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Aim: To analyze the psychometric properties and the clinical utility of the Scale of Existential Loneliness (EDSOL) in hospitalized patients with advanced disease. Method: To determine the psychometric properties of the scale, the EDSOL scale was administered along with other instruments to 103 adult patients with advanced diseases admitted to 5 palliative care units of Catalan hospitals. Results: The scale presents an excellent reliability measured through Cronbach’s alpha (0.902) and adequate temporal stability (r = 0.71). The scale showed positive and significant correlations with anxiety and depression of the HADS scale and with the overall score of HADS, as well as with the clinical psychological assessment (p

Objective: To know the experiences, expectations and perceived satisfaction in a group of breast cancer women who had undergone immediate breast reconstruction after mastectomy. Material and Methods: 20 women took part in a qualitative study. 4 women were assessed through an in-depth interview and the other 16 women were divided into two focus groups (8 each). The recorded interview and focus group discussions were transcribed and analyzed using “framework analysis”. Results: Five areas were explored: 1) Impact of cancer diagnosis, 2) Information received about the surgery, 3) Post-surgery experiences, 4) Fulfilment of expectations and 5) Satisfaction with the decision. Cancer diagnosis was overwhelming for most of the women. For women, information received was considered good and sufficient, but the study shows that after the post-surgical period, more complaints related to pain and other complications appear. The expectations about immediate breast reconstruction were linked with the final aesthetic results. Some women would choose to do the same procedure again despite the complications but some other women would not choose the same option because of the complications and they regret their decision. Conclusion: There is no clear and unanimous position among women about whether they would go through immediate breast reconstruction again and whether the surgery has fulfilled their expectations. The patients need complete, unbiased and appropriate information in order to be able to make an informed and shared decision. It is for that reason that we think it is necessary to devise patient decision aids which could facilitate the information delivering process to patients.

Objective: The aim of this study is to describe the cognitive achievement previous to oncological treatment in a group of breast cancer women included in a longitudinal study. Method: Thirty five non metastatic breast cancer women, with a mean age of 48.6 years old, were assessed in different neurocognitive domains and also in some psychological variables (emotional distress and subjective perception of cognitives failures) before to start the oncological treatment. Results: Twenty two percent of the group received chemotherapy alone, 28.6% hormonotherapy and 48.6% a mixed treatment (chemotherapy plus hormonotherapy). Results show that: (1) Bewteen a 62% and a 100% of the women present a normal achievement in the different cognitive domains, except for visual memory where only 43% gets into the normality. (2) There is a light cognitive impairment in selective attention (23.5%) and visual memory (14.4%), also there is a severe cognitive impairment in attention and processing speed (28.6%) and visual memory (22.9%). (3) A low percentage of women shows high levels of emotional distress, 2.9% for depression and 14.5% for anxiety. (4) The 71% reports a low subjective perception of cognitives failures. (5) Neurocogntive test and psychological variables do not show any correlation. (6) Subjective perception of cognitive failure correlates with anxiety (r = – 0.409). Conclusion: A reduced number of patients shows cognitive impairment before to start the oncological treatment, a small percentage of this group shows severe impairment. It is very important to have a baseline of cognitive functioning to correctly assess these patients. It is also necesary to review the methodology and the neurocognitive test used

Las mujeres con cáncer de mama se quejan de problemas cognitivos tras los tratamientos oncológicos sistémicos. Esto conduce a estudiar el efecto de estos tratamientos sobre la cognición. Objetivo y Método: Revisar los estudios disponibles sobre el deterioro cognitivo inducido por los tratamientos oncológicos sistémicos en cáncer de mama y extraer conclusiones. Resultados: Se han encontrado 24 estudios sobre el deterioro cognitivo asociado a la quimioterapia y 5 sobre el deterioro asociado a la hormonoterapia. Los estudios de quimioterapia encuentran deterioro cognitivo sutil y específico en un porcentaje variable de pacientes. Los estudios de hormonoterapia no coinciden en su efecto perjudicial o neuroprotector. Conclusiones: 1) Se necesitan nuevos estudios que superen las limitaciones metodológicas de los anteriores y evalúen más variables; 2) Importancia de introducir pruebas de neuroimagen; 3) Relevancia de las quejas cognitivas verbalizadas por las pacientes; 4) Desarrollo de programas de rehabilitación cognitiva para compensar estos déficits.

