Comparison of Proxy Ratings of Main Family Caregivers and Physicians on the Quality of Dying of Terminally Ill Cancer Patients.

Comparison of Proxy Ratings of Main Family Caregivers and Physicians on the Quality of Dying of Terminally Ill Cancer Patients.

Jpn J Clin Oncol. 2013 Jun 30;
Cheng SY, Dy S, Huang SB, Chen CY, Chiu TY

Proxy data collection is a prevalent and important source of information in palliative medicine, and few studies have evaluated the level of agreement between different types of proxies.A study was conducted to compare the agreement in quality of dying of terminally ill cancer patients from the perspective of (i) the main family caregiver and (ii) the main caregiving physician. The Kappa statistic was applied to measure agreement between the proxies in a prospective study. Using the good death scale and the audit scales, 126 dyads (70%) were compared from a tertiary medical center in Taiwan.In general, the physicians rated quality of dying higher than did family caregivers. The kappa ranged from 0 to 0.232 for the five items, indicating marginal agreement. The prevalence index was applied to correct the Kappa statistic and showed the data to be asymmetrically distributed. Both proxies tended to agree at higher scores (Pneg = 0.745-0.996) in all five items and the total good death scale. For the audit scale, both proxies tended to agree at higher scores in most of the 12 items, except ‘alleviation of anxiety’, ‘resolution of depression’ and ‘fulfillment of last wishes’.The observed agreement between the two proxies was good, except the psychological aspects, demonstrating the validity of proxy rating of patients between physicians and main caregivers. More communications toward the end-of-life issues should be encouraged and conducted in this population. Further research is needed to determine how to best use proxy assessments to evaluate the quality of the dying process. HubMed – depression


Factors influencing long-term quality of life and depression in German liver transplant recipients: A single-centre cross-sectional study.

Ann Transplant. 2013; 18: 327-35
Zahn A, Seubert L, Jünger J, Schellberg D, Weiss KH, Schemmer P, Stremmel W, Sauer P, Gotthardt DN

Background Health-related quality of life (HRQOL) following orthotopic liver transplantation (OLT) has become increasingly important. Therefore, we aimed to identify factors affecting HRQOL after OLT. Material and Methods This cross-sectional, single-centre study surveyed 281 OLT patients. Survey tools included the Short Form (SF-36) Health Survey, the Patient Health Questionnaire 9 (PHQ9), and a self-designed employment questionnaire. Patient medical records were reviewed. Results Participants included 187 men (mean age at OLT: 50 [±11; 13-69] years). Primary indications for OLT were viral hepatitis (28%), alcoholic liver disease (35%), cholestatic liver disease (11%), and others (26%). Follow-up ranged from 2 to 136 months. Clinical factors associated with improved HRQOL were age ?45 years at OLT and current MELD score <=?13. Time after OLT and indication for transplantation affected SF-36 HRQOL. SF-36 physical component summary scales plateaued at 3-years post-OLT and then stabilized. For the SF-36 HRQOL, scores were the lowest in all domains for OLT recipients transplanted for chronic viral hepatitis and for unemployed patients, whereas sex and number of transplantations showed no significant differences. The PHQ9 results showed that depression was significantly more frequent among patients with current MELD score ? 13 or impaired liver function and those transplanted for chronic viral hepatitis or unemployed patients. Age and sex did not influence PHQ9 results. Conclusions Medical and psychosocial support is crucial for long-term HRQOL after OLT. Developing multidisciplinary interventions to address issues such as employment, age, MELD score, and liver function may improve long-term HRQOL in these patients. HubMed – depression