Differences between proxy and patient assessments of cancer care experiences and quality ratings
Roydhouse, J and Gutman, R and Keating, NL and Mor, V and Wilson, IB, Differences between proxy and patient assessments of cancer care experiences and quality ratings, Health Services Research, 53, (2) pp. 919-943. ISSN 1475-6773 (2018) [Refereed Article]
Objective. To assess the impact of proxy survey responses on cancer care experience
reports and quality ratings.
Data Sources/Study Setting. Secondary analysis of data from Cancer Care Outcomes Research and Surveillance (CanCORS). Recruitment occurred from 2003 to
Study Design. The study was a cross-sectional observational study. The respondents
were patients with incident colorectal or lung cancer or their proxies.
Data Collection/Extraction Methods. Analyses used linear regression models with
an independent variable for proxy versus patient responses as well as study site and
clinical covariates. The outcomes were experiences with medical care, nursing care,
care coordination, and care quality rating. Multiple imputation was used for missing
Principal Findings. Among 6,471 respondents, 1,011 (16 percent) were proxies. The
proportion of proxy respondents varied from 6 percent to 28 percent across study sites.
Adjusted proxy scores were modestly higher for medical care experiences (+1.28
points [95 percent CI:+ 0.05 to +2.51]), but lower for nursing care (-2.81 [95 percent
CI: -4.11 to -1.50]) and care coordination experiences (-2.98 [95 percent CI: -4.15
to -1.81]). There were no significant differences between adjusted patient and proxy
ratings of quality.
Conclusions. Proxy responses have small but statistically significant differences from
patient responses. However, if ratings of care are used for financial incentives, such differences could be exaggerated across practices or areas if proxy use varies.
cancer, proxy-reported, quality of life, care experience, survey