Influence of proxy respondents in children's health interview surveys.
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STUDY OBJECTIVES: To study the influence of the proxy respondent on health interview surveys in children. DESIGN: Cross sectional study. SETTING: Children under the age of 15 years drawn from the general population of Catalonia, Spain. PARTICIPANTS: The Catalan Health Interview Survey consisted of a multistage probability sample representative to the population of Catalonia. The sample size was 2433 children younger than 15 years of age. The interviews were answered by proxy respondents (the mother, father, or other carer), with the questionnaire adapted for the proxy respondent. Logistic regression models were used to analyse the relation between the proxy respondent's characteristics and health status and health care utilisation, controlling for the effect of sociodemographic factors. MAIN RESULTS: Proxy respondent's characteristics influenced the reports of chronic conditions and accidents within the last year. Proxy respondents over 55 years (OR = 0.47; 95% CI = 0.26, 0.82), men (OR = 0.69; 95% CI = 0.53, 0.89), the father (OR = 0.66; 95% CI = 0.50, 0.89), and the grandparents (OR = 0.49; 95% CI = 0.26, 0.89), reported a lower rate of chronic conditions. Age of the proxy 55 years or greater (OR = 0.41; 95% CI = 0.20, 0.82), men (OR = 0.70; 95% CI = 0.52, 0.94), fathers (OR = 0.68; 95% CI = 0.49, 0.92), and grandparents (OR = 0.40; 95% CI = 0.18, 0.85) showed a lower probability to report accidents. No variables related to the proxy were associated with physician visits or hospitalisation in the previous year. CONCLUSIONS: Selected characteristics of the proxy respondent can influence responses to health surveys involving children. A minimum set of basic data should be collected from the proxy respondent to evaluate different patterns of response. (+info)
Smoking status by proxy and self report: rate of agreement in different ethnic groups.
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OBJECTIVE: To examine the rate of agreement between proxy and self report of smoking status in Hispanics compared with other ethnic groups. DESIGN: Data source is the 1990 California Tobacco Survey (CTS) which includes proxy and self reported smoking status. The CTS is a random digit dialed survey conducted in 57,244 households. A sample of 10,011 adults was included in the analyses. MAIN OUTCOME MEASURE: Percentages of agreement and disagreement between self report and report by other member of the household on smoking status. RESULTS: Cohen's kappa coefficients of agreement on smoking status between self report and proxy report was highest in non-Hispanic whites and African Americans (kappa = 0.91), followed by Asian Americans (kappa = 0.82) and Hispanics (kappa = 0.76). Among adults identified as current smokers by proxy, a lower percentage of Hispanics compared with non-Hispanics indicated that they were current smokers (odds ratio (OR) = 3.74, 95% confidence intervals (CI) = 3.28 to 4.20). Furthermore, agreement between proxy and self report was also lower in Hispanics of low acculturation compared with Hispanics with a high level of acculturation (OR = 0.40, 95% CI = 0 to 0.94). CONCLUSIONS: The agreement between self reported and proxy reported smoking status is higher among non-Hispanics compared with Hispanics. Smoking rates in different ethnic groups that are estimated by telephone surveys including proxy and self report might not be comparable. (+info)
Validity of rapid estimates of household wealth and income for health surveys in rural Africa.
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STUDY OBJECTIVE: To test the validity of proxy measures of household wealth and income that can be readily implemented in health surveys in rural Africa. DESIGN: Data are drawn from four different integrated household surveys. The assumptions underlying the choice of wealth proxy are described, and correlations with the true value are assessed in two different settings. The expenditure proxy is developed and then tested for replicability in two independent datasets representing the same population. SETTING: Rural areas of Mali, Malawi, and Cote d'Ivoire (two national surveys). PARTICIPANTS: Random sample of rural households in each setting (n=275, 707, 910, and 856, respectively). MAIN RESULTS: In both Mali and Malawi, the wealth proxy correlated highly (r>/=0.74) with the more complex monetary value method. For rural areas of Cote d'Ivoire, it was possible to generate a list of just 10 expenditure items, the values of which when summed correlated highly with expenditures on all items combined (r=0.74, development dataset, r=0. 72, validation dataset). Total household expenditure is an accepted alternative to household income in developing country settings. CONCLUSIONS: It is feasible to approximate both household wealth and expenditures in rural African settings without dramatically lengthening questionnaires that have a primary focus on health outcomes. (+info)
End-of-life decision making: a qualitative study of elderly individuals.
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OBJECTIVE: To identify the desired features of end-of-life medical decision making from the perspective of elderly individuals. DESIGN: Qualitative study using in-depth interviews and analysis from a phenomenologic perspective. SETTING: A senior center and a multilevel retirement community in Los Angeles. PARTICIPANTS: Twenty-one elderly informants (mean age 83 years) representing a spectrum of functional status and prior experiences with end-of-life decision making. MAIN RESULTS: Informants were concerned primarily with the outcomes of serious illness rather than the medical interventions that might be used, and defined treatments as desirable to the extent they could return the patient to his or her valued life activities. Advanced age was a relevant consideration in decision making, guided by concerns about personal losses and the meaning of having lived a "full life." Decision-making authority was granted both to physicians (for their technical expertise) and family members (for their concern for the patient's interests), and shifted from physician to family as the patient's prognosis for functional recovery became grim. Expressions of care, both by patients and family members, were often important contributors to end-of-life treatment decisions. CONCLUSIONS: These findings suggest that advance directives and physician-patient discussions that focus on acceptable health states and valued life activities may be better suited to patients' end-of-life care goals than those that focus on specific medical interventions, such as cardiopulmonary resuscitation. We propose a model of collaborative surrogate decision making by families and physicians that encourages physicians to assume responsibility for recommending treatment plans, including the provision or withholding of specific life-sustaining treatments, when such recommendations are consistent with patients' and families' goals for care. (+info)
A randomized, controlled trial of advanced care planning discussions during preoperative evaluations.
