Quality of Life Research

, Volume 19, Issue 5, pp 721–727 | Cite as

Measurement of quality of life using EQ-5D in patients on prolonged mechanical ventilation: comparison of patients, family caregivers, and nurses

  • Mei-Chuan Hung
  • Yuan-Horng Yan
  • Po-Sheng Fan
  • Ming-Shian Lin
  • Cheng-Ren Chen
  • Lu-Cheng Kuo
  • Chong-Jen Yu
  • Grace Yao
  • Ching-Lin Hsieh
  • Jung-Der WangEmail author



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.


Prolonged 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


EuroQol five-dimensional


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.


  1. 1.
    Carson, S. S. (2006). Outcomes of prolonged mechanical ventilation. Current Opinion in Critical Care, 12(5), 405–411. doi: 10.1097/01.ccx.0000244118.08753.dc.CrossRefPubMedGoogle Scholar
  2. 2.
    Carson, S. S., Cox, C. E., Holmes, G. M., & Howard, A. (2006). The changing epidemiology of mechanical ventilation: A population-based study. Journal of Intensive Care Medicine, 21(3), 173–182. doi: 10.1177/0885066605282784.CrossRefPubMedGoogle Scholar
  3. 3.
    Cox, C. E., Carson, S. S., Holmes, G. M., & Howard, A. (2004). Increase in tracheotomy for prolonged mechanical ventilation in North Carolina, 1993–2002. Critical Care Medicine, 32(11), 2219–2226. doi: 10.1097/01.CCM.0000145232.46143.4.PubMedGoogle Scholar
  4. 4.
    Douglas, S. L., Daly, B. J., Gordon, N., & Brennan, P. F. (2002). Survival and quality of life: Short term versus long-term ventilator patients. Critical Care Medicine, 30, 2655–2662. doi: 10.1097/01.CCM.0000034688.55283.6.CrossRefPubMedGoogle Scholar
  5. 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. 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
  7. 7.
    Department of Statistics, Ministry of the Interior (2009). Number of population. Available online at: Accessed August 24, 2009.
  8. 8.
    Bureau of National Health Insurance (2009). Insurance coverage. Available online at: Accessed August 24, 2009.
  9. 9.
    Bureau of National Health Insurance (2009). Prospective payment system of ventilator dependents managed care demonstration. Available online at. (In Chinese). Accessed August 24, 2009.
  10. 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
  11. 11.
    Bryan, S., Hardyman, W., Bentham, P., Buckley, A., & Laight, A. (2005). Proxy completion of EQ-5D in patients with dementia. Quality of Life Research, 14(1), 107–118. doi: 10.1007/s11136-004-1920-6.CrossRefPubMedGoogle Scholar
  12. 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
  13. 13.
    McPhail, S., Beller, E., & Haines, T. (2008). Two perspectives of proxy reporting of health-related quality of life using the Euroqol-5D, an investigation of agreement. Medical Care, 46(11), 1140–1148. doi: 10.1097/MLR.0b013e31817d69a6.CrossRefPubMedGoogle Scholar
  14. 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 Scholar
  15. 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 Scholar
  16. 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
  17. 17.
    Szende, A., Oppe, M., & Devlin, N. (2007). EQ-5D value sets: Inventory, comparative review and user guide. UK: EuroQol Group.CrossRefGoogle Scholar
  18. 18.
    Badia, X., Diaz-Prieto, A., Rue, M., & Patrick, D. L. (1996). Measuring health and health state preferences among critically ill patients. Intensive Care Medicine, 22(12), 1379–1384. doi: 10.1007/s001340050267.CrossRefPubMedGoogle Scholar
  19. 19.
    Cristina, G., Armando, T. P., & Altamiro, C. P. (2002). Quality of life after intensive care—evaluation with EQ-5D questionnaire. Intensive Care Medicine, 28(7), 898–907. doi: 10.1007/s00134-002-1345-z.CrossRefGoogle Scholar
  20. 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
  21. 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 Scholar
  22. 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
  23. 23.
    Altman, D. G. (1991). Practical statistics for medical research (1st ed.). London: Chapman and Hall.Google Scholar
  24. 24.
    Cohen, J. (1988). Statistical power analysis for the behavior sciences (2nd ed.). New Jersey: Lawrence Erlbaum Associates.Google Scholar
  25. 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
  26. 26.
    Schrout, P., & Fleiss, J. (1979). Intraclass correlations: Uses in assessing rater reliability. Psychiatric Bulletin, 86(2), 420–428. Retrieved from
  27. 27.
    Nunnally, J. C. (1994). Psychometric theory. New York: McGraw-Hill.Google Scholar
  28. 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
  29. 29.
    Fleiss, J. L. (1986). The design and analysis of clinical experiments. New York: Wiley.Google Scholar
  30. 30.
    Agresti, A., & Ghosh, A. (1995). Rank kappa: Describing potential impact of marginal distributions on measures of agreement. Biometrical Journal, 37(7), 811–820. doi: 10.1002/bimj.4710370705.CrossRefGoogle Scholar
  31. 31.
    Novella, J. L., Jochum, C., Jolly, D., et al. (2004). Agreement between patients’ and proxies’ reports of quality of life in Alzheimer’s disease. Quality of Life Research, 10(5), 443–452. doi: 10.1023/A:1012522013817.CrossRefGoogle Scholar
  32. 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
  33. 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
  34. 34.
    Andresen, E. M., Vahle, V. J., & Lollar, D. (2001). Proxy reliability: Health-related quality of life (HRQoL) measures for people with disability. Quality of Life Research, 10, 609–619. doi: 10.1023/A:1013187903591.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Mei-Chuan Hung
    • 1
  • Yuan-Horng Yan
    • 2
  • Po-Sheng Fan
    • 2
  • Ming-Shian Lin
    • 2
  • Cheng-Ren Chen
    • 2
  • Lu-Cheng Kuo
    • 3
  • Chong-Jen Yu
    • 3
  • Grace Yao
    • 4
  • Ching-Lin Hsieh
    • 5
  • Jung-Der Wang
    • 1
    • 3
    • 6
    Email author
  1. 1.Institute of Occupational Medicine and Industrial Hygiene, College of Public HealthNational Taiwan UniversityTaipeiTaiwan
  2. 2.Department of Internal MedicineChia-Yi Christian HospitalChiayiTaiwan
  3. 3.Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
  4. 4.Department of PsychologyNational Taiwan UniversityTaipeiTaiwan
  5. 5.Department of Occupational TherapyNational Taiwan UniversityTaipeiTaiwan
  6. 6.Department of Environmental and Occupational MedicineNational Taiwan University HospitalTaipeiTaiwan

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