web of Science Citation Count  Cited 47 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 46 times in Scopus Article | Citations
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Created: Thu, 09 Apr 2009, 22:56:21 EST by Geraldine Fitzgerald on behalf of School of Public Health