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Spoor JKH, Donders-Kamphuis M, Veenstra WS, van Dijk SA, Dirven CMF, Sillevis Smitt PAE, van den Bent MJ, Leenstra S, Satoer DD. Cognition and health-related quality of life in long-term survivors of high-grade glioma: an interactive perspective from patient and caregiver. Acta Neurochir (Wien) 2024; 166:166. [PMID: 38565800 PMCID: PMC10987343 DOI: 10.1007/s00701-024-06037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The health-related quality of life (HRQoL) and cognition are important indicators for the quality of survival in patients with high-grade glioma (HGG). However, data on long-term survivors and their caregivers are scarce. We aim to investigate the interaction between cognition and HRQoL in long-term survivors, their caregivers' evaluations, and the effect on caregiver strain and burden. METHODS 21 long-term HGG (8 WHO grade III and 13 WHO grade IV) survivors (survival ≥ 5 years) and 15 caregivers were included. Cognition (verbal memory, attention, executive functioning, and language), HRQoL, anxiety and depression, caregiver strain, and caregiver burden were assessed with standardized measures. Questionnaires were completed by patients and/or their caregivers. RESULTS Mean survival was 12 years (grade III) and 8 years (grade IV). Cognition was significantly impaired with a large individual variety. Patients' general HRQoL was not impaired but all functioning scales were deviant. Patient-proxy agreement was found in most HRQoL subscales. Three patients (14%) showed indications of anxiety or depression. One-third of the caregivers reported a high caregiver strain or a high burden. Test scores for attention, executive functioning, language, and/or verbal memory were correlated with perceived global health status, cognitive functioning, and/or communication deficits. Caregiver burden was not related to cognitive deficits. CONCLUSIONS In long-term HGG survivors maintained HRQoL seems possible even when cognition is impaired in a large variety at the individual level. A tailored approach is therefore recommended to investigate the cognitive impairments and HRQoL in patients and the need for patient and caregiver support.
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Affiliation(s)
- Jochem K H Spoor
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Marike Donders-Kamphuis
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- HMC, Department of Neurosurgery, The Hague, The Netherlands
| | - Wencke S Veenstra
- Department of Rehabilitation Medicine, Center for Rehabilitation - University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sarah A van Dijk
- Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Peter A E Sillevis Smitt
- Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martin J van den Bent
- Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sieger Leenstra
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Djaina D Satoer
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Lopez A, Tinella L, Caffò A, Bosco A. Measuring the reliability of proxy respondents in behavioural assessments: an open question. Aging Clin Exp Res 2023; 35:2173-2190. [PMID: 37540380 PMCID: PMC10520105 DOI: 10.1007/s40520-023-02501-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND In behavioural assessment, information can be gathered from internally referenced self-reports or from proxy informants. AIMS This study aimed to fine-tune a brief but reliable method for evaluating the proxy accuracy in cases where responses obtained from adult and older adults' patient cannot be considered reliable. METHODS We generated a set of items reflecting both overt and covert behaviours related to the basic instrumental activities of daily living. The psychometric properties of the content, factorial, and criterium validity of these items were then checked. The Proxy Reliability Questionnaire-ProRe was created. We tested the frequency of "I don't know" responses as a measure of proxy reliability in a sample of healthy older adults and their proxies, and in a second sample of proxy respondents who answered questions about their parents. RESULTS As expected, response precision was lower for items characterizing covert behaviours; items about covert compared to overt behaviours generated more "I don't know" answers. Proxies provided less "I don't know" responses when evaluating the parent, they claimed they knew better. Moreover, we tried to validate our approach using response confidence. Encouragingly, these results also showed differences in the expected direction in confidence between overt and covert behaviours. CONCLUSIONS The present study encourages clinicians/researchers to how well the proxy the patient know each other, the tendency of proxies to exhibit, for example, response bias when responding to questions about patients' covert behaviours, and more importantly, the reliability of informants in providing a clinical assessment of neurocognitive diseases associated with aging.
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Affiliation(s)
- Antonella Lopez
- Faculty of Law, Giustino Fortunato University, Via Delcogliano, 12, Benevento, Italy
- Department of Educational Sciences, Psychology, Communication, University of Bari, Via Crisanzio 42, 70122 Bari, Italy
| | - Luigi Tinella
- Department of Educational Sciences, Psychology, Communication, University of Bari, Via Crisanzio 42, 70122 Bari, Italy
| | - Alessandro Caffò
- Department of Educational Sciences, Psychology, Communication, University of Bari, Via Crisanzio 42, 70122 Bari, Italy
| | - Andrea Bosco
- Department of Educational Sciences, Psychology, Communication, University of Bari, Via Crisanzio 42, 70122 Bari, Italy
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Kesler SR, Henneghan AM, Prinsloo S, Palesh O, Wintermark M. Neuroimaging based biotypes for precision diagnosis and prognosis in cancer-related cognitive impairment. Front Med (Lausanne) 2023; 10:1199605. [PMID: 37720513 PMCID: PMC10499624 DOI: 10.3389/fmed.2023.1199605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Cancer related cognitive impairment (CRCI) is commonly associated with cancer and its treatments, yet the present binary diagnostic approach fails to capture the full spectrum of this syndrome. Cognitive function is highly complex and exists on a continuum that is poorly characterized by dichotomous categories. Advanced statistical methodologies applied to symptom assessments have demonstrated that there are multiple subclasses of CRCI. However, studies suggest that relying on symptom assessments alone may fail to account for significant differences in the neural mechanisms that underlie a specific cognitive phenotype. Treatment plans that address the specific physiologic mechanisms involved in an individual patient's condition is the heart of precision medicine. In this narrative review, we discuss how biotyping, a precision medicine framework being utilized in other mental disorders, could be applied to CRCI. Specifically, we discuss how neuroimaging can be used to determine biotypes of CRCI, which allow for increased precision in prediction and diagnosis of CRCI via biologic mechanistic data. Biotypes may also provide more precise clinical endpoints for intervention trials. Biotyping could be made more feasible with proxy imaging technologies or liquid biomarkers. Large cross-sectional phenotyping studies are needed in addition to evaluation of longitudinal trajectories, and data sharing/pooling is highly feasible with currently available digital infrastructures.
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Affiliation(s)
- Shelli R. Kesler
- Division of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Diagnostic Medicine, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
| | - Ashley M. Henneghan
- Division of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, United States
- Department of Oncology, Dell School of Medicine, The University of Texas at Austin, Austin, TX, United States
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Oxana Palesh
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
| | - Max Wintermark
- Department of Neuroradiology, The University of Texas MD Anderson Cancer, Houston, TX, United States
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Jacinto M, Rodrigues F, Monteiro D, Antunes R, Ferreira JP, Matos R, Campos MJ. Quality of Life in Individuals with Intellectual and Developmental Disabilities: The Congruency Effect between Reports. Healthcare (Basel) 2023; 11:1748. [PMID: 37372866 DOI: 10.3390/healthcare11121748] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Assessing quality of life (QoL) is important to provide personalized and individualized support plans with the purpose of improving personal outcomes. Based on the conceptual model of QoL, the aim of this study was to assess the congruence between the perceptions of institutionalized individuals with intellectual and developmental disabilities (IDD) and the perception of a third party, regarding QoL. Forty-two individuals participated in this study, including twenty-one with mild to severe IDD and their family members/caregiver/reference technician, who responded to the Personal Outcomes Scale (Portuguese version). Significant differences (p < 0.05) were found between reports in the personal development (t = -2.26; p = 0.024), emotional well-being (t = -2.263; p = 0.024), physical well-being (t = -2.491; p = 0.013) and total QoL (t = -2.331; p = 0.02). The results further show that most third-party reports tend to undervalue the QoL of the individual with IDD, and that there is no congruence in any of the QoL domains. The inclusion of self-reports in the QoL assessment is important. In addition to the assessment of third-party reports, the process of making decisions appropriate to the context and individual characteristics is equally important. On the other hand, the inclusion of third-party reports is an opportunity to promote communication among all stakeholders, recognize and discuss differences, and promote QoL, not only of individuals with IDD, but also of families.
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Affiliation(s)
- Miguel Jacinto
- Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-248 Coimbra, Portugal
- ESECS, Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal
| | - Filipe Rodrigues
- ESECS, Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal
| | - Diogo Monteiro
- ESECS, Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal
- Research Center in Sport Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Raul Antunes
- ESECS, Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - José Pedro Ferreira
- Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-248 Coimbra, Portugal
- Research Center for Sport and Physical Activity (CIDAF), 3040-248 Coimbra, Portugal
| | - Rui Matos
- ESECS, Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Life Quality Research Centre (CIEQV), 2040-413 Rio Maior, Portugal
| | - Maria João Campos
- Faculty of Sport Sciences and Physical Education, University of Coimbra, 3040-248 Coimbra, Portugal
- Research Center for Sport and Physical Activity (CIDAF), 3040-248 Coimbra, Portugal
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Roydhouse J, Reeve BB. Incorporating Information From Proxies for Patient-Centered Outcomes in Adult and Pediatric Oncology Settings. J Clin Oncol 2023; 41:1518-1522. [PMID: 36269934 DOI: 10.1200/jco.22.01049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI
| | - Bryce B Reeve
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
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Adegboyega G, Jordan C, Kawka M, Chisvo N, Toescu SM, Hill C. Quality of life reporting in the management of posterior fossa tumours: A systematic review. Front Surg 2022; 9:970889. [PMID: 36303860 PMCID: PMC9594859 DOI: 10.3389/fsurg.2022.970889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Survival amongst posterior fossa tumour (PFT) patients is improving. Clinical endpoints such as overall survival fail to depict QoL. There is yet to be a review of current QoL instruments used for adult PFTs. Aim of this review is to outline the QoL reporting in the management of PFTs and measure participation level. Methods This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A search strategy to identify adult patients with PFTs who took part in QoL metrics was conducted. Observational and experimental studies published from 1990 to date were included. Studies with a sample size less than 10 and performance measures such as Karnofsky Performance Status were not considered. Results A total of 116 studies were included in the final analysis. Vestibular schwannomas were the most common tumour pathology (n = 23,886, 92.6%) followed by pilocytic astrocytomas (n = 657, 2.5%) and meningiomas (n = 437, 1.7%) Twenty-five different QoL measures were used in the study pool. SF-36 was the most common (n = 55, 17 47.4%) QoL metric in the whole study pool, followed by the Penn Acoustic Neuroma QoL scale (n = 24, 20.7%) and Dizziness Handicap Inventory (n = 16, 13.8%). Seventy-two studies reported less-than 100% participation in QoL evaluation. The commonest reason for non-participation was a lack of response (n = 1,718, 60.8%), incomplete questionnaires (n = 268, 9.4%) and cognitive dysfunction (n = 258, 9.1%). Conclusion Informed clinical decision-making in PFT patients requires the development of specific QoL outcomes. Core outcome sets, and minimal clinically important differences (MCID) are essential for these metrics to show clinically significant improvements in patient QoL.