Purpose: The aim of the study was to describe the relationship between preferences for communication and socio-demographic, tumour-related, and personality variables in a sample of Spanish cancer patients. Methods: A sample of 168 cancer patients completed a set of questionnaires: (1) the Spanish adaptation of the Measure of Patients’ Preferences, which includes three scales: content (what and how much information is given), facilitation (setting and context variables) and support (emotional support during the interaction); (2) the Extroversion and Neuroticism scales from the EPQ-RS; (3) the EORTC QLQ-3.0; and (4) the HADS. Results: Regression analysis showed that the patients who scored highest on the Content scale were women, young people, those whose illness was in an advanced stage or who had received the diagnosis for the first time and those who scored high on the Extroversion scale. Patients who scored highest on the Support scale were those with a first diagnosis and those with high Extroversion scores. Women, with high Extroversion scores, scored higher on the Facilitation scale than did other patients. Conclusions: Personality, age, gender and cancer diagnosis experience are important variables to take into account when conducting studies of doctor-cancer patient communication.

Establecer la sistemática de trabajo de un grupo multidisciplinar cuyo objetivo es elaborar un instrumento para detectar el malestar emocional en enfermos al fi nal de la vida. Material y métodos: Se describe la formación y composición del equipo investigador así como su dinámica de trabajo a lo largo de 2007 y 2008 en múltiples reuniones presenciales y on-line así como la bibliografía, el modelo y criterios que sirvieron de base para el debate que condujo a la elaboración del instrumento. Se presenta el cuestionario DME, que consta de dos partes: 1) cuatro preguntas dirigidas al enfermo, y 2) observación, por parte del sanitario, de signos que muestren la presencia de malestar emocional. Actualmente se encuentra en proceso de validación.

Los objetivos de nuestro estudio fueron: 1) Adaptar un instrumento dirigido a conocer las preferencias de comunicación de pacientes oncológicos (“Measure of Patients’ Preferences”, MPP, Parker y cols, 2001)y 2) Determinar la relación entre las preferencias de comunicación y variables socio-demográficas, clínicas y de calidad de vida. 180 pacientes oncológicos tratados de diferentes centros de Catalaluña, mayores de 18 años. Se administró la adaptación del cuestionario original a una muestra de 180 pacientes oncológicos adultos. Se registraron variables socio-demográficas (edad, sexo, nivel educativo, situación laboral, estado civil), médicas (tipo de cáncer, tiempo desde el diagnóstico, situación evolutiva, tipo de tratamiento,) y se administraron los cuestionarios EORTC y HADS para valorar calidad de vida y adaptación psicológica, respectivamente. Se analizó la consistencia interna del cuestionario MPP mediante el coeficiente de Cronbach. Se calcularon las medias de los ítems y escalas del MPP (contenido, apoyo, facilitación) comparándose con el estudio original (USA). Para cada una de las escalas de la MPP se efectuó una regresión múltiple incluyendo como predictores las variables socio-demográficas, clínicas y de calidad de vida. La adaptación española del MPP mostró buenas propiedades psicométricas. Los pacientes evaluados dieron mayor importancia a aspectos relacionados con el contenido de la información médica, aunque también valoraron como importantes el apoyo emocional y el contexto en el que se da la interacción con el médico. Los pacientes que preferían obtener la información con mayor detalle fueron las mujeres y pacientes jóvenes. Las mujeres jóvenes y los pacientes que habían sido diagnosticados por primera vez manifestaron mayores necesida- des de apoyo por parte de los profesionales. Finalmente, las mujeres que no convivían con pareja dieron mayor importancia a los elementos del contexto en el que se da la información médica. El sexo, la edad, la convivencia y la experiencia con el diagnóstico son variables importantes en las preferencias de información de pacientes oncológicos españoles.

