Surrogates of acute respiratory failure survivors were significantly more likely to report positively deviated perceived health relative to objective health compared to patients (OR 11.2; 95% CI 2-60; p<0.005).
Cohort (n=187)
In ARF survivors, surrogates are more likely than patients to attribute a favorable perception of health to a given objective utility score.
Effect estimate: OR 11.2 (95% CI 2-60)
p-value: p=< 0.005
Abstract Rationale The EuroQuol-5 Dimensions (EQ-5D-5L) is a patient- or surrogate-reported, standardized, and widely used questionnaire that measures health-related quality of life. The instrument evaluates function across five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and perceived health using a Visual Analogue Scale (VAS). We examined the relationship between function and perceived health in serial EQ-5D-5L responses among a prospective cohort of ARF survivors. Methods Patients with ARF and/or their surrogates were recruited to complete the EQ-5D-5L at 13 timepoints from ICU discharge through 6 months. Surrogates provided proxy responses on behalf of patients. “Objective health” in the form of EQ-5D-5L utility score was obtained by applying the United States-specific EQ-5D-5L value set to functional domain responses. Deviation between objective and perceived health was calculated for each participant-timepoint by first normalizing utility scores from 0 to 100, then subtracting normalized utility scores from VAS scores. Positive and negative deviation were defined using the VAS minimum clinically important difference of 8. A mixed-effects model was fitted to evaluate within-participant stability of deviation over time. Logistic regression models with random intercepts for participant were fitted to examine demographic and comorbidity influence on deviation group. Results Eighty-seven patients and 120 surrogates representing 187 unique ARF survivors enrolled in the cohort and reached 6-month follow-up. One hundred eighty-four participants (89%) completed at least one EQ-5D-5L, with a total 1,745 responses included in analysis (Figure 1). Eighty-one participants (39%) had only negative (or neutral) deviation across all responses and 33 participants (16%) had only positive (or neutral) responses. Sixty-seven participants (32%) had both positively and negatively deviated responses during follow-up. The intraclass correlation coefficient for numerical deviation score over time was 0.62, indicating relative within-respondent stability. In logistic regression, surrogates were more likely to have positively deviated responses than patients (OR = 11.2, 95% CI 2, 60; p 0.005). Conclusions ARF survivors and their surrogates frequently reported lower perceived health relative to objective health. Surrogates were more likely to attribute a favorable perception of health to a given utility score, highlighting differences between a patient’s own perception of their health compared to an outside observer’s assessment. A third of respondents exhibited both positive and negative deviation during follow-up, suggesting variation in perception of health over time. Factors influencing perceived health are not fully captured by function or population-based utility scores. Both objective and perceived health should be assessed in patient-reported outcomes for ARF survivors. This abstract is funded by: National Institute of Health, National Heart, Lung, and Blood Institute (NHLBI) Career Development Award K23HL163402 (C.L.A)
Black et al. (Fri,) conducted a cohort in Acute Respiratory Failure (n=187). Surrogate proxy responses vs. Patient self-responses was evaluated on Positively deviated responses between perceived and objective health (OR 11.2, 95% CI 2-60, p=< 0.005). Surrogates of acute respiratory failure survivors were significantly more likely to report positively deviated perceived health relative to objective health compared to patients (OR 11.2; 95% CI 2-60; p<0.005).