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Affiliation(s)
- Gideon Adegboyega
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Chloe Jordan
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Michal Kawka
- Imperial College London School of Medicine, London, United Kingdom
| | - Nathan Chisvo
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Ciaran Hill
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
- University College London Cancer Institute, London, United Kingdom
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Strand PS, Sagberg LM, Gulati S, Solheim O. Brain infarction following meningioma surgery-incidence, risk factors, and impact on function, seizure risk, and patient-reported quality of life. Neurosurg Rev 2022; 45:3237-3244. [PMID: 35902426 PMCID: PMC9492562 DOI: 10.1007/s10143-022-01840-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/28/2022] [Accepted: 07/20/2022] [Indexed: 02/03/2023]
Abstract
In this study, we seek to explore the incidence of and potential risk factors for postoperative infarctions after meningioma surgery, in addition to the possible association with new neurological deficits, seizures, and health-related quality of life (HRQoL). A single-center cohort study was conducted, where all patients operated for an intracranial meningioma at our institution between 2007 and 2020 were screened for inclusion. Clinical data were prospectively collected in a local tumor registry, and HRQoL was assessed using both generic and disease-specific instruments. In total, 327 meningioma operations were included, and early postoperative MRIs showed peritumoral infarctions in 114 (34.9%). Median infarction volume was 4.5 ml (interquartile range 2.0-9.5) and 43 (37.7%) of the infarctions were rim-shaped, 44 (38.6%) were sector-shaped, 25 (21.9%) were a combination of rim- and sector-shaped, and two (1.8%) were remote infarctions. Permanent neurological deficits were seen in 22 patients (6.7%) and deficits were associated with infarctions (p < 0.001). There was no difference in frequency of registered postoperative epilepsy between patients with versus without infarctions. Patients with infarctions reported more future uncertainty; otherwise, there were no significant differences in disease specific HRQoL between patients with versus without infarctions. In this study, we found that peritumoral infarctions after meningioma resection are common. Most patients with permanent neurological deficits had infarctions. Yet, most infarctions were small, and although sometimes symptomatic on individual level, infarctions did not lead to significant deterioration of HRQoL on group level.
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Affiliation(s)
- Per S. Strand
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lisa M. Sagberg
- grid.52522.320000 0004 0627 3560Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sasha Gulati
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ole Solheim
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Kesler SR, Henneghan AM, Thurman W, Rao V. Identifying themes for assessing cancer-related cognitive impairment identified by topic modeling and qualitative content analysis of public online comments (Preprint). JMIR Cancer 2021; 8:e34828. [PMID: 35612878 PMCID: PMC9178450 DOI: 10.2196/34828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022] Open
Abstract
Background Cancer-related cognitive impairment (CRCI) is a common and significant adverse effect of cancer and its therapies. However, its definition and assessment remain difficult due to limitations of currently available measurement tools. Objective This study aims to evaluate qualitative themes related to the cognitive effects of cancer to help guide development of assessments that are more specific than what is currently available. Methods We applied topic modeling and inductive qualitative content analysis to 145 public online comments related to cognitive effects of cancer. Results Topic modeling revealed 2 latent topics that we interpreted as representing internal and external factors related to cognitive effects. These findings lead us to hypothesize regarding the potential contribution of locus of control to CRCI. Content analysis suggested several major themes including symptoms, emotional/psychological impacts, coping, “chemobrain” is real, change over time, and function. There was some conceptual overlap between the 2 methods regarding internal and external factors related to patient experiences of cognitive effects. Conclusions Our findings indicate that coping mechanisms and locus of control may be important themes to include in assessments of CRCI. Future directions in this field include prospective acquisition of free-text responses to guide development of assessments that are more sensitive and specific to cognitive function in patients with cancer.
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Affiliation(s)
- Shelli R Kesler
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Ashley M Henneghan
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Whitney Thurman
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Vikram Rao
- School of Nursing, University of Texas at Austin, Austin, TX, United States
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Roydhouse JK, Cohen ML, Eshoj HR, Corsini N, Yucel E, Rutherford C, Wac K, Berrocal A, Lanzi A, Nowinski C, Roberts N, Kassianos AP, Sebille V, King MT, Mercieca-Bebber R. The use of proxies and proxy-reported measures: a report of the international society for quality of life research (ISOQOL) proxy task force. Qual Life Res 2021; 31:317-327. [PMID: 34254262 DOI: 10.1007/s11136-021-02937-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 12/15/2022]
Abstract
AIMS Proxy reports are often used when patients are unable to self-report. It is unclear how proxy measures are currently in use in adult health care and research settings. We aimed to describe how proxy reports are used in these settings, including the use of measures developed specifically for proxy reporting in adult health populations. METHODS We systematically searched Medline, PsycINFO, PsycTESTS, CINAHL and EMBASE from database inception to February 2018. Search terms included a combination of terms for quality of life and health outcomes, proxy-reporters, and health condition terms. The data extracted included clinical context, the name of the proxy measure(s) used and other descriptive data. We determined whether the measures were developed specifically for proxy use or were existing measures adapted for proxy use. RESULTS The database search identified 17,677 possible articles, from which 14,098 abstracts were reviewed. Of these, 11,763 were excluded and 2335 articles were reviewed in full, with 880 included for data extraction. The most common clinical settings were dementia (30%), geriatrics (15%) and cancer (13%). A majority of articles (51%) were paired studies with proxy and patient responses for the same person on the same measure. Most paired studies (77%) were concordance studies comparing patient and proxy responses on these measures. DISCUSSION Most published research using proxies has focused on proxy-patient concordance. Relatively few measures used in research with proxies were specifically developed for proxy use. Future work is needed to examine the performance of measures specifically developed for proxies. SYSTEMATIC REVIEW REGISTRATION PROSPERO No. CRD42018103179.
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Affiliation(s)
- Jessica K Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Matthew L Cohen
- Department of Communication Sciences and Disorders, University of Delaware, Newark, DE, USA
| | - Henrik R Eshoj
- Department of Hematology, Quality of Life Research Center, Odense University Hospital, Odense, Denmark
| | - Nadia Corsini
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Emre Yucel
- Amgen, Global Health Economics, Thousand Oaks, CA, USA
- Bristol Myers Squibb, New York, NY, USA
| | - Claudia Rutherford
- Cancer Nursing Research Unit (CNRU), Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Katarzyna Wac
- Quality of Life Technologies Lab, University of Geneva, Geneva, Switzerland
- Quality of Life Technologies Lab, University of Copenhagen, Copenhagen, Denmark
| | - Allan Berrocal
- Quality of Life Technologies Lab, University of Geneva, Geneva, Switzerland
| | - Alyssa Lanzi
- Department of Communication Sciences and Disorders, University of Delaware, Newark, DE, USA
| | - Cindy Nowinski
- Departments of Medical Social Sciences and Neurology, Northwestern University Feinberg School of Medicine, Evanston, IL, USA
| | - Natasha Roberts
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
| | - Angelos P Kassianos
- Department of Applied Health Research, University College London, London, UK
| | - Veronique Sebille
- SPHERE, University of Nantes, University of Tours, INSERM, Nantes, France
- Department of Methodology and Biostatistics, Nantes University Hospital, Nantes, France
| | - Madeleine T King
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Rebecca Mercieca-Bebber
- Faculty of Medicine, Sydney Medical School, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
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Assessment of Executive Functioning in Patients with Meningioma and Low-Grade Glioma: A Comparison of Self-Report, Proxy-Report, and Test Performance. J Int Neuropsychol Soc 2020; 26:187-196. [PMID: 31699166 DOI: 10.1017/s1355617719001164] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study aimed to examine: (1) patient-proxy agreement on executive functioning (EF) of patients with primary brain tumors, (2) the relationships between patient- and proxy-report with performance-based measures of EF, and (3) the potential influence of performance-based measures on the level of agreement. METHODS Meningioma and low-grade glioma patients and their informal caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF-A) 3 months after surgery. The two index scores of the BRIEF-A, Behavioral Regulation and Metacognition, were evaluated. Mean scores of patients and proxies were compared with normative values and with each other. Patient-proxy agreement was evaluated with Lin's concordance correlation coefficients (CCCs) and Bland-Altman plots. Pearson correlation coefficients between reported EF and performance-based measures of EF were calculated. Multiple regression analysis was used to evaluate the potential influence of test performance on differences in dyadic reports. RESULTS A total of 47 dyads were included. Patients reported significantly more problems on the Metacognition Index compared to norms, and also in comparison with their proxies. Effect sizes indicated small differences. Moderate to substantial agreement was observed between patients and proxies, with CCCs of 0.57 and 0.61 for Metacognition and Behavioral Regulation, respectively. Correlations between reported EF and test performance ranged between -0.37 and 0.10. Dyadic agreement was not significantly influenced by test performance. CONCLUSIONS Patient-proxy agreement was found to be moderate. No clear associations were found between reported EF and test performance. Future studies should further explore the existing and new methods to assess everyday EF in brain tumor patients.
