Measurement of quality of life using EQ-5D in patients on prolonged mechanical ventilation: comparison of patients, family caregivers, and nurses
- 382 Downloads
This study reports how QOL (quality of life) assessments differ between patients on prolonged mechanical ventilation (PMV) and their proxies (family caregivers and nurses).
We enrolled consecutive subjects on PMV for more than 21 days from five institutions. We conducted QOL assessments using the Taiwanese version of the EQ-5D in face-to-face interviews. Direct caregivers (family members and nurses) also completed the EQ-5D from the patient’s point of view.
For 55 of the 142 enrolled patients who were able to assess their QOL, we recruited 44 patient–family caregiver pairs, 53 patient–nurse pairs, and 42 family caregiver–nurse pairs. There were 81 family caregiver–nurse pairs out of 87 patients with poor cognition. The agreement between patient–family caregiver pairs was generally higher than that of patient–nurse pairs. As the proportions of exact agreement between family caregivers and nurses for patients with poor cognition were 98–99% for observable dimensions of mobility, self-care, and usual activities, they lead to a minimal difference in the final values.
QOL assessments from family caregivers agreed more closely with patients than did those from nurses using EQ-5D evaluations for patients with clear cognition, but either proxy was acceptable for rating PMV patients with poor cognition.
KeywordsProlonged mechanical ventilation Proxy Quality of life EQ-5D Utility
Prolonged mechanical ventilation
Quality of life
Intensive care unit
Respiratory care center
Respiratory care ward
Institutional review board
Mini-mental status examination
Intra-class correlation coefficient
This work was partially supported by grants from the National Health Research Institute (NHRI, Grant 97A1-HDPP01-014 and 98A1-PHAPHD-014), Chia-Yi Christian Hospital (CYCH, Grant R98-3), and the National Science Council (NSC, Grant 98-2341-B-002-129) in Taiwan. The authors also thank the members of the respiratory care ward of Chia-Yi Hospital, the Department of Health, Executive Yuan, Taiwan; the private Chen Ren-Der Hospital; Yang Ming Hospital (Chia-Yi); and the National Taiwan University Hospital for helping us to recruit study subjects.
- 5.Combes, A., Costa, M. A., Trouillet, J. L., Baudot, J., Mokhtari, M., Gibert, C., et al. (2003). Morbidity, mortality, and quality-of-life outcomes of patients requiring ≧14 days of mechanical ventilation. Critical Care Medicine, 31, 1373–1381. doi: 10.1097/01.CCM.0000065188.87029.C3.CrossRefPubMedGoogle Scholar
- 6.Chatila, W., Kreimer, D. T., & Criner, G. J. (2001). Quality of life in survivors of prolonged mechanical ventilatory support. Critical Care Medicine, 29(4), 737–742. Retrieved from http://journals.lww.com/ccmjournal/pages/default.aspx.
- 7.Department of Statistics, Ministry of the Interior (2009). Number of population. Available online at: http://www.moi.gov.tw/stat/english/monthly.asp. Accessed August 24, 2009.
- 8.Bureau of National Health Insurance (2009). Insurance coverage. Available online at: http://www.nhi.gov.tw/webdata. Accessed August 24, 2009.
- 9.Bureau of National Health Insurance (2009). Prospective payment system of ventilator dependents managed care demonstration. Available online at. http://www.nhi.gov.tw/webdata. (In Chinese). Accessed August 24, 2009.
- 10.Coucill, W., Bryan, S., Bentham, P., Buckley, A., & Laight, A. (2001). EQ-5D in patients with dementia: An investigation of inter-rater agreement. Medical Care, 39(8), 760–771. Retrieved from http://journals.lww.com/lww-medicalcare/pages/default.aspx.
- 12.Pickard, A. S., & Knight, S. J. (2005). Proxy evaluation of health-related quality of life: A conceptual framework for understanding multiple proxy perspectives. Medical Care, 43(5), 493–499. Retrieved from http://journals.lww.com/lww-medicalcare/pages/default.aspx.
- 14.Sneeuw, K. C. A., Sprangers, M. A. G., & Aaronson, N. K. (2002). . The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease. Journal of Clinical Epidemiology, 55(11), 1130–1143. Retrieved from http://www.sciencedirect.com/science/journal/08954356.Google Scholar
- 15.Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. Retrieved from http://www.sciencedirect.com/science/journal/00223956.Google Scholar
- 16.EuroQol Group (1990). EuroQol-a new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199–208. Retrieved from http://www.sciencedirect.com/science/journal/01688510.
- 20.Granja, C., Dias, C., Costa-Pereira, A., & Sarmento, A. (2004). Quality of life of survivors from severe sepsis and septic shock may be similar to that of others who survive critical illness. Critical Care, 8, R91–R98. Retrieved from http://journals.lww.com/lww-medicalcare/pages/default.aspx.
- 21.Chang, T. J., Tarn, Y. H., Hsieh, C. L., Liou, W. S., Shaw, J. W., & Chiou, X. G. (2007). Taiwanese version of the EQ-5D: Validation in a representative sample of the Taiwanese population. Journal of the Formosan Medical Association, 106(12), 1023–1031. Retrieved from http://fma.mc.ntu.edu.tw/.Google Scholar
- 22.Shaw, J. W., Johnson, J. A., & Coons, S.J. (2007). US valuation of the EQ-5D health states: Development and testing of the D1 valuation model. Med Care, 43(3), 203–220. Retrieved from http://journals.lww.com/lww-medicalcare/pages/default.aspx.
- 23.Altman, D. G. (1991). Practical statistics for medical research (1st ed.). London: Chapman and Hall.Google Scholar
- 24.Cohen, J. (1988). Statistical power analysis for the behavior sciences (2nd ed.). New Jersey: Lawrence Erlbaum Associates.Google Scholar
- 25.Deyo, R. A., Diehr, P., & Patrick, D. L. (1991). Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. Controlled Clinical Trials, 12(4Suppl), 142S–158S. Retrieved from http://www.sciencedirect.com/science/journal/01972456.
- 26.Schrout, P., & Fleiss, J. (1979). Intraclass correlations: Uses in assessing rater reliability. Psychiatric Bulletin, 86(2), 420–428. Retrieved from http://pb.rcpsych.org/.
- 27.Nunnally, J. C. (1994). Psychometric theory. New York: McGraw-Hill.Google Scholar
- 28.Lee, J., Koh, D., & Ong, C. N. (1989). Statistical evaluation of agreement between two methods for measuring a quantitative variable. Computers in Biology & Medicine, 19(1), 61–70. Retrieved from http://www.sciencedirect.com/science/journal/00104825.
- 29.Fleiss, J. L. (1986). The design and analysis of clinical experiments. New York: Wiley.Google Scholar
- 32.Tamim, H., McCusker, J., & Dendukuri, N. (2002). Proxy reporting of quality of life using the EQ-5D. Medical Care, 40(12), 1186–1195. Retrieved from http://journals.lww.com/lww-medicalcare/pages/default.aspx.
- 33.Pickard, A. S., Johnson, J. A., Feeny, D. H., Shuaib, A., Carriere, K. C., & Nasser, A. M. (2004). Agreement between patient and proxy assessments of health-related quality of life after stroke using the EQ-5D and health utilities index. Stroke, 35(2), 607–612. doi: 10.1161/01.STR.0000110984.91157.BD.CrossRefPubMedGoogle Scholar