The main objective of this study is to describe psycho-oncological intervention at the Genetic Counselling Unit in the University Hospital Sant Joan. We also present data on a study which aims were: (1) to study the approach and understanding of the information given at the Genetic Counselling Unit and (2) to report the effect that genetic counselling has on the psychosocial adjustment for patients and family members. A total sample of 51 subjects were assessed (1) cancer patients who are candidates to a genetic testing, (2) cancer patients who do not meet the criteria for a genetic testing, (3) family members of cancer patients who do not meet the criteria for a genetic testing, and (4) family members of cancer patients who meet the criteria for a genetic testing. A number of variables were assessed regarding socio-demographic variables and type of tumor. Pre-genetic counselling variables evaluated were: reasons for attending the genetic counselling unit,beliefs about the cause of cancer in the family,and about the risk of developing cancer. Postgenetic counselling variables were: understanding of being or not candidate to genetic testing,advantages and disadvantages of being candidate to genetic testing, beliefs about the apparition of cancer in the family, conclusions from the visit, anxiety and depression and psychiatric history. The sample assessed shows a better understanding of the cancer risk they have and the reasons of having so many cancer cases in the family after the counselling visit. They rate the visit as important, informative and satisfactory,and they appear more relieved and relaxed.

La piel, como órgano externo, juega un papel importante en las relaciones interpersonales. El carácter crónico de las dermatosis y la dificultad de establecer su etiología, hacen a quienes las sufren, candidatos y candidatas ad hoc para padecer altos niveles de ansiedad. Para valorar la influencia de la ansiedad en la aparición y mantenimiento de la patología dermatológica aplicamos el Inventario de Situaciones y Respuestas de Ansiedad -ISRA- y un cuestionario relativo a la historia de la enfermedad a 95 pacientes comparándoles con el mismo número de personas sanas. Consideramos factores como género, edad, tiempo de evolución y nivel de afectación del trastorno así como su relación con el estrés. Encontramos diferencias significativas entre los grupos y principalmente entre los géneros. El impacto psicológico que produce la dermopatía, así como su carácter crónico, se relaciona con un alto grado de ansiedad demostrado en este estudio, definiéndose el perfil de reactividad de ansiedad característico de tales pacientes.

Na situação de cirurgia existem três tipos de estresse, (1) Estresse produzido pela avaliação da situação cirúrgica como ameaça, dano ou perda (estresse psicológico), (2) Estresse produzido pela enfermidade prévia do paciente, e (3) Estresse produzido pela intervenção cirúrgica em si (estresse cirúrgico). Dotar o paciente de estratégias de confronto frente à cirurgia, reduz o estresse. Os resultados podem ser medidos tanto em termos clínicos quanto econômicos, diminuindo a permanência do paciente no hospital e a ingestão de analgésico e sedativo. Neste artigo, apresentam-se as técnicas concretas e adaptadas ao ambiente hospitalar que se mostram mais efetivas na avaliação e redução da ansiedade pré-cirúrgica.In a surgery situation we can clearly find three types of stress, (1) the stress derived from the assessment of the surgical situation as a threat, injury or loss (psychological stress), (2) the stress derived from the illness itself, and (3) the stress derived from surgery itself (surgical stress). Stress can be reduced if the patient is trained to cope with certain strategies. Results will be related to clinical and economical issues, provided that the length of the stay at the hospital will be shorter and the intake of analgesics and sedatives will decrease. This paper is a theoretical review about the psychological techniques adapted to the hospital setting which have demonstrated to be more effective in the assessment and reduction of the pre-surgical anxiety.

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