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Rosenlund L, Degsell E, Jakola AS. Moving from clinician-defined to patient-reported outcome measures for survivors of high-grade glioma. Patient Relat Outcome Meas 2019; 10:267-276. [PMID: 31692481 PMCID: PMC6711557 DOI: 10.2147/prom.s179313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Persons with high-grade glioma face both neurological and cancer-related symptoms from the tumor itself and its treatment affecting their daily lives. Survival alone is not an adequate outcome, the quality of the survivorship experience needs to be regarded with equal importance. Patient-reported outcome (PRO) measures can be used to evaluate treatment effects and symptom management interventions. PURPOSE The aim of this review was to identify the use, challenges, and potential of PRO measures in survivors of high-grade glioma. METHODS A narrative expert opinion review was performed on the subject. In addition to our own experiences we searched PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and PsycINFO for brain tumor-specific PRO measures used in the population of adult patients with high-grade glioma, both original articles and reviews were included. RESULTS There are several PRO measures that have been validated for patients with primary brain tumors including high-grade glioma. PRO measures are used both in clinical trials to evaluate the effect of treatment on health-related quality of life, and in daily clinical practice for holistic needs assessment and symptom management. Common PRO measures used for patients with high-grade glioma are European Organization for Research and Treatment of Cancer general instrument for patients with cancer together with brain tumor module, Functional Assessment of Cancer Therapy-Brain, and MD Anderson Symptom Inventory for Brain Tumor. Neurologic and cognitive disorders often occur in patients with high-grade glioma, which affects patients' ability to self-report over time, making it more challenging in this population. PRO as a primary outcome seems underutilized. CONCLUSION For clinical research, PRO measures need to be used together with other clinical outcome measures rather than replacing traditional outcome measures. Moving to more use of PRO measures in survivorship care has potential to improve patient-caregiver-healthcare team communication, symptom management, and quality of care. Implementing PROs in survivorship care should also involve caregivers and a response based on the results.
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Affiliation(s)
- Lena Rosenlund
- Regional Cancer Centre Stockholm, Stockholm, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Eskil Degsell
- Regional Cancer Centre Stockholm, Stockholm, Sweden
- Malignant Brain Tumor Pathway, Quality and Patient Safety Department, Karolinska University Hospital, Stockholm, Sweden
- The Swedish Brain Tumor Association, Stockholm, Sweden
| | - Asgeir Store Jakola
- Department of Clinical Neurosciences, Institute of Physiology and Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
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12
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Bucki B, Spitz E, Baumann M. Emotional and social repercussions of stroke on patient-family caregiver dyads: Analysis of diverging attitudes and profiles of the differing dyads. PLoS One 2019; 14:e0215425. [PMID: 31013289 PMCID: PMC6478282 DOI: 10.1371/journal.pone.0215425] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/02/2019] [Indexed: 12/18/2022] Open
Abstract
For patients, the social and emotional repercussions of stroke include shame, personality changes, and upheavals experienced by the couple (i.e. patient and main family caregiver). These impacts on the couple 'patient/family caregiver' are scarcely documented. Focusing on the perceptions of the patients and the family caregivers living at home, two years after a stroke occurrence, the aims of the study were to analyse the concordance of attitudes towards the emotional and social repercussions of stroke and to determine the profiles of the differing dyads. Two researchers conducted separate face-to-face structured interviews with stroke survivors and their family caregivers. Eleven items, identified through a content analysis of interviews and after a qualitative process of generating questionnaire items, assessed the commonly experienced impact of stroke on the family, the social repercussions of stroke, and its emotional effects on the stroke survivors. The kappa concordance coefficient was used to determine the response convergence between patients and family caregivers. Four items, selected by a panel of experts, were included in logistic regressions (i.e., demographic characteristics and patients' impaired functions) to identify the differing dyadic profiles. Family caregivers' and patients' attitudes towards the social repercussions of stroke were similar. Patients with motor deficiencies tended to underestimate the upheaval brought to their couple by stroke, whereas caregivers of language-impaired patients tended to underestimate their feelings of shame and demeaning. Communication disturbances, but also residual physical disabilities in stroke survivors, may affect the understanding of each other's attitudes within dyads. In order to avoid dysfunctional relationships between family caregivers and patients, healthcare professionals need to pay special attention to this issue, especially in cases of aphasia and motor deficiencies.
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Affiliation(s)
- Barbara Bucki
- Institute for Research on Socio-Economy and health Inequalities (IRSEI), Unit INSIDE, University of Luxembourg, Luxembourg city, Grand-Duchy of Luxembourg
- Department of Psychology, EA4360 APEMAC, University of Lorraine, Paris Descartes University, Metz, France
| | - Elisabeth Spitz
- Department of Psychology, EA4360 APEMAC, University of Lorraine, Paris Descartes University, Metz, France
| | - Michèle Baumann
- Institute for Research on Socio-Economy and health Inequalities (IRSEI), Unit INSIDE, University of Luxembourg, Luxembourg city, Grand-Duchy of Luxembourg
- * E-mail:
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13
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Mcpherson CJ, Wilson KG, Lobchuk MM, Brajtman S. Self-Perceived Burden to Others: Patient and Family Caregiver Correlates. J Palliat Care 2019. [DOI: 10.1177/082585970702300303] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims To provide further evidence about the prevalence and correlates of the sense of “self-perceived burden” (SPB) to others, and to examine its association with caregiver reports of burden. Methods The participants were 65 patients with advanced cancer and their family caregivers. Patients completed measures of SPB and family members completed a caregiver burden scale. Results SPB was experienced at minimal to mild levels by 35% of patients, and at moderate to extreme levels by another 28%. It was correlated with some physical symptoms, but more frequently with psychological symptoms. The family members of patients who reported that SPB was a significant problem had higher scores on the caregiver burden scale than family members of other patients (p=0.048), although the overall correlation was modest. Conclusions SPB is a common and distressing concern for many patients receiving palliative care and is associated with a number of other distressing concerns.
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Affiliation(s)
| | | | | | - Susan Brajtman
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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14
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Ruben MA, Blanch-Hartigan D, Shipherd JC. To Know Another’s Pain: A Meta-analysis of Caregivers’ and Healthcare Providers’ Pain Assessment Accuracy. Ann Behav Med 2018; 52:662-685. [DOI: 10.1093/abm/kax036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Mollie A Ruben
- School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences University, Boston, MA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, US Department of Veterans Affairs, Boston, MA
| | | | - Jillian C Shipherd
- National Center for PTSD, Women’s Health Sciences, VA Boston Healthcare System, Boston, MA
- Boston University School of Medicine, Boston, MA
- Lesbian, Gay, Bisexual, and Transgender (LGBT) Program, Veterans Health Administration, Washington, DC
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Hsu T, Loscalzo M, Ramani R, Forman S, Popplewell L, Clark K, Katheria V, Strowbridge R, Rinehart R, Smith D, Matthews K, Dillehunt J, Feng T, Smith D, Sun C, Hurria A. Are Disagreements in Caregiver and Patient Assessment of Patient Health Associated with Increased Caregiver Burden in Caregivers of Older Adults with Cancer? Oncologist 2017; 22:1383-1391. [PMID: 28808093 PMCID: PMC5679832 DOI: 10.1634/theoncologist.2017-0085] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/08/2017] [Indexed: 12/27/2022] Open
Abstract
Cancer‐related therapy is increasingly administered in the outpatient setting, resulting in increased dependence on caregivers suggest to provide physical and emotional support to patients. This article describes differences in patient versus caregiver assessments of patient health, considering caregiver perceptions of the patient's health and abilities compared to that reported by the patient. Background. As patients age, caregivers increasingly provide essential support and patient information. We sought to determine if patient‐caregiver assessments of patient health differ and if differences contribute to burden in caregivers of older adults with cancer. Materials and Methods. One hundred patients, aged ≥65, and their caregivers independently assessed patient function, comorbidity, nutrition, social activity, social support, and mental health. Caregivers completed the Caregiver Strain Index (CSI). Patient‐caregiver assessments were compared using the Wilcoxon signed rank test and paired t test. Association between caregiver burden and differences between patient‐caregiver assessments was examined using generalized linear regression. Results. Median patient age was 70 (range 65–91) and 70% had advanced disease. Sixty percent of patients reported requiring help with instrumental activities of daily living (IADLs); most had good social support (median Medical Outcomes Study [MOS]‐Social Support Survey score 92) and mental health (median Mental Health Inventory score 85). Caregivers were a median age of 66 (range 28–85), 73% female, 68% spousal caregivers, and 79% lived with the patient. Caregivers rated patients as having poorer physical function (more IADLs dependency [p = .008], lower Karnofsky Performance Status [p = .02], lower MOS‐Physical Function [p < .0001]), poorer mental health (p = .0002), and having more social support (p = .03) than patients themselves. Three‐quarters of caregivers experienced some caregiver burden (mean CSI score 3.1). Only differences in patient‐caregiver assessment of the patient's need for help with IADLs were associated with increased caregiver burden (p = .03). Conclusion. Patient‐caregiver assessments of patient function, mental health, and social support differ. However, only differences in assessment of IADLs dependency were associated with increased caregiver burden. Implications for Practice. As patients age, there is a higher incidence of frailty and cognitive impairments. As a result, caregivers play an increasingly vital role in providing information about patient health to healthcare providers, which is used to help healthcare providers tailor treatments and optimize patient health. These findings highlight that caregiver reporting in older adults with cancer may not replace patient reporting in those older adults who are otherwise able to self‐report. Furthermore, clinicians should check for caregiver burden in caregivers who report providing more help with instrumental activities of daily living than patients themselves report and provide appropriate support as needed.
