Quality of life in long-term forensic psychiatric care: comparison of self-report and proxy assessments.

OBJECTIVE To compare quality of life (QoL) ratings of long term forensic psychiatric care patients with the ratings of psychiatric nurses, in which the nurses indicate how they think the patient would answer. METHODS Agreement on QoL-scores according to the Forensic inpatient Quality of Life Questionnaire (FQL) was investigated for seventy- seven pairs of patients and psychiatric nurses from two forensic psychiatric long-care facilities where QoL is seen as an important treatment goal. This study also examined whether the amount of agreement was related to specific patient characteristics and characteristics of the patient- psychiatric nurse relationship. RESULTS On group level, only small and mostly non-significant differences were found between patients' and psychiatric nurses' mean QoL scores. However, pairwise comparisons revealed poor agreement between patients' and nurses' QoL scores for half of the domains and moderate agreement on the other half of the domains, except for Leave, which was the only domain on which patients and their nurses had similar scores. Patient characteristics such as type of offence and type of psychopathology were negligibly related to the level of agreement. However, characteristics of the patient-nurse relationship such as age of the nurse and length of the patient-nurse relationship did influence the amount of consensus between patients' and proxies' QoL-scores significantly. CONCLUSIONS Nurses were not sufficiently able to accurately estimate their patients' QoL experience and could probably benefit from a training aimed at assessing QoL of their patients and how to support their patients in optimizing their QoL themselves.