Bias in Assessment of Health-Related Quality of Life in a Hemodialysis Population

Abstract

Abstract. Examined is the relationship of patient-reported health-related quality of life (HRQOL) to the mode of survey administration in the Hemodialysis Study. In addition to selfadministered surveys to assess HRQOL, interviewer-administered surveys were made available to include patients with poor vision, decreased manual dexterity, or strong preference. For examining the predictors of participation by self-administration of the survey, multiple logistic regression was performed. For examining the relationship of HRQOL results to mode of survey administration, adjusted differences between the selfadministered and interviewer-administered groups were obtained from multiple linear regression models accounting for sociodemographic and case-mix factors. A total of 978 of the first 1000 subjects in the Hemodialysis Study completed the survey by interview (n ϭ 427) or by self-administration (n ϭ 551). The interviewer-administered group was older, was more likely black, had longer duration of ESRD, had a higher prevalence of diabetes, and had more severe comorbidity (all P Ͻ 0.01). After adjustment for these differences, patients in the interviewer-administered group had higher scores on scales that measured Role-Physical, Role-Emotional, and Effects of Kidney Disease (all P Ͻ 0.001). Dialysis studies that restrict HRQOL measurement to patients who are able to complete surveys without assistance will not accurately represent the health of the overall hemodialysis population. Clinical studies and clinical practices using HRQOL as an outcome should include interviewer administration or risk a selection bias against subjects with older age, minority status, and higher level of comorbidity. Future investigation should include research of survey modalities with a low response burden such as telephone interview, computer-assisted interview, and proxy administration.Patient reports of health-related quality of life (HRQOL) are recognized as providing important information about the impact of ESRD and its treatment on daily life (1-6). HRQOL questionnaires are used increasingly in studies of ESRD patients (7) and by dialysis providers (8,9). HRQOL surveys may be used in clinical care to screen for potential problems, to prioritize problems, to facilitate communication between health care workers and patients, and to monitor response to treatment (10,11). However, there is little guidance about how best to gather HRQOL information from patients with kidney failure.HRQOL surveys may be self-administered, but other alternatives, such as interviewer administration of surveys, may be particularly important in the ESRD population, because many of these patients are advanced in age and have comorbid conditions that preclude traditional questionnaire self-administration. It is precisely these older and sicker patients for whom HRQOL measures may be most needed (12). Although HRQOL assessment has become a commonly reported outcome in ESRD, we are unaware of previous studies examining the influence of mode of survey administration on...

Prevalence, Severity, and Importance of Physical and Emotional Symptoms in Chronic Hemodialysis Patients

“…Conversely, patients may have underreported potentially embarrassing symptoms such as erectile dysfunction in the context of face-to-face interviews. Future studies should examine the impact of mode of survey administration on symptom reporting as this variable was found to affect reporting of HRQoL in the HEMO study (46). Third, we used the IEQ to measure HRQoL.…”

Mode of data elicitation, acquisition and response to surveys: a systematic review.

“…Seventeen studies 104,[111][112][113][114][115][116][117][118][119][120][121][122][123][124][125][126] published between 1994 and 2003 used SF-36. Not all studies reported all subscales.…”

“…The impact of the different modes of using SF-36 was assessed using weighted pooled measures of agreement for within-subject comparisons and random-effects meta-analysis for between-subject comparison. There were seven studies 104,111,112,[114][115][116][117] that provided betweensubject comparisons only, eight studies [119][120][121][122][123][124][125][126] that provided within-subject comparisons only and two studies 113,118 that contributed data to both analyses. Table 15 summarises the information available from each study.…”

“…Eight studies 104,112,[114][115][116][117][118] had some data available that could contribute to the meta-analysis. One of these (Amodei et al 111 ) was a comparison of an interview in which the interviewer asked the questions and recorded the response to one in which the interviewer asked the questions and the responder confidentially recorded their own response.…”

“…104,[112][113][114][116][117][118] All of these also had a difference in sensory stimuli, with auditory stimuli with interviewer administration and visual stimuli with self. Of these, five studies 104,112,114,116,118 provided data that could contribute to a meta-analysis. The results of the meta-analysis for each subscale of the SF-36 can be seen in Figures 19-26 (forest plots in order of magnitude of pooled difference).…”