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Affiliation(s)
- Tina Hsu
- City of Hope National Medical Center, Duarte, California, USA
| | | | - Rupal Ramani
- City of Hope National Medical Center, Duarte, California, USA
| | - Stephen Forman
- City of Hope National Medical Center, Duarte, California, USA
| | | | - Karen Clark
- City of Hope National Medical Center, Duarte, California, USA
| | - Vani Katheria
- City of Hope National Medical Center, Duarte, California, USA
| | - Rex Strowbridge
- City of Hope National Medical Center, Duarte, California, USA
| | | | - Dan Smith
- City of Hope National Medical Center, Duarte, California, USA
| | - Keith Matthews
- City of Hope National Medical Center, Duarte, California, USA
| | - Jeff Dillehunt
- City of Hope National Medical Center, Duarte, California, USA
| | - Tao Feng
- City of Hope National Medical Center, Duarte, California, USA
| | - David Smith
- City of Hope National Medical Center, Duarte, California, USA
| | - Canlan Sun
- City of Hope National Medical Center, Duarte, California, USA
| | - Arti Hurria
- City of Hope National Medical Center, Duarte, California, USA
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Thorn H, Uhrenfeldt L. Experiences of non-specialist nurses caring for patients and their significant others undergoing transitions during palliative end-of-life cancer care: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:1711-1746. [PMID: 28628524 DOI: 10.11124/jbisrir-2016-003026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Non-specialist nurses, who are providing palliative end-of-life cancer care to patients and significant others undergoing psychosocial and existential transitions, may experience dissatisfaction, frustration and sorrow. On the other hand, they may also experience happiness, increased knowledge and personal growth. OBJECTIVE/QUESTION What are non-specialist nurses' experiences when providing palliative end-of-life cancer care that involves the psychosocial and existential transitions of their patients and significant others? INCLUSION CRITERIA TYPES OF PARTICIPANTS The current review considered studies that included a description of the experiences of non-specialist trained registered nurses (RNs) working in non-specialist wards. PHENOMENA OF INTEREST The current review considered studies that investigated experiences of RNs when providing palliative end-of-life cancer care that involves the psychosocial and existential transitions of their patients and significant others. CONTEXT The contact and care for patients and their significant others during palliative end-of-life cancer care. TYPES OF STUDIES The current review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. SEARCH STRATEGY The search aimed at finding both published and unpublished studies in English, Danish, Norwegian, Swedish and German, and was unrestricted by time. Eleven electronic databases and seven websites were searched. METHODOLOGICAL QUALITY Methodological validity of the qualitative papers was assessed independently by two reviewers using the standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA EXTRACTION Data were extracted from papers included in the review using the standardized data extraction tool from the JBI-QARI. DATA SYNTHESIS Qualitative research findings were synthesized using the JBI-QARI. RESULTS A total of 81 findings were extracted from the three studies and allocated to five categories and merged into a meta-synthesis with the overarching synthesized finding related to the challenges that non-specialist nurses faced when providing palliative end-of-life cancer care. The summary of findings is illustrated below. CONCLUSION The studies in this review provided useful and credible statements from non-specialist nurses working in non-specialist wards about their challenges when providing palliative end-of-life cancer care to patients and their significant others undergoing psychosocial and existential transitions.
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Affiliation(s)
- Hrønn Thorn
- 1Department of Gynecology and Obstetrics, Horsens Regional Hospital, Horsens, Denmark 2Department of Research, Horsens Regional Hospital, Horsens, Denmark 3Department of Health Science and Technology, Aalborg University, Aalborg, Denmark 4Danish Center of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence, the Center of Clinical Guidelines - Clearing House, Aalborg University, Aalborg, Denmark 5Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
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17
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Sabyani H, Wiechula R, Magarey J, Donnelly F. Experiences of healthcare professionals of having their significant other admitted to an acute care facility: a qualitative systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:1409-1439. [PMID: 28498175 DOI: 10.11124/jbisrir-2016-003028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Most healthcare professionals at some time will experience having a significant other admitted to an acute care hospital. The knowledge and understanding that these individuals possess because of their professional practice can potentially alter this experience. Expectations of staff and other family members (FMs) can potentially increase the burden on these health professionals. All FMs of patients should have their needs and expectations considered; however, this review specifically addresses what may be unique for healthcare professionals. OBJECTIVES To synthesize the qualitative evidence on the experiences of healthcare professionals when their significant others are admitted to an acute care hospital. INCLUSION CRITERIA TYPES OF PARTICIPANTS The current review considered studies reporting the experiences of healthcare professionals, specifically registered nurses (RNs) and physicians. PHENOMENA OF INTEREST The experiences of RNs and physicians when a significant other is admitted to an acute care facility. TYPES OF STUDIES Qualitative studies that have examined the phenomenon of interest including, but not limited to, designs such as phenomenology and grounded theory. SEARCH STRATEGY The search strategy aimed to find both published and unpublished studies with no date restrictions. Only studies published in English were considered for inclusion in this review. METHODOLOGICAL QUALITY Qualitative papers selected for retrieval were assessed using the standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA EXTRACTION Data were extracted from the seven included papers using the standardized data extraction tool from JBI-QARI. DATA SYNTHESIS The data were synthesized using the JBI approach to meta-synthesis by meta-aggregation using the JBI-QARI software and methods. RESULTS Seven studies of moderate quality were included in the review. Forty findings were extracted and aggregated to create 10 categories, from which five synthesized findings were derived: CONCLUSION: In contrast to "lay" FMs, health professionals possess additional knowledge and understanding that alter their perceptions and expectations, and the expectations others have of them. This knowledge and understanding can be an advantage in navigating a complex health system but may also result in an additional burden such as role conflict.
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Affiliation(s)
- Hussamaldeen Sabyani
- 1Adelaide Nursing School, The University of Adelaide, Adelaide, Australia 2The Centre for Evidence-Based Practice South Australia (CEPSA): a Joanna Briggs Institute Centre of Excellence, Adelaide, Australia 3King Abdullah Medical City, Makkah, Mecca, Saudi Arabia
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Systematic review of caregiver responses for patient health-related quality of life in adult cancer care. Qual Life Res 2017; 26:1925-1954. [PMID: 28293821 DOI: 10.1007/s11136-017-1540-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE In surveys and in research, proxies such as family members may be used to assess patient health-related quality of life. The aim of this research is to help cancer researchers select a validated health-related quality of life tool if they anticipate using proxy-reported data. METHODS Systematic review and methodological appraisal of studies examining the concordance of paired adult cancer patient and proxy responses for multidimensional, validated HRQOL tools. We searched PubMed, CINAHL, PsycINFO and perused bibliographies of reviewed papers. We reviewed concordance assessment methods, results, and associated factors for each validated tool. RESULTS A total of 32 papers reporting on 29 study populations were included. Most papers were cross-sectional (N = 20) and used disease-specific tools (N = 19), primarily the FACT and EORTC. Patient and proxy mean scores were similar on average for tools and scales, with most mean differences <10 points but large standard deviations. Average ICCs for the FACT and EORTC ranged from 0.35 to 0.62, depending on the scale. Few papers (N = 15) evaluated factors associated with concordance, and results and measurement approaches were inconsistent. The EORTC was the most commonly evaluated disease-specific tool (N = 5 papers). For generic tools, both concordance and associated factor information was most commonly available for the COOP/WONCA (N = 3 papers). The MQOL was the most frequently evaluated end-of-life tool (N = 3 papers). CONCLUSIONS Proxy and patient scores are similar on average, but there is large, clinically important residual variability. The evidence base is strongest for the EORTC (disease-specific tools), COOP/WONCA (generic tools), and MQOL (end-of-life-specific tools).
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19
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Ediebah DE, Reijneveld JC, Taphoorn MJB, Coens C, Zikos E, Aaronson NK, Heimans JJ, Bottomley A, Klein M. Impact of neurocognitive deficits on patient-proxy agreement regarding health-related quality of life in low-grade glioma patients. Qual Life Res 2016; 26:869-880. [PMID: 27744512 PMCID: PMC5334398 DOI: 10.1007/s11136-016-1426-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Clinical trials in glioma patients with neurocognitive deficits face challenges due to lacking or unreliable patient self-reports on their health-related quality of life (HRQOL). Patient-proxy data could help solve this issue. We determined whether patient-proxy concordance levels were affected by patients' neurocognitive functioning. METHODS Patient and patient-by-proxy HRQOL ratings were assessed via SF-36 and EORTC QLQ-BN20, respectively, in 246 patients. Data on neurocognitive functioning were collected on a subgroup of 195 patients. Patient-proxy agreement was measured using the Bland-Altman limit of agreement, the mean difference, the concordance correlation coefficient (CCC), and the percentage difference (PD, ±0, 5, or 10 points). We defined patients to be cognitively impaired (n = 66) or cognitively intact (n = 129) based on their neurocognitive performance. RESULTS Patients rated their physical function and general health to be better than their proxies did, while at the same time, patients reported more visual disorders, communication deficits, itchy skin, and problems with bladder control. The cognitively impaired subgroup reported poorer physical functioning, more visual disorders, headaches, itchy skin, and issues with bladder control. In the cognitively intact group, no statistical significant differences were observed between patients and proxies. Not surprisingly, Bland-Altman plots revealed a high agreement between the patient and patient-by-proxy rating in all HRQOL domains ranging from 95 to 99 %. The CCC was fairly high in all HRQOL domains (0.37-0.80), and the percentage of perfect agreement (PD ± 0) ranged from 8.5 to 76.8 %. In the cognitively impaired patients, the mean difference between patients and proxies was overall larger, and accordingly, agreement based on Bland-Altman plots was lower. CONCLUSIONS The level of agreement between patient and patient-by-proxy ratings of low-grade glioma patients' HRQOL is generally high. However, patient-proxy agreement is lower in patients with neurocognitive deficits than in patients without neurocognitive deficits.
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Affiliation(s)
- Divine E Ediebah
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Jaap C Reijneveld
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.,Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands
| | - Corneel Coens
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Efstathios Zikos
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan J Heimans
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Andrew Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Martin Klein
- Department of Medical Psychology - B7D349, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Sabyani H, Wiechula R, Magarey J, Donnelly F. Healthcare professionals’ experiences of having a significant other admitted into an acute care facility. ACTA ACUST UNITED AC 2016; 14:103-9. [DOI: 10.11124/jbisrir-2016-002617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
OBJECTIVE In orthopaedic trauma, patients' functional status scores cannot be collected before injury. Due to the lack of these data, it is difficult to reliably determine if patients have returned to their preinjury level of physical function. The goal of this article is to determine if patients' assessment of preinjury function agrees with that of familiar proxies, to determine whether patient assessment of preinjury function may be regarded as reliable. METHODS At first postinjury outpatient follow up, orthopaedic trauma patients and their proxies were asked to independently complete the PROMIS physical function computer adaptive test (PF CAT) based on how they perceived the function of the patient before injury. Intraclass correlation, paired sample t tests, and 95% confidence intervals were used to analyze patient-proxy agreement. RESULTS Fifty patient-proxy pairs completed the questionnaire at an average of 14.3 (SD = 1.1) days postoperative (average 19.3, SD = 12.1 days postinjury). Patient mean PF CAT score was 57.92 (SD = 10.38) for patients and 56.59 (SD = 11.50) for proxies. Paired samples t test showed that patient's PF CAT scores were not significantly different from proxy scores [mean score difference = 1.33; 95% CI = (-1.28, 3.94); P = 0.311]. Intraclass correlation between patient and proxy scores was 0.79. There was no notable bias. DISCUSSION Good agreement in PF CAT preinjury assessment between patients and proxies support patients' ability to report reliable preinjury physical functioning in the early postinjury setting using the PF CAT.
