Patient-Family Caregiver Concordance in Assessment of Psychological Distress of Chinese Patients with Head and Neck Cancer during Chemoradiotherapy

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To examine patient-caregiver concordance in assessment of psychological distress of Chinese patients with head and neck cancer undergoing chemoradiotherapy and to identify factors related to concordance between patients and family caregivers. This was a cross-sectional observational study. From October 2021 to January 2022, 200 patient-caregiver dyads were enrolled in Chengdu, China. Sociodemographic information and the distress thermometer (including the problem list), the Distress Disclosure Index and the Family Adaptability and Cohesion Evaluation Scale scores were collected. Data were analyzed using intraclass correlation coefficients (ICCs) and kappa statistics, two-related-samples, chi-square and/or Fisher's exact tests, and binary logistic regression. A fair level of agreement was identified between Head and Neck Cancer (HNC)patients' and caregiver's reports of patient distress (intraclass correlation coefficients [ICC] = 0.456). The patients reported significantly higher psychological distress scores than the paired caregiver reports. Gender (odds ratio [OR], 0.380; 95% confidence interval [CI], 0.147-0.979), metastasis (odds ratio [OR], 0.092; 95% confidence interval [CI], 0.017-0.492) and patient knowledge of the disease (OR, 3.107; 95% CI, 1.035-9.326) affected the concordance of psychological distress. There was relatively low concordance between HNC patients' reports and caregivers' perceptions of psychological distress. Family caregivers tended to underestimate HNC patients' psychological distress. Having an awareness of the incongruence between patient and caregiver may help healthcare providers better interpret caregiver assessments. Healthcare providers should reinforce Patient-family caregiver psychosocial education to improve concordance. More psychological care and substantial emotional support should be provided for Chinese HNC patients undergoing chemoradiotherapy by family caregivers and healthcare providers. The authors would like to thank every patient and family member who participated in the study.