Whose Life is it Anyway? Proxy v. Self reported quality of life in Childhood Cancer Survivors
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Whose Life is it Anyway? Proxy v. Self reported quality of life in Childhood Cancer Survivors Penney Upton. What is Quality of Life?. ‘Subjective well-being' or ‘life satisfaction’ ‘Health related quality of life’ (HRQL) refers to how health affects life satisfaction

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Whose Life is it Anyway? Proxy v. Self reported quality of life in Childhood Cancer Survivors

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Whose life is it anyway proxy v self reported quality of life in childhood cancer survivors

Whose Life is it Anyway? Proxy v. Self reported quality of life in Childhood Cancer Survivors

Penney Upton


What is quality of life

What is Quality of Life?

  • ‘Subjective well-being' or ‘life satisfaction’

  • ‘Health related quality of life’ (HRQL) refers to how health affects life satisfaction

  • Physical, social and emotional components of well-being and function


Why measure hrql

Why measure HRQL?

  • Changing emphasis in healthcare

  • Increased survivorship, but at a cost

  • Importance of patient perspective


Whose life is it anyway proxy v self reported quality of life in childhood cancer survivors

How is it measured?

  • Disease specific questionnaires are sensitive to intervention effects

  • Broader generic measurement allows comparison to the general population


Issues in measurement

Issues in measurement

  • Developmental differences in the meaning of health

  • Limitations in cognitive or linguistic skills

  • Self or Proxy measure?


Why use a proxy measure

Why use a proxy measure?

  • If child is unwilling or unable to complete a self report

  • Parent report provides different perspective

  • Need both parent and child for a complete picture


Factors influencing parent child agreement

Factors influencing parent-child agreement

  • Child and parent gender

  • Child age – child v. adolescent

  • Health status of the child

  • Component of HRQL being assessed


Unanswered questions in parent child agreement

Unanswered questions in parent-child agreement

  • Is agreement better for observable physical or emotional functioning?

  • What is the direction of any differences in ratings?

  • What is the influence of child illness?

  • Group or individual analysis?


Whose life is it anyway proxy v self reported quality of life in childhood cancer survivors

Aims

  • To examine the extent of mother-child agreement in HRQL reporting and the influence of child gender, age and health status on the extent and direction of agreement.


Method

Method

  • A cross-sectional sample of children (age range 8-18 years) and their mothers completed the Pediatric Quality of Life Inventory (PedsQL™)

  • 474 healthy children (213 males and 261 females)

  • 70 cancer survivors(35 males and 35 females)


Summary of results

Summary of Results

  • Mother-child agreement not associated with child age

  • Better agreement for females on the emotional functioning sub-scale

  • Better agreement for cancer survivors on all summary and subscales of PedsQL™


Comparison of mother child agreement at individual level

Comparison of mother-child agreement at individual level

* P< 0.001


Comparison of mother child agreement at group level

Comparison of mother-child agreement at group level

  • Group level analysis showed significant differences on all scales

  • Effect size of differences was trivial or small (d=0.03-0.23)

  • Mother’s of survivors more likely to underestimate HRQL


Implications of these findings

Implications of these findings

  • Mothers can provide an accurate estimate of their child’s HRQL using PedsQL

  • Proxies should be used where self-report is not available

    • May prevent research bias

    • Importance clinically - e.g. palliative care

  • Why is agreement is better where the child has survived cancer?


Why does child health influence agreement

Why does child health influence agreement?

  • Focus on child health leads to:

    • Better communication

    • Increased parental knowledge and understanding of HRQL implications

  • Methodological issue?


A caveat to the use of parent reports

A caveat to the use of parent reports:

  • Researchers/clinicians must be clear on what they want to gain from using a parent report

  • Are instructions to parents clear?


Conclusion

Conclusion:

  • Parents can provide a proxy report for their child, but the gold standard for reporting children’s HRQL should be self report as with adults…….

…….whose life is it anyway?


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