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Chow R, Lao N, Popovic M, Chow E, Cella D, Beaumont J, Lam H, Pulenzas N, Bedard G, Wong E, DeAngelis C, Bottomley A. Comparison of the EORTC QLQ-BN20 and the FACT-Br quality of life questionnaires for patients with primary brain cancers: a literature review. Support Care Cancer 2015; 22:2593-8. [PMID: 25015058 DOI: 10.1007/s00520-014-2352-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 07/01/2014] [Indexed: 11/12/2022]
Abstract
PURPOSE This review compares and contrasts the development, validity, and characteristics of two quality of life (QOL) assessment tools used in patients with primary brain cancers: the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Brain Cancer Module (EORTC QLQ-BN20) and the Functional Assessment of Cancer Therapy-Brain (FACT-Br). METHODS A literature search was conducted using the Cochrane Central Register of Controlled Trials (June 2013), Ovid EMBASE (1947 to 2013, week 27), and Ovid MEDLINE (1946 to July 2013, week 1) to identify studies that discussed the development, characteristics, validity, and reliability of the EORTC QLQ-BN20 or the FACT-Br. RESULTS The EORTC QLQ-BN20 consists of 20 items that assess future uncertainty, visual disorder, motor dysfunction, and communication deficit. Items are presented as questions on a scale ranging from 1 = “not at all” to 4 = “very much.” Reliability and validity testing of the QLQ-BN20 revealed a Cronbach’s alpha coefficient that ranged from 0.71 to 0.90. The FACT-Br consists of 23 items that assess general well-being and brain cancer-specific concerns that include concentration, memory, seizures, eyesight, hearing, speech, personality, expression of thoughts, weakness, coordination, and headaches. These items are presented as statements on a scale ranging from 0 = “not applicable” to 4 = “extremely relevant.” The FACT-Br underwent validity as well as test-retest reliability testing with 101 and 46 patients, respectively. Validity testing found low to moderate correlation with the FACT-G questionnaire, while reliability testing for the brain subscale revealed an acceptable correlation coefficient (r = 0.66; p < 0.001). CONCLUSIONS The QLQ-BN20 and the FACT-Br are both valid and reliable tools that have been used extensively in the primary brain cancer population. Choice between the two tools should consider each instrument’s individual strengths and weaknesses.
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Predicting distress among people who care for patients living longer with high-grade malignant glioma. Support Care Cancer 2015; 24:43-51. [DOI: 10.1007/s00520-015-2739-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 04/13/2015] [Indexed: 11/26/2022]
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Crocker TF, Smith JK, Skevington SM. Family and professionals underestimate quality of life across diverse cultures and health conditions: systematic review. J Clin Epidemiol 2014; 68:584-95. [PMID: 25662007 DOI: 10.1016/j.jclinepi.2014.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 11/27/2014] [Accepted: 12/23/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine how accurately proxies evaluate quality of life (QoL) in people they know, using cross-cultural data from the multidimensional, multilingual World Health Organization Quality of Life assessment short-form (the WHOQOL-BREF) and whether accuracy varies by health condition or proxy type (eg, family/professional). STUDY DESIGN AND SETTING Systematic review with meta-analysis: We searched five databases for reports of proxy-completed WHOQOL-BREF scores and aggregated results using a random-effects model. Minimal clinically important difference values were calculated. RESULTS Analyses included nine studies (1980 dyads) of physical (n = 762) or mental (n = 604) health conditions, or intellectual disability (n = 614), in 10 countries. Mean person-proxy correlations ranged from 0.28 (social QoL) to 0.44 (physical QoL). Proxy measures were underestimates (ie, significantly lower than persons reported for themselves) for social [mean difference (MD) = 4.7, 95% confidence interval (CI): 1.8, 7.6], psychological (MD = 3.7, 95% CI: 0.6, 6.8), and physical (MD = 3.1, 95% CI: 0.6, 5.6) QoL. Underestimates varied significantly between health conditions for social (P < 0.001), psychological (P = 0.009), and physical (P = 0.02) QoL. Family members assessed psychological and environmental QoL better than professionals. CONCLUSION Proxies tend to be imprecise, underestimating QoL, and should be aware of this tendency. Where health care is decided for others, family members' views about QoL should be prioritized.
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Affiliation(s)
- Thomas F Crocker
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK.
| | - Jaime K Smith
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK; Caudwell Children, Minton Hollins Building, Shelton Old Road, Stoke-On-Trent ST4 7RY, UK
| | - Suzanne M Skevington
- Manchester Centre for Health Psychology, School of Psychological Sciences, Coupland 1 Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK
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Dirven L, Reijneveld JC, Taphoorn MJ. Health-Related Quality of Life or Quantity of Life: A Difficult Trade-Off in Primary Brain Tumors? Semin Oncol 2014; 41:541-552. [DOI: 10.1053/j.seminoncol.2014.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Living longer with adult high-grade glioma:setting a research agenda for patients and their caregivers. J Neurooncol 2014; 120:1-10. [DOI: 10.1007/s11060-014-1516-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
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Jacobs DI, Kumthekar P, Stell BV, Grimm SA, Rademaker AW, Rice L, Chandler JP, Muro K, Marymont M, Helenowski IB, Wagner LI, Raizer JJ. Concordance of patient and caregiver reports in evaluating quality of life in patients with malignant gliomas and an assessment of caregiver burden. Neurooncol Pract 2014; 1:47-54. [PMID: 26034616 DOI: 10.1093/nop/npu004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 02/05/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Given the neurocognitive impairment experienced by many patients with malignant gliomas, caregiver reports can be critical in assessing the quality of life (QOL) of these patients. In this study, we explored whether assessment of patient QOL by the primary caregiver shows concordance with the patient's self-reported QOL, and we quantified the burden faced by caregivers. METHODS QOL of 45 patients was evaluated by both the patient and primary caregiver on 3 or more separate occasions using the Functional Assessment of Cancer Therapy-Brain (FACT-Br) instrument, and concordance between the 2 reports was evaluated. Caregiver burden was measured using the Caregiver Quality of Life Index-Cancer (CQOL-C) instrument. RESULTS Overall, good concordance was observed between the patient and caregiver FACT-Br reports (intraclass correlation coefficient = 0.74). Patient-reported FACT-Br scores were 4.75 (95% CI, 1.44-8.05) points higher than paired caregiver reports on the 200-point scale (P = .008); however, this difference did not achieve clinical significance. Caregiver burden, as measured by the CQOL-C, was significantly greater among caregivers in this study than those previously reported for caregivers of patients with lung, breast, or prostate cancer (P < .001). CONCLUSIONS Despite minor discrepancies in caregiver assessments of patient QOL relative to patient self-reports, our results suggest that the caregiver assessments can serve as adequate proxies for patient reports. Our results also illustrate the particularly heavy burden faced by caregivers of patients with malignant glioma. Further research into both of these areas is warranted.
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Affiliation(s)
- Daniel I Jacobs
- Department of Neurology, Northwestern University , Chicago, Illinois (D.I.J., P.K., B.V.S., S.A.G., L.R., J.J.R.); Department of Preventive Medicine Northwestern University , Chicago, Illinois (A.W.R., I.B.H.); Department of Neurosurgery Northwestern University , Chicago, Illinois (J.P.C., K.M.); Department of Radiation Oncology , Northwestern University , Chicago, Illinois (M.M.); Medical Social Sciences , Northwestern University , Chicago, Illinois (L.I.W.)
| | - Priya Kumthekar
- Department of Neurology, Northwestern University , Chicago, Illinois (D.I.J., P.K., B.V.S., S.A.G., L.R., J.J.R.); Department of Preventive Medicine Northwestern University , Chicago, Illinois (A.W.R., I.B.H.); Department of Neurosurgery Northwestern University , Chicago, Illinois (J.P.C., K.M.); Department of Radiation Oncology , Northwestern University , Chicago, Illinois (M.M.); Medical Social Sciences , Northwestern University , Chicago, Illinois (L.I.W.)
| | - Becky V Stell
- Department of Neurology, Northwestern University , Chicago, Illinois (D.I.J., P.K., B.V.S., S.A.G., L.R., J.J.R.); Department of Preventive Medicine Northwestern University , Chicago, Illinois (A.W.R., I.B.H.); Department of Neurosurgery Northwestern University , Chicago, Illinois (J.P.C., K.M.); Department of Radiation Oncology , Northwestern University , Chicago, Illinois (M.M.); Medical Social Sciences , Northwestern University , Chicago, Illinois (L.I.W.)
| | - Sean A Grimm
- Department of Neurology, Northwestern University , Chicago, Illinois (D.I.J., P.K., B.V.S., S.A.G., L.R., J.J.R.); Department of Preventive Medicine Northwestern University , Chicago, Illinois (A.W.R., I.B.H.); Department of Neurosurgery Northwestern University , Chicago, Illinois (J.P.C., K.M.); Department of Radiation Oncology , Northwestern University , Chicago, Illinois (M.M.); Medical Social Sciences , Northwestern University , Chicago, Illinois (L.I.W.)
| | - Alfred W Rademaker
- Department of Neurology, Northwestern University , Chicago, Illinois (D.I.J., P.K., B.V.S., S.A.G., L.R., J.J.R.); Department of Preventive Medicine Northwestern University , Chicago, Illinois (A.W.R., I.B.H.); Department of Neurosurgery Northwestern University , Chicago, Illinois (J.P.C., K.M.); Department of Radiation Oncology , Northwestern University , Chicago, Illinois (M.M.); Medical Social Sciences , Northwestern University , Chicago, Illinois (L.I.W.)
