Underlying assumptions and potential ramifications of having proxy subjective health status

Underlying the Nursing Middle Range theory is the idea of proxy subjective health state. Patients’ impressions and understanding of what they regard to be high-quality or healthy living can fluctuate because of the transient nature of proxy subjective health status. AlRuthia and colleagues define evaluation measures or proxy subjective health status as actions taken by family members or healthcare professionals (2021, p. 730). Because of worries about the “accuracy” of proxy decision-making, including the possibility that proxies may not be able to accurately predict the desires of patients who are permanently disabled in as many as one-third of those cases, using proxies has been questioned (Fernández-Lora & Provost, 2022, p.2). A proxy correctly infers a person’s preferences based on the notion that there is only one option, according to the concept of “accuracy.” Studies demonstrating erroneous proxy decision-making usually compare patients’ expressed preferences and proxy-reported assessments using fictitious settings. The patient’s forecast of what they intend to do is used as the “gold standard” by which the proxy option is judged, raising hypothetical and other analytical challenges. According to a recent study on real-world proxy decision-making that involved research participation, authenticity should be considered the foundation for proxy decision-making rather than correctness. Although the moral ideal of “being true to oneself” is taken into consideration in this essay, it is understood that it is socio-culturally constructed and has evolved via interaction with people and the development of a coherent story. Others who reject the use of narrative coherence contend that authenticity may take into account not only the historical preferences of people with diminished capacity but also their current preferences. It is obvious that the purpose of proxy decision-making is authenticity rather than accuracy, and it might be advantageous to draw on ideas found in the substantial body of research into enhancing and promoting decision-making rather than pursuing interventions to improve accuracy or ultimately eliminating the use of proxies (Cheng et al.,2022, p.3). The ability to make decisions with confidence is crucial, and earlier empirical studies have linked it to better judgments made by proxy. Although confidence is an important and modifiable factor in proxy decision-making, the exact relationship or causal mechanism between confidence and choice quality is not immediately clear. The assumption that a quality-adjusted life-year (QALY) may quantify the degree of health improvement for children and persons who are unable to speak for themselves is another assumption made to proxy subjective health status (Basu & Gandhay 2021, p.633). The Health-Related Quality of Life (HRQOL) questionnaire can be used as a proxy subject to determine the health status of patients who are unable to speak for themselves and their children.

References

AlRuthia, Y., Almuaythir, G. S., Alrasheed, H. H., Alsharif, W. R., Temsah, M. H., Alsohime, F., … & Bashiri, F. A. (2021). Proxy-reported quality of life and access to nusinersen among patients with spinal muscular atrophy in Saudi Arabia. Patient preference and adherence, 15, 729.

Basu, A., & Gandhay, V. J. (2021). Quality-adjusted life-year losses averted with every COVID- 19 infection prevented in the United States. Value in Health, 24(5), 632-640.

Cheng, H. F., Stapleton, L., Kawakami, A., Sivaraman, V., Cheng, Y., Qing, D., … & Zhu, H. (2022, April). How Child Welfare Workers Reduce Racial Disparities in Algorithmic Decisions. In CHI Conference on Human Factors in Computing Systems (pp. 1-22).

Fernández-Loría, C., & Provost, F. (2022). Causal decision making and causal effect estimation are not the same… and why it matters. INFORMS Journal on Data Science.

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Discuss  the underlying assumptions and potential ramifications of having proxy subjective health status or evaluation measures for children or those unable to speak for themselves.

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