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Inter-rater reliability in performance status assessment between clinicians and patients: a systematic review and meta-analysis


Introduction Performance status is an essential consideration for clinical practice and for patient eligibility for clinical trials in oncology. Assessment of performance status is traditionally done by clinicians, but there is an increasing interest in patient-completed assessment. The aim of this systematic review and meta-analysis was to summarise inter-rater concordance between patient and clinician ratings of performance status.

Methods A search strategy was developed and executed in the databases of Ovid MEDLINE, Embase and Cochrane Central Register of Controlled Trials, from inception until 15 August 2019. Articles were eligible for inclusion if there was mention of both (1) use of performance status tool Karnofsky Performance Status (KPS) or Eastern Cooperative Oncology Group Performance Status (ECOG), and (2) assessment of performance status by both clinicians and patients. Pearson correlation coefficients were calculated for each study and were meta-analysed according to a random-effect analysis model. Analyses were conducted using Comprehensive Meta-Analysis (V.3) by Biostat.

Results Sixteen articles were included in our review, reporting on a cumulative sample size of 6619 patients. The quality of evidence was moderate, as determined by the GRADE tool.

Concordance ranged from fair to moderate for both the KPS and ECOG tools. The Pearson correlation coefficient was 0.449 for KPS and 0.584 for ECOG.

Conclusions There is fair to moderate concordance of patient and clinician performance status ratings. Future studies should examine the reasoning behind clinician and patient ratings to better understand discrepancies between ratings.

  • prognosis
  • performance status
  • concordance
  • clinicians
  • patients

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