| | - Laurie Rice
- Department of Neurology, Northwestern University , Chicago, Illinois (D.I.J., P.K., B.V.S., S.A.G., L.R., J.J.R.); Department of Preventive Medicine Northwestern University , Chicago, Illinois (A.W.R., I.B.H.); Department of Neurosurgery Northwestern University , Chicago, Illinois (J.P.C., K.M.); Department of Radiation Oncology , Northwestern University , Chicago, Illinois (M.M.); Medical Social Sciences , Northwestern University , Chicago, Illinois (L.I.W.)
| | - James P Chandler
- Department of Neurology, Northwestern University , Chicago, Illinois (D.I.J., P.K., B.V.S., S.A.G., L.R., J.J.R.); Department of Preventive Medicine Northwestern University , Chicago, Illinois (A.W.R., I.B.H.); Department of Neurosurgery Northwestern University , Chicago, Illinois (J.P.C., K.M.); Department of Radiation Oncology , Northwestern University , Chicago, Illinois (M.M.); Medical Social Sciences , Northwestern University , Chicago, Illinois (L.I.W.)
| | - Kenji Muro
- Department of Neurology, Northwestern University , Chicago, Illinois (D.I.J., P.K., B.V.S., S.A.G., L.R., J.J.R.); Department of Preventive Medicine Northwestern University , Chicago, Illinois (A.W.R., I.B.H.); Department of Neurosurgery Northwestern University , Chicago, Illinois (J.P.C., K.M.); Department of Radiation Oncology , Northwestern University , Chicago, Illinois (M.M.); Medical Social Sciences , Northwestern University , Chicago, Illinois (L.I.W.)
| | - MaryAnne Marymont
- Department of Neurology, Northwestern University , Chicago, Illinois (D.I.J., P.K., B.V.S., S.A.G., L.R., J.J.R.); Department of Preventive Medicine Northwestern University , Chicago, Illinois (A.W.R., I.B.H.); Department of Neurosurgery Northwestern University , Chicago, Illinois (J.P.C., K.M.); Department of Radiation Oncology , Northwestern University , Chicago, Illinois (M.M.); Medical Social Sciences , Northwestern University , Chicago, Illinois (L.I.W.)
| | - Irene B Helenowski
- Department of Neurology, Northwestern University , Chicago, Illinois (D.I.J., P.K., B.V.S., S.A.G., L.R., J.J.R.); Department of Preventive Medicine Northwestern University , Chicago, Illinois (A.W.R., I.B.H.); Department of Neurosurgery Northwestern University , Chicago, Illinois (J.P.C., K.M.); Department of Radiation Oncology , Northwestern University , Chicago, Illinois (M.M.); Medical Social Sciences , Northwestern University , Chicago, Illinois (L.I.W.)
| | - Lynne I Wagner
- Department of Neurology, Northwestern University , Chicago, Illinois (D.I.J., P.K., B.V.S., S.A.G., L.R., J.J.R.); Department of Preventive Medicine Northwestern University , Chicago, Illinois (A.W.R., I.B.H.); Department of Neurosurgery Northwestern University , Chicago, Illinois (J.P.C., K.M.); Department of Radiation Oncology , Northwestern University , Chicago, Illinois (M.M.); Medical Social Sciences , Northwestern University , Chicago, Illinois (L.I.W.)
| | - Jeffrey J Raizer
- Department of Neurology, Northwestern University , Chicago, Illinois (D.I.J., P.K., B.V.S., S.A.G., L.R., J.J.R.); Department of Preventive Medicine Northwestern University , Chicago, Illinois (A.W.R., I.B.H.); Department of Neurosurgery Northwestern University , Chicago, Illinois (J.P.C., K.M.); Department of Radiation Oncology , Northwestern University , Chicago, Illinois (M.M.); Medical Social Sciences , Northwestern University , Chicago, Illinois (L.I.W.)
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Hadziahmetovic M, Lo SS, Clarke JW, Farace E, Cavaliere R. Palliative treatment of poor prognosis patients with malignant gliomas. Expert Rev Anticancer Ther 2014; 8:125-32. [DOI: 10.1586/14737140.8.1.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Popovic M, Nguyen J, Chen E, Di Giovanni J, Zeng L, Chow E. Comparison of the EORTC QLQ-BM22 and the FACT-BP for assessment of quality of life in cancer patients with bone metastases. Expert Rev Pharmacoecon Outcomes Res 2014; 12:213-9. [PMID: 22458622 DOI: 10.1586/erp.11.99] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marko Popovic
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, M4N 3M5, ON, Canada
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Leung A, Lien K, Zeng L, Nguyen J, Caissie A, Culleton S, Holden L, Chow E. The EORTC QLQ-BN20 for assessment of quality of life in patients receiving treatment or prophylaxis for brain metastases: a literature review. Expert Rev Pharmacoecon Outcomes Res 2014; 11:693-700. [DOI: 10.1586/erp.11.66] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Thorn H, Uhrenfeldt L. Experiences of non-specialist nurses with patients and their significant others undergoing transitions during palliative end-of-life care: a systematic review protocol. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Novella JL, Boyer F, Jochum C, Jovenin N, Morrone I, Jolly D, Bakchine S, Blanchard F. Health Status in Patients with Alzheimer’s Disease: An Investigation of Inter-rater Agreement. Qual Life Res 2013; 15:811-9. [PMID: 16721641 DOI: 10.1007/s11136-005-5434-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of the present study was to examine the level of agreement between health status ratings provided by patients with Alzheimer's disease and by their proxies. BACKGROUND Because proxy-completed responses are often necessary in assessing health outcomes for the elderly, it is necessary to determine the feasibility and potential limitations of using proxies as a patient substitutes. METHODS To assess the potential utility of proxy responses on health status when subjects present a cognitive impairment, this study compared the responses of 70 subjects with Alzheimer's disease and those of their family and/or care provider proxy using the SF-36. Agreement between proxies and patients was measured by intraclass correlation coefficients (ICCs). RESULTS The proportion of exact agreement between patients and proxies on the 36 items ranged from 3.3 to 41.7%. Results reveal poor to moderate agreement between patient and proxy reports. Proxy reliability varied according to the relationship of the proxy to the index subject. Agreement decreased significantly with increasing severity of dementia and with increasing severity of Physical status (Katz ADL). Agreement was better for measures of functions that are directly observable and relatively poor for more subjective measures. CONCLUSIONS Our results confirm the importance of the information source used for patient health status.
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Affiliation(s)
- J L Novella
- Department of Internal Medicine and Gerontology M4A, Hôpital Sébastopol, 51092, Reims Cedex, France.
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Kirkman MA, Borg A, Al-Mousa A, Haliasos N, Choi D. Quality-of-Life after Anterior Skull Base Surgery: A Systematic Review. J Neurol Surg B Skull Base 2013; 75:73-89. [PMID: 24719794 DOI: 10.1055/s-0033-1359303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/18/2013] [Indexed: 10/25/2022] Open
Abstract
Background Improved treatment and survival of patients with skull base tumors has made the assessment of quality-of-life (QoL) in this population increasingly important. This article provides a comprehensive systematic review pertaining to QoL assessment in adults undergoing anterior skull base surgery. Methods We performed a literature search using the electronic databases of Ovid Medline and Embase. Additional articles were identified through a search using the phrase anterior skull base. Further articles were sought through hand-searching relevant journals and reference lists of identified articles. Results Our search strategy identified 29 articles for inclusion in our systematic review, with considerable variation between studies in population characteristics, methodological design and quality, follow-up length, and outcome assessment. The most commonly used QoL tools were the Karnofsky Performance Status and the Anterior Skull Base Questionnaire. QoL following anterior skull base surgery appears to improve beyond preoperative levels in the months after surgery. For patients undergoing endoscopic skull base surgery, the gain in QoL appears to be greater and may manifest earlier, with no clear long-term deleterious effect on sinonasal outcomes compared with open surgery. Conclusions QoL after anterior skull base surgery in adults appears to improve within several months of surgery, but earlier and to a larger extent if the endoscopic approach is used. Given the relative paucity and heterogeneity of anterior skull base tumors, large-scale prospective multicentre studies utilizing valid and reliable multidimensional QoL tools are required. This may result in improved patient care, by understanding patients' needs better and facilitating the provision of reliable outcome data for clinical trials.
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Affiliation(s)
- Matthew A Kirkman
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom ; Department of Otolaryngology, The Royal National Throat, Nose and Ear Hospital, Gray's Inn Road, London, United Kingdom
| | - Anouk Borg
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Alaa Al-Mousa
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Nikolaos Haliasos
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - David Choi
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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Sizoo EM, Dirven L, Reijneveld JC, Postma TJ, Heimans JJ, Deliens L, Pasman HRW, Taphoorn MJB. Measuring health-related quality of life in high-grade glioma patients at the end of life using a proxy-reported retrospective questionnaire. J Neurooncol 2013; 116:283-90. [DOI: 10.1007/s11060-013-1289-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/21/2013] [Indexed: 11/12/2022]
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Health-related quality of life and cognitive functioning in long-term anaplastic oligodendroglioma and oligoastrocytoma survivors. J Neurooncol 2013; 116:161-8. [DOI: 10.1007/s11060-013-1278-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/09/2013] [Indexed: 01/25/2023]
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Cook KF, Keefe F, Jensen MP, Roddey TS, Callahan LF, Revicki D, Bamer AM, Kim J, Chung H, Salem R, Amtmann D. Development and validation of a new self-report measure of pain behaviors. Pain 2013; 154:2867-2876. [PMID: 23994451 DOI: 10.1016/j.pain.2013.08.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 08/21/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
Abstract
Pain behaviors that are maintained beyond the acute stage after injury can contribute to subsequent psychosocial and physical disability. Critical to the study of pain behaviors is the availability of psychometrically sound pain behavior measures. In this study we developed a self-report measure of pain behaviors, the Pain Behaviors Self Report (PaB-SR). PaB-SR scores were developed using item response theory and evaluated using a rigorous, multiple-witness approach to validity testing. Participants included 661 survey participants with chronic pain and with multiple sclerosis, back pain, or arthritis; 618 survey participants who were significant others of a chronic pain participant; and 86 participants in a videotaped pain behavior observation protocol. Scores on the PaB-SR were found to be measurement invariant with respect to clinical condition. PaB-SR scores, observer reports, and the videotaped protocol yielded distinct, but convergent views of pain behavior, supporting the validity of the new measure. The PaB-SR is expected to be of substantial utility to researchers wishing to explore the relationship between pain behaviors and constructs such as pain intensity, pain interference, and disability.
