Differences between proxy and patient assessments of cancer care experiences and quality ratings

Objective. To assess the impact of proxy survey responses on cancer care experiencereports and quality ratings.Data Sources/Study Setting. Secondary analysis of data from Cancer Care Outcomes Research and Surveillance (CanCORS). Recruitment occurred from 2003 to2005.Study Design. The study was a cross-sectional observational study. The respondentswere patients with incident colorectal or lung cancer or their proxies.Data Collection/Extraction Methods. Analyses used linear regression models withan independent variable for proxy versus patient responses as well as study site andclinical covariates. The outcomes were experiences with medical care, nursing care,care coordination, and care quality rating. Multiple imputation was used for missingdata.Principal Findings. Among 6,471 respondents, 1,011 (16 percent) were proxies. Theproportion of proxy respondents varied from 6 percent to 28 percent across study sites.Adjusted proxy scores were modestly higher for medical care experiences (+1.28points [95 percent CI:+ 0.05 to +2.51]), but lower for nursing care (-2.81 [95 percentCI: -4.11 to -1.50]) and care coordination experiences (-2.98 [95 percent CI: -4.15to -1.81]). There were no significant differences between adjusted patient and proxyratings of quality.Conclusions. Proxy responses have small but statistically significant differences frompatient responses. However, if ratings of care are used for financial incentives, such differences could be exaggerated across practices or areas if proxy use varies