Search

Objective To study the impact of the spontaneous use of Internet on breast cancer patients and on their relationship with health professionals. Methods A mixed methodology was used. Two questionnaires were designed through three focus groups, and then administered to 186 patients and 59 professionals in order to assess: (1) patients' use of Internet for health-related information and (2) the impact of this information on patients' psychological outcomes and on their relationship with professionals. Results Patients spent more time looking for illness-related information after diagnosis, using interactive communities more than static information websites. Patients and professionals disagreed about the use of Internet in terms of the knowledge it provides, and its psychological impact. The main barrier reported by patients regarding the sharing of online information with their professionals was the belief that it would damage their relationship. Conclusions Both professionals and patients have a protectionist conception of the therapeutic relationship. This attitude tends to dismiss the positive impact that the use of Internet and the new communication tools may have in cancer patients. New resources should provide an "Internet Prescription" and modes of interaction to facilitate a more open digital communication.

BackgroundFamily caregivers of patients with advanced illness at end of life often report high levels of emotional distress. To address this emotional distress is necessary to have adequate and reliable screening tools.AimThis study analyses the psychometric properties and clinical utility of the Family Caregiver Emotional Detection Scale for caregivers of patients with end-stage cancer (DME-C, Spanish acronym) who are receiving palliative care (PC).DesignMulticentre, cross-sectional study.Settings/participantsFamily caregivers of patients with advanced cancer at end of life receiving palliative treatment were interviewed to explore their emotional distress through the DME-C scale and other instruments measuring anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), distress thermometer (DT) and overload (B), as well as a clinical psychological assessment (CPA).Results138 family caregivers, 85 (61.6%) female and 53 (38.4%) male, with an average age of 59.69±13.3 participated in the study. The reliability of the scale, as measured by Cronbach’s alpha, was 0.76, and its stability over time was 0.734. Positive, significant correlations were found between the DME-C and the scores for anxiety and depression registered on the HADS scale, as well as with the total result of this latter scale and the results for B, the DT and the CPA. A statistical analysis of the receiver-operating characteristic curves showed that the scale has a sensitivity and specificity of 75%, and that the cut-off point for the detection of emotional distress was a score ≥11. Fifty-four per cent of the caregivers displayed emotional distress according to this scale.ConclusionsThe DME-C displays good psychometric properties. It is simple, short, reliable and easy to administer. We believe that the instrument is useful for the detection of emotional distress in the family caregivers of hospitalised patients suffering from end-stage illnesses and receiving PC.

espanolObjetivo: Analizar las propiedades psicometricas y la utilidad clinica de la Escala de Soledad Existencial (EDSOL) en enfermos hospitalizados con enfermedad avanzada. Metodo: Para determinar las propiedades psicometricas de la escala, se administro la escala EDSOL junto con otros instrumentos a 103 pacientes adultos con enfermedades avanzadas ingresados en 5 unidades de cuidados paliativos de hospitales catalanes. Resultados: La escala presenta una excelente fiabilidad medida a traves del alfa de Cronbach (0,902) y una adecuada estabilidad temporal (r=0,71). La escala mostro correlaciones positivas y significativas con ansiedad y depresion de la escala HADS y con la suma total de la misma, asi como con la valoracion clinica psicologica (p EnglishAim: 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:As a part of a European study, we cross-culturally examined the rate of emotional distress and maladaptive coping and their association with cancer patients' satisfaction with their interactions with the physician responsible for their care.Methods:Cancer patients (n = 