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Affiliation(s)
- Karon F Cook
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, NC, USA Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA School of Physical Therapy, Texas Woman's University Houston Center, Houston, TX, USA Thurston Arthritis Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA Center for Health Outcomes Research, United BioSource Corporation, Bethesda, MD, USA Department of Education, College of Education, Chungnam National University, Yuseong-gu, Daejeon, South Korea
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Dirven L, Reijneveld JC, Aaronson NK, Bottomley A, Uitdehaag BMJ, Taphoorn MJB. Health-related Quality of Life in Patients with Brain Tumors: Limitations and Additional Outcome Measures. Curr Neurol Neurosci Rep 2013; 13:359. [DOI: 10.1007/s11910-013-0359-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
BACKGROUND Over the last 20 years, a number of instruments developed for the assessment of health-related quality of life (HRQL) in dementia have been introduced. The aim of this review is to synthesize evidence from published reviews on HRQL measures in dementia and any new literature in order to identify dementia specific HRQL instruments, the domains they measure, and their operationalization. METHODS An electronic search of PsycINFO and PubMed was conducted, from inception to December 2011 using a combination of key words that included quality of life and dementia. RESULTS Fifteen dementia-specific HRQL instruments were identified. Instruments varied depending on their country of development/validation, dementia severity, data collection method, operationalization of HRQL in dementia, psychometric properties, and the scoring. The most common domains assessed include mood, self-esteem, social interaction, and enjoyment of activities. CONCLUSIONS A number of HRQL instruments for dementia are available. The suitability of the scales for different contexts is discussed. Many studies do not specifically set out to measure dementia-specific HRQL but do include related items. Determining how best to operationalize the many HRQL domains will be helpful for mapping measures of HRQL in such studies maximizing the value of existing resources.
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Screening for major depressive disorder in adults with glioma using the PHQ-9: a comparison of patient versus proxy reports. J Neurooncol 2013; 113:49-55. [PMID: 23436131 DOI: 10.1007/s11060-013-1088-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 02/17/2013] [Indexed: 10/27/2022]
Abstract
When screening for depression in glioma patients, the utility of proxy carer report is unknown. We studied how patients and proxies differed in the frequency, severity and agreement of reported depressive symptoms, the external validity of these reports, and whether patient-proxy agreement was associated with cognitive function. This was a cross-sectional study within a prospective cohort study of depression in glioma. Eligible patients were adults with a new diagnosis of cerebral glioma whose cohabiting partners chose to attend study interviews. Patients completed the Patient Health Questionnaire-9 (PHQ-9, maximum score 27) to screen for major depressive disorder. Proxies independently completed the PHQ-9 'for the patient'. A structured clinical interview for MDD was then given. From 55 couples attending, 41 participated (74 %). Patient-proxy total PHQ-9 score differed by 3 or more points in 26/41 cases (63.4 %). Disagreement within dyads ranged from -7 to +10 points. Proxies observed more individual depressive symptoms than patients reported (mean 2.7 vs 1.8 symptoms respectively, p = 0.013, Wilcoxon Rank Sum Test), and a greater severity of symptom burden (mean PHQ-9 score 8.4 vs 6.8 respectively, p = 0.016, Wilcoxon Rank Sum Test). Proxies were more reliable than patients on objective behavioural symptoms of depression. Dyadic agreement was not associated with severity of patient cognitive impairment. There was frequent disagreement between glioma patients and proxies reports of depressive symptoms. Proxies reported more depressive symptoms than patients, and were more reliable when reporting observable behavioural symptoms. When diagnosing depression in glioma, collateral history should be obtained.
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Challenge of assessing symptoms in seriously ill intensive care unit patients: can proxy reporters help? Crit Care Med 2012; 40:2760-7. [PMID: 22890258 DOI: 10.1097/ccm.0b013e31825b94d8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Determine levels of agreement among intensive care unit patients and their family members, nurses, and physicians (proxies) regarding patients' symptoms and compare levels of mean intensity (i.e., the magnitude of a symptom sensation) and distress (i.e., the degree of emotionality that a symptom engenders) of symptoms among patients and proxy reporters. DESIGN Prospective study of proxy reporters of symptoms in seriously ill patients. SETTINGS Two intensive care units in a tertiary medical center in the Western United States. PATIENTS Two hundred and forty-five intensive care unit patients, 243 family members, 103 nurses, and 92 physicians. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS On the basis of the magnitude of intraclass correlation coefficients, where coefficients from .35 to .78 are considered to be appropriately robust, correlation coefficients between patients' and family members' ratings met this criterion (≥.35) for intensity in six of ten symptoms. No intensity ratings between patients and nurses had intraclass correlation coefficients >.32. Three symptoms had intensity correlation coefficients of ≥.36 between patients' and physicians' ratings. Correlation coefficients between patients and family members were >.40 for five symptom-distress ratings. No symptoms had distress correlation coefficients of ≥.28 between patients' and nurses' ratings. Two symptoms had symptom-distress correlation coefficients between patients' and physicians' ratings at >.39. Family members, nurses, and physicians reported higher symptom-intensity scores than patients did for 80%, 60%, and 60% of the symptoms, respectively. Family members, nurses, and physicians reported higher symptom-distress scores than patients did for 90%, 70%, and 80% of the symptoms, respectively. CONCLUSIONS Patient-family intraclass correlation coefficients were sufficiently close for us to consider using family members to help assess intensive care unit patients' symptoms. Relatively low intraclass correlation coefficients between intensive care unit clinicians' and patients' symptom ratings indicate that some proxy raters overestimate whereas others underestimate patients' symptoms. Proxy overestimation of patients' symptom scores warrants further study because this may influence decisions about treating patients' symptoms.
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Steinmann D, Vordermark D, Geinitz H, Aschoff R, Bayerl A, Gerstein J, Hipp M, van Oorschot B, Wypior HJ, Schäfer C. Proxy assessment of patients before and after radiotherapy for brain metastases. Results of a prospective study using the DEGRO brain module. Strahlenther Onkol 2012; 189:47-53. [PMID: 23161120 DOI: 10.1007/s00066-012-0239-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 09/17/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Proxies of patients with poor performance status could give useful information about the patients' quality of life (QoL). We applied a newly developed questionnaire in a prospective QoL study of patients undergoing radiotherapy for brain metastases in order to make the first move to validate this instrument, and we compared the results with scores obtained using validated patient-completed instruments. MATERIALS AND METHODS From January 2007 to June 2010, 166 patients with previously untreated brain metastases were recruited at 14 centers in Germany and Austria. The EORTC-QLQ-C15-PAL and the brain module BN20 were used to assess QoL in patients at the start of treatment and 3 months later. At the same time points, 141 of their proxies estimated the QoL with the new DEGRO brain module (DBM), a ten-item questionnaire rating the general condition as well as functions and impairment by symptoms in areas relevant to patients with brain metastases. RESULTS At 3 months, 85 of 141 patients (60%) with initial response by a proxy were alive. Sixty-seven of these patients (79% of 3-month survivors) and 65 proxies completed the second set of questionnaires. After 3 months, QoL significantly deteriorated in all items of proxy-assessed QoL except headache. Correlations between self-assessed and proxy-assessed QoL were high in single items such as nausea, headache, and fatigue. CONCLUSIONS The high correlation between self-assessment and proxy ratings as well as a similar change over time for both approaches suggest that in patients with brain metastases, proxy assessment using the DBM questionnaire can be an alternative approach to obtaining QoL data when patients are unable to complete questionnaires themselves. Our self-constructed and first applied DBM is the only highly specific instrument for patients with brain metastases, but further tests are needed for its final validation.
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Affiliation(s)
- D Steinmann
- Department of Radiation Oncology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Taphoorn MJB, Klein M. Evaluation of cognitive functions and quality of life. HANDBOOK OF CLINICAL NEUROLOGY 2012; 104:173-83. [PMID: 22230444 DOI: 10.1016/b978-0-444-52138-5.00014-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Affiliation(s)
- Martin J B Taphoorn
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
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Armstrong TS, Wefel JS, Gning I, Acquaye A, Vera-Bolanos E, Gilbert MR, Cleeland CS, Mendoza T. Congruence of primary brain tumor patient and caregiver symptom report. Cancer 2012; 118:5026-37. [PMID: 22415423 DOI: 10.1002/cncr.27483] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/19/2011] [Accepted: 01/23/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Evaluating the severity of symptoms in patients with primary brain tumors (PBTs) is important in clinical care and research but may be difficult due to patient neurocognitive (NC) impairment. This study was conducted to evaluate the congruence of symptom reporting in patient and caregiver dyads, examining potential impact of NC impairment and Karnofsky performance status (KPS). METHODS PBT patients undergoing NC testing and their caregivers were included in this study. These dyads (paired patient and caregiver group) completed the MD Anderson Symptom Inventory-Brain Tumor Module prior to testing, and impairment was categorized based on NC test scores. Concordance and equivalency was then assessed using Bland-Altman analysis and 2 one-sided techniques. RESULTS A total of 115 dyads participated. Median patient and caregiver age was 49 and 51 years, respectively, and 63% of patients were male (73% female caregivers). Most patients had a good KPS (≥90, 66%) but were classified as NC impaired (58%). Caregiver's report of patient symptoms are congruent to the self-report of the patient. Equivalency between patient and caregiver report were found using prespecified confidence intervals. KPS group (good, ≥90; poor, ≤80) comparisons of equivalency indicated no significant differences in symptoms and interference reporting between dyads (good = 0.49, P > .05; and poor = 0.3, P > .05) overall, but there was a tendency for higher report by caregivers if the patients had a poor KPS. CONCLUSIONS Caregivers of PBT patients have similar assessments of symptom severity (highly congruent) with patient self-report regardless of NC function or KPS. These findings suggest that caregivers may serve as proxy report of symptoms for primary brain tumor patients.
