Performance of EQ5D-5L and AHPEQS for measuring outcomes and experiences of patients with peripherally inserted central catheters: a secondary analysis

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Peripherally Inserted Central Catheter (PICC)-associated complications, such as infections and thrombosis, impact significantly upon patients’ experiences and outcomes of care. The purpose of this study was to assess the utility of a patient-reported outcome measure (EuroQol Five Dimension Five Level (EQ5D-5L)), and patient-reported experience measure (Australian Hospital Patient Experience Question Set (AHPEQS)), to discriminate incidence of PICC failure among adults. A secondary analysis was undertaken of two large randomised controlled trials, conducted in two adult tertiary hospitals in Queensland, Australia. The EQ5D-5L and AHPEQS instruments were assessed against incidence of three clinical outcomes likely to impact upon self-reported outcomes and experiences: Central Line Associated Bloodstream Infection (CLABSI), venous thrombosis, and all-cause PICC complication. Partial proportional odds, multinomial logistic, linear regression and generalised linear regression models were used to assess instrument performance. Overall, 984 participants provided baseline EQ5D-5L responses. Subsequently, n=628 completed an EQ5D-5L at study end; n=552 further completed the AHPEQS. EQ5D-5L demonstrated poor discrimination of individual complications (CLABSI, thrombosis), however, there was a significant association (p=<0.05) between all-cause PICC complication and: utility (− 0.1, Confidence Interval (CI) − 0.1 to − 0.1); disutility (0.4, CI 0.2–0.7); and self-reported health (– 4.3, CI − 7.8 to − 0.9). AHPEQS demonstrated poor discrimination; one item (‘both physical and emotional harm’) was significantly associated with all-cause PICC complication (1.0, 95%CI 0.1–1.9); CLABSI (2.4, 95%CI 0.7–4.2); and thrombosis (2.0, 95%CI 0.7–3.4). EQ5D-5L demonstrated moderate suitability for use among patients with PICCs; AHPEQS demonstrated little reliability. Patients needing long-term or ‘irritant’ intravenous treatments (like chemotherapy, or antibiotics) often need Peripherally Inserted Central Catheters. One in every four of these devices fail (e., they fall out, or become blocked or infected). As a result, patients can experience both negative physical (discomfort, treatment delay) and psychological (distress) effects. It is important that researchers, doctors, and nurses understand these experiences, to identify where and how care can improve. To do this, special questionnaires called ‘patient-reported outcome measures’ and ‘patient-reported experience measures’ are used to assess health outcomes of patients’ care, and how patients experience this care. These questionnaires can either be very general or relate specifically to a condition (cancer) or intervention (surgery). To date there has been no ‘gold standard’ questionnaire for Peripherally Inserted Central Catheters. Two recent large trials have used general questionnaires as part of their regular data collection. This data was combined and analysed to find out if they were good at picking up whether a patient had experienced Peripherally Inserted Central Catheter complications (i.e., do they do what they are supposed to?). Neither questionnaire was considered ‘gold standard,’ however a few select questions within them appeared useful.

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