Proxy Subjective Health Status Paper MSN5270
Proxy Subjective Health Status
Symptom management is an important part of providing high-quality care to both children and adults. Active screening and assessment are required to identify symptoms early and institute treatment measures to optimize an individual’s health. Proxy reports, according to Roydhouse et al. (2022), are used when patients are unable to self-report.
However, in children, multiple reasons account for the use of proxy reports including an inability to speak, low cognitive ability to comprehend the complex screening tools, and acuity or severity of symptoms that make them frail (Hyslop et al., 2018). The inability to self-report necessitates a valid approach for a proxy report of children’s symptoms. Despite their increasing use in assessing and caring for children, proxy symptom reporting is based on assumptions that may potentially have ramifications, as discussed further below.
Underlying Assumptions of Proxy Subjective Health Status
In most cases, patient factors prompt the use of proxy reporting of symptoms. It is assumed that the patient, in this case, a child, is unable to speak, cannot comprehend the complexities of the screening tools or the questions asked, and is too ill to respond. Children in cancer clinics frequently meet the aforementioned criteria, necessitating the use of proxy symptom reporting.
A systematic review of 2335 articles on the use of proxy and proxy reported measures conducted by Roydhouse et al. (2022) discovered that cancer clinics made up 13% of clinical settings, bolstering the previous statement. Furthermore, it is assumed that the proxy is fully aware of the child’s illness and can legitimately account for the main complaints and history of presenting illness. This is why Mpundu-Kaambwa et al. (2022) advocate for a child’s proxy to be someone close to him or her, or someone in the immediate environment as the child, such as a parent, or guardian, or sibling. The third assumption is that the proxy’s information approximates the child’s self-report.
To evaluate the validity of a proxy version of symptoms screening in pediatric cancer patients, Hyslop et al. (2018) discovered that the proxy report of observable phenomena such as diarrhea and mouth sores had a high intraclass correlation coefficient (ICC), as did other subjective symptoms such as feeling scared or worried, disappointed, sad, or tired. This finding is reassuring because it implies that proxy reports of the stated subjective symptoms may approximate the child’s self-report.
Potential Ramifications of Having Proxy Subjective Health Status
While its use may be unavoidable in some situations, proxy symptom reporting may have ramifications. There may be a response bias, in which the information reported by the proxy differs from the information that would be reported by the patient. This type of information discrepancy may result in suboptimal patient care. The information provided by the proxy is critical in determining the extent of a disease, such as regional spread or metastatic potential in children in the cancer unit; thus, any discrepancy in the information may result in incorrect cancer staging (Murtagh et al., 2019).
Furthermore, proxy reporting may not accurately represent some of the entirely subjective symptoms. When assessing pain, for example, the patient is the most accurate person to report the severity. This, once again, may result in suboptimal care for such patients. Moreover, proxies’ omission to report symptoms may result in an incomplete diagnosis and, as a result, inadequate patient care. As much as proxy symptom reporting is used, it is important to note that the disadvantages stated may alter clinical decision-making.
Conclusion
The age difference could be a significant determinant of patient care. For example, children may be unable to speak or understand the questions posed, or they may be too ill to respond. As a result, someone who is aware of the child’s symptoms must account for the child’s illness history. This, however, assumes that the proxy stays close or is in the child’s immediate environment, or that the proxy can provide information that approximates the child’s self-report. While proxy symptom reporting may be unavoidable, the information discrepancy, omission of some data, and failure to provide an accurate measure of some symptoms, such as pain, may impede clinical care decisions.
References
Hyslop, S., Dupuis, L. L., Baggott, C., Dix, D., Gibson, P., Kuczynski, S., Johnston, D. L., Orsey, A., Portwine, C., Price, V., Spiegler, B., Tomlinson, D., Vanan, M., Tomlinson, G. A., & Sung, L. (2018). Validation of the proxy version of Symptom Screening in Pediatrics Tool in children receiving cancer treatments. Journal of Pain and Symptom Management, 56(1), 107–112. https://doi.org/10.1016/j.jpainsymman.2018.03.025
Mpundu-Kaambwa, C., Bulamu, N., Lines, L., Chen, G., Dalziel, K., Devlin, N., Ratcliffe, J., & Quality of Life in Kids: Key Evidence for Decision Makers in Australia (QUOKKA) Project Team. (2022). A systematic review of international guidance for self-report and proxy completion of child-specific utility instruments. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research. https://doi.org/10.1016/j.jval.2022.04.1723
Murtagh, F. E., Ramsenthaler, C., Firth, A., Groeneveld, E. I., Lovell, N., Simon, S. T., Denzel, J., Guo, P., Bernhardt, F., Schildmann, E., van Oorschot, B., Hodiamont, F., Streitwieser, S., Higginson, I. J., & Bausewein, C. (2019). A brief, patient- and proxy-reported outcome measure in advanced illness: Validity, reliability and responsiveness of the Integrated Palliative care Outcome Scale (IPOS). Palliative Medicine, 33(8), 1045–1057. https://doi.org/10.1177/0269216319854264
Roydhouse, J. K., Cohen, M. L., Eshoj, H. R., Corsini, N., Yucel, E., Rutherford, C., Wac, K., Berrocal, A., Lanzi, A., Nowinski, C., Roberts, N., Kassianos, A. P., Sebille, V., King, M. T., Mercieca-Bebber, R., & ISOQOL Proxy Task Force and the ISOQOL Board of Directors. (2022). The use of proxies and proxy-reported measures: a report of the international society for quality-of-life research (ISOQOL) proxy task force. Quality of Life Research: An International Journal of Quality-of-Life Aspects of Treatment, Care and Rehabilitation, 31(2), 317–327. https://doi.org/10.1007/s11136-021-02937-8