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Affiliation(s)
- Terri S Armstrong
- Department of Family Health, University of Texas Health Science Center-School of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Hocaoglu MB, Gaffan EA, Ho AK. Health-related quality of life in Huntington's disease patients: a comparison of proxy assessment and patient self-rating using the disease-specific Huntington's disease health-related quality of life questionnaire (HDQoL). J Neurol 2012; 259:1793-800. [PMID: 22392579 PMCID: PMC3432781 DOI: 10.1007/s00415-011-6405-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 12/28/2011] [Indexed: 11/01/2022]
Abstract
Huntington's disease (HD) is a fatal, neurodegenerative disease for which there is no known cure. Proxy evaluation is relevant for HD as its manifestation might limit the ability of persons to report their health-related quality of life (HrQoL). This study explored patient-proxy ratings of HrQoL of persons at different stages of HD, and examined factors that may affect proxy ratings. A total of 105 patient-proxy pairs completed the Huntington's disease health-related quality of life questionnaire (HDQoL) and other established HrQoL measures (EQ-5D and SF-12v2). Proxy-patient agreement was assessed in terms of absolute level (mean ratings) and intraclass correlation. Proxies' ratings were at a similar level to patients' self-ratings on an overall Summary Score and on most of the six Specific Scales of the HDQoL. On the Specific Hopes and Worries Scale, proxies on average rated HrQoL as better than patients' self-ratings, while on both the Specific Cognitive Scale and Specific Physical and Functional Scale proxies tended to rate HrQoL more poorly than patients themselves. The patient's disease stage and mental wellbeing (SF-12 Mental Component scale) were the two factors that primarily affected proxy assessment. Proxy scores were strongly correlated with patients' self-ratings of HrQoL, on the Summary Scale and all Specific Scales. The patient-proxy correlation was lower for patients at moderate stages of HD compared to patients at early and advanced stages. The proxy report version of the HDQoL is a useful complementary tool to self-assessment, and a promising alternative when individual patients with advanced HD are unable to self-report.
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Affiliation(s)
- Mevhibe B Hocaoglu
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
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Steel J, Geller DA, Tsung A, Marsh JW, Dew MA, Spring M, Grady J, Likumahuwa S, Dunlavy A, Youssef M, Antoni M, Butterfield LH, Schulz R, Day R, Helgeson V, Kim KH, Gamblin TC. Randomized controlled trial of a collaborative care intervention to manage cancer-related symptoms: lessons learned. Clin Trials 2011; 8:298-310. [PMID: 21730078 DOI: 10.1177/1740774511402368] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Collaborative care interventions to treat depression have begun to be tested in settings outside of primary care. However, few studies have expanded the collaborative care model to other settings and targeted comorbid physical symptoms of depression. PURPOSE The aims of this report were to: (1) describe the design and methods of a trial testing the efficacy of a stepped collaborative care intervention designed to manage cancer-related symptoms and improve overall quality of life in patients diagnosed with hepatobiliary carcinoma; and (2) share the lessons learned during the design, implementation, and evaluation of the trial. METHODS The trial was a phase III randomized controlled trial testing the efficacy of a stepped collaborative care intervention to reduce depression, pain, and fatigue in patients diagnosed with advanced cancer. The intervention was compared to an enhanced usual care arm. The primary outcomes included the Center for Epidemiological Studies-Depression scale, Brief Pain Inventory, and Functional Assessment of Cancer Therapy (FACT)-Fatigue, and the FACT-Hepatobiliary. Sociodemographic and disease-specific characteristics were recorded from the medical record; Natural Killer cells and cytokines that are associated with these symptoms and with disease progression were assayed from serum. RESULTS and Discussion The issues addressed include: (1) development of collaborative care in the context of oncology (e.g., timing of the intervention, tailoring of the intervention, ethical issues regarding randomization of patients, and changes in medical treatment over the course of the study); (2) use of a website by chronically ill populations (e.g., design and access to the website, development of the website and intervention, ethical issues associated with website development, website usage, and unanticipated costs associated with website development); (3) evaluation of the efficacy of intervention (e.g., patient preferences, proxy raters, changes in medical treatment, and inclusion of biomarkers as endpoints); and (4) analyses and interpretation of the intervention (e.g., confounding factors, dose and active ingredients, and risks and benefits of collaborative care interventions in chronically ill patients). LIMITATIONS The limitations to the study, although not fully realized at this time as the trial is ongoing, include: (1) heterogeneity of the diagnoses and treatments of participants; and (2) inclusion of caregivers as proxy raters but not as participants in the intervention. CONCLUSIONS Collaborative care interventions to manage multiple symptoms in a tertiary cancer center are feasible. However, researchers designing and implementing interventions that are web-based, target multiple symptoms, and for oncology patients may benefit from previous experiences.
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Affiliation(s)
- Jennifer Steel
- Department of Surgery and Psychiatry, University of Pittsburgh School of Medicine, PA, USA.
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Abstract
BACKGROUND Examining the perception of patient safety culture (PSC) of top managers in health care settings is important because their orientation to PSC can have a large influence on the facility. PURPOSES In this research, the perception of PSC of nursing home administrators (NHAs) and directors of nursing (DONs) is examined. METHODOLOGY/APPROACH Primary data were collected to examine the opinions of NHAs and DONs regarding PSC. Information was collected from a large nationally representative sample of 4,000 nursing homes. The Nursing Home Survey on Patient Safety Culture survey instrument was used as a measure of PSC. This has 12 domains and 38 items. Bias indexes, intraclass correlation coefficients, and Pearson's product-moment correlation coefficients of the differences between NHA and DON item scores were examined. FINDINGS Using a 0-100 scale, most scores fell into the 55-80 range. Higher scores represent a higher (more favorable) PSC. Agreement between the NHAs and DONs was excellent in 10 items, good in 15 items, moderate in 4 items, and poor in 8 items. Of the four largest differences in scores, the NHA scores were higher than the DON scores for 1 item, and DON scores were higher than the NHA scores for 3 items. IMPLICATIONS The overall perception from both NHAs and DONs appear to represent a somewhat "positive" outlook from these top managers on their institution's PSC. However, NHAs in general report higher scores than DONs do. The areas of divergence between these top managers are further discussed, with a view toward directing future patient safety investigations and initiatives in nursing homes.
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Witgert ME, Veramonti T, Hanna E. Instruments for estimation of health-related quality of life in patients with skull base neoplasms. Skull Base 2011; 20:5-10. [PMID: 20592851 DOI: 10.1055/s-0029-1242978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
With advances in treatment of patients with tumors of the skull base and associated improvement in length of survival, the need for assessment of quality of life (QOL) is becoming increasingly apparent. A thorough assessment of QOL, including functional, physical, social, and emotional status, as well as disease-specific symptoms, allows for comparison of treatments and informs treatment decisions. In addition, it allows for problems following intervention to be identified and addressed, thereby assisting patients in their pursuits of returning to their normal activities and level of functioning. Although health care providers and researchers are increasingly aware of the need to assess patients' QOL, few standardized measures exist with which to perform a comprehensive assessment of QOL in patients with skull base neoplasms. Further research is needed, including prospective trials using reliable and valid measures tapping various aspects of QOL and specific symptoms unique to patients with tumors of the skull base.
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Affiliation(s)
- Mariana E Witgert
- Department of Neuro-Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
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Merz EL, Malcarne VL, Ko CM, Sadler M, Kwack L, Varni JW, Sadler GR. Dyadic concordance among prostate cancer patients and their partners and health-related quality of life: does it matter? Psychol Health 2011; 26:651-66. [PMID: 20680885 DOI: 10.1080/08870441003721251] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Serious and chronic illnesses occur within a family context, affecting not only the patient but also the spouse/partner, children and extended family network. Spouses/partners are likely to experience the greatest personal impact, and may influence patient adjustment. Also, the intimate relationship may be affected by the illness experience. This study examined whether dyadic concordance on the characteristics of prostate cancer (PC) was related to health-related quality of life (HRQOL), psychological distress and marital adjustment in PC patients and their female partners. Couples (N=164) completed questionnaires on the appraisals of PC, and individual and dyadic adjustment. Patient and partner PC appraisal ratings were positively correlated. There was a general pattern of patients and partners in concordant dyads, versus those in dyads in which spouses maximised or minimised PC characteristics, reporting significantly better individual HRQOL outcomes, although there were several exceptions. Patient-partner appraisal (dis)agreement generally did not significantly predict dyadic adjustment. Overall, results suggest that dyadic disagreement is associated with worse HRQOL in couples facing PC.
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Affiliation(s)
- Erin L Merz
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120-4913, USA
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Nwaru BI, Klemetti R, Yuan S, Kun H, Wang Y, Hemminki E. Completeness and utility of interview data from proxy respondents in prenatal care research in rural China. Matern Child Health J 2011; 16:867-76. [PMID: 21553083 DOI: 10.1007/s10995-011-0810-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In household surveys, the use of data provided by relatives can increase response rates and generalisability of research findings. This study assessed the quality of data from relatives and the impact of the data source on the association between the use of prenatal care and pregnancy outcomes. Data for 3,673 new mothers and 293 proxy respondents were available from a house-hold survey in 2008-2009 in rural China. Analyses were performed using chi-square test, ANOVA, Kruskal-Wallis test, and logistic regression models. Differences in the studied variables were small, but proxy respondents were slightly more likely to have missing data than the new mothers. Differences and missing data were more common for the use of prenatal care and outcome variables (mode of delivery, place of delivery, birth weight, use of postnatal care, and gestational age at birth) than for the background characteristics of the participants. Husbands' reports were closer to the index reports than that of the other proxies. The associations between the exposures and outcomes were mostly similar between the proxy and index respondents. Relatives can be interviewed instead of women to study prenatal care without a substantial negative impact on study results. Studies using proxy respondents should stratify the analysis by type of respondents.
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Affiliation(s)
- Bright I Nwaru
- School of Health Sciences, University of Tampere, Tampere, Finland.
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Roos D. What is the randomised evidence for surgery and stereotactic radiosurgery for patients with solitary (or few) brain metastases? INT J EVID-BASED HEA 2011; 9:61-6. [DOI: 10.1111/j.1744-1609.2010.00201.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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