title: Selection of ultimately ill cancer patients able to fulfill a questionnaire: Identification of inherent biases.
abstract: OBJECTIVE
  Physical or psychological well-being is an essential component of quality care assessment in palliative unit. This assessment is mainly based on self-assessment (questionnaires or interviews). The aim of this study is to compare the clinical characteristics of patients able to fulfill a questionnaire and those not able to do that.
  
  
  METHODS
  The clinical characteristics of 166 cancer patients admitted in palliative care unit from December 2006 to February 2008 have been collected. Characteristics of patients able to fulfill a questionnaire (80, 48.2%) have been compared to other patients (86, 51.8%). Moreover, functional independence measure (FIM) had been evaluated by nurses.
  
  
  RESULTS
  Median age (60 versus 62) and sex ratio (40/40 versus 42/44) are similar in both groups. Lung primaries are significantly less frequent in patients able to fulfill the questionnaire (4% versus 17%, P=0.005). Patients able to fulfill the questionnaire had had better performance status (Karnofsky Index≤30%: 54% versus 21%, P<0.0001). The total score of FIM (56.0 versus 91.5, P<0.00001) and the median overall survivals (2.3 weeks versus 6.6 weeks, P=0.0001) were significantly lower in the group of patients non able to fulfill the questionnaire.
  
  
  CONCLUSIONS
  Patients able to fulfill a questionnaire represent only 48.2% of all consecutive admitted patients. These patients are not representative of all patients since they had better performance status, they are less dependent and they display significant better survival. We have to think about new methods to avoid the biases generated by the use of patient-reported outcomes.
authors.affiliation: University Lille 3, URECA EA 1059 (Research Unit: Cognitive and Affective Sciences), UFR de psychologie, rue du Barreau, BP 60149, 59653 Villeneuve d'Ascq cedex, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Fournier
authors.affiliation: Centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Fournier
authors.affiliation: University Lille 3, URECA EA 1059 (Research Unit: Cognitive and Affective Sciences), UFR de psychologie, rue du Barreau, BP 60149, 59653 Villeneuve d'Ascq cedex, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Christophe
authors.affiliation: Centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Reich
authors.affiliation: Centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Villet
authors.affiliation: Centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Gamblin
authors.affiliation: Centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ryckewaert
authors.affiliation: Centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rodrigues
authors.affiliation: Centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France.
authors.forename: Eric Yaovi
authors.initials: EY
authors.lastname: Amela
authors.affiliation: Centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France.
authors.forename: Gautier
authors.initials: G
authors.lastname: Lefebvre
authors.affiliation: Centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Clisant
authors.affiliation: University Lille 3, URECA EA 1059 (Research Unit: Cognitive and Affective Sciences), UFR de psychologie, rue du Barreau, BP 60149, 59653 Villeneuve d'Ascq cedex, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Antoine
authors.affiliation: University Lille 3, URECA EA 1059 (Research Unit: Cognitive and Affective Sciences), UFR de psychologie, rue du Barreau, BP 60149, 59653 Villeneuve d'Ascq cedex, France; University Lille 2, EA 264 (Resarch Unit: Epidemiology and Care Quality) and SIRIC ONCoLille, Platform 4, place de Verdun, 59045 Lille cedex, France. Electronic address: n-penel@o-lambret.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Penel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006304:Health Status; D006801:Humans; D017567:Karnofsky Performance Status / Q000706:statistics & numerical data*; D008175:Lung Neoplasms / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology*; D010166:Palliative Care; D011446:Prospective Studies; D012648:Self Care; D011795:Surveys and Questionnaires; D019452:Terminally Ill
keywords: Biais; Bias; Palliative care unit; Psycho-oncologie; Psycho-oncology studies; Soins palliatifs