title: Family and professionals underestimate quality of life across diverse cultures and health conditions: systematic review.
abstract: OBJECTIVE
  To examine how accurately proxies evaluate quality of life (QoL) in people they know, using cross-cultural data from the multidimensional, multilingual World Health Organization Quality of Life assessment short-form (the WHOQOL-BREF) and whether accuracy varies by health condition or proxy type (eg, family/professional).
  
  
  METHODS
  Systematic review with meta-analysis: We searched five databases for reports of proxy-completed WHOQOL-BREF scores and aggregated results using a random-effects model. Minimal clinically important difference values were calculated.
  
  
  RESULTS
  Analyses included nine studies (1980 dyads) of physical (n = 762) or mental (n = 604) health conditions, or intellectual disability (n = 614), in 10 countries. Mean person-proxy correlations ranged from 0.28 (social QoL) to 0.44 (physical QoL). Proxy measures were underestimates (ie, significantly lower than persons reported for themselves) for social [mean difference (MD) = 4.7, 95% confidence interval (CI): 1.8, 7.6], psychological (MD = 3.7, 95% CI: 0.6, 6.8), and physical (MD = 3.1, 95% CI: 0.6, 5.6) QoL. Underestimates varied significantly between health conditions for social (P < 0.001), psychological (P = 0.009), and physical (P = 0.02) QoL. Family members assessed psychological and environmental QoL better than professionals.
  
  
  CONCLUSIONS
  Proxies tend to be imprecise, underestimating QoL, and should be aware of this tendency. Where health care is decided for others, family members' views about QoL should be prioritized.
authors: Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK. Electronic address: tom.crocker@bthft.nhs.uk.
authors: Thomas F
authors: TF
authors: Crocker
authors: Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK; Caudwell Children, Minton Hollins Building, Shelton Old Road, Stoke-On-Trent ST4 7RY, UK.
authors: Jaime K
authors: JK
authors: Smith
authors: Manchester Centre for Health Psychology, School of Psychological Sciences, Coupland 1 Building, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
authors: Suzanne M
authors: SM
authors: Skevington
mesh_terms: D017028:Caregivers; D003469:Culture; D005190:Family; D006304:Health Status; D006801:Humans; D008603:Mental Health; D019989:Persons with Intellectual Disabilities; D019727:Proxy; D011788:Quality of Life; D014944:World Health Organization
keywords: Minimal clinically important difference; Proxy; Quality of life; Social comparison theory; Systematic review; WHOQOL-BREF