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BACKGROUND: Although many patients and physicians support the concept of advance care planning, only a small percentage of patients actually have the necessary discussion with health care providers. Hospital-based physicians other than primary care providers often are needed to increase physician, patient, and proxy communication about advanced directives. This study evaluated the effectiveness of a 5-10-min discussion designed to foster dialogue between patients and their proxies in a preoperative evaluation clinic. The discussions were lead by anesthesiologists. METHODS: A randomized controlled trial was conducted from September 1998 through May 1999 in a preoperative evaluation clinic at University of California, San Francisco, a tertiary care center. English-speaking patients aged 65 yr or older who were scheduled for elective surgery were randomized to receive a short information session stressing the importance of communication about end-of-life care between the patients and their proxies. Patients randomized to the control group received the standard preoperative anesthesia screening. An admitting counselor questioned all patients (control and intervention) about whether they have an advanced directive as part of the registration process before their arrival in clinic. RESULTS: The intervention significantly increased discussions about end-of-life care between patients and their proxies. Eighty seven percent of patients reported having discussions with their proxies as compared with only 66% of control patients (P = 0.001). The intervention also increased durable power of attorney completion rate to 27% as compared with 10% completion rate by controls. CONCLUSIONS: The preoperative evaluation period can be an opportunity to encourage patient and proxy communication about end-of-life care. (+info)
Proxy reporting in the National Population Health Survey.
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OBJECTIVES: This article examines the extent of proxy reporting in the National Population Health Survey (NPHS). It also explores associations between proxy reporting status and the prevalence of selected health problems, and investigates the relationship between changes in proxy reporting status and two-year incidence of health problems. DATA SOURCE: Cross-sectional results are based on the 1996/97 NPHS Health file and General file. Longitudinal results are based on 1994/95 respondents who were still residing in households in 1996/97. ANALYTICAL TECHNIQUES: The extent of proxy reporting in the various NPHS files was computed. Prevalence estimates of selected health problems from the two 1996/97 cross-sectional files were compared. Multivariate analyses were used to estimate associations between proxy reporting status and health problems. MAIN RESULTS: For several health conditions, prevalence estimates based on the 1996/97 cross-sectional Health file (where proxy reporting was less common) were significantly higher than estimates derived from the General file. Individuals whose data were proxy-reported in 1994/95 and self-reported in 1996/97 had higher odds of reporting new cases of certain health conditions. (+info)
The role of proxies in treatment decisions: evaluating functional capacity to consent to end-of-life treatments within a family context.
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Psychology as a profession has entered the arena of palliative and hospice care later in the process than other health care professions. Through the use of Familial Advance Planning Evaluations (FAPEs), however, psychologists can assist individuals and families in facing end-of-life transitions in important ways. Hospice and palliative care philosophy treats the patient and family as the unit of care. End-of-life decision-making is therefore a family matter as well as a normative developmental transition. Yet, little is known about the decision-making process. This paper reviews the literature regarding informed consent, advance care planning, and proxy decision-making and outlines a theoretical model for familial decision-making. Previous models of end-of-life capacity evaluations and family assessments are presented and serve as the basis for a comprehensive assessment of familial decision-making at the end of life. Functional capacity evaluations of individuals at the end of life regarding decisions about life-sustaining medical treatments enable both the individual patient and one identified proxy from his or her family to discuss important issues families may face during medical crises at the end of life. The information gleaned from such evaluations has the potential to assist psychologists and other professionals in designing family-specific interventions to reduce caregiving distress, improve quality of life for dying patients, and ease the transition to bereavement for caregivers. (+info)
Family history of cancer and incidence of acute leukemia in adults.
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Family history of cancer may represent shared genetic and environmental risk factors for leukemia. The authors examined associations of first-degree family history of cancer with adult acute leukemia incidence by using data on 811 patients (or their proxies) identified at diagnosis and 637 population-based controls in the United States and Canada during 1986-1990. For proxy-interviewed patients, relative risks were elevated for family history of any cancer (relative risk = 1.7, 95% confidence interval (CI): 1.3, 2.4), hematopoietic cancer (relative risk = 1.8, 95% CI: 1.1, 3.0), leukemia (relative risk = 2.4, 95% CI: 1.3, 4.6), and breast cancer (relative risk = 1.7, 95% CI: 1.0, 3.0) but not for colorectal, prostate, or lung cancer. For self-interviewed patients, family history of hematopoietic cancer was inversely associated with leukemia incidence (relative risk = 0.6, 95% CI: 0.4, 1.1). Regardless of patient interview type, history of breast cancer in sisters was positively associated with adult acute leukemia, whereas history of breast cancer in mothers was not. The role of family history of cancer in leukemia etiology is unclear because of differential reporting by patients and proxies. Specifically, self-interviewed patients may underreport cancer in their first-degree relatives. Associations between family history of breast cancer and leukemia incidence may be the result of unmeasured, shared etiologies specific to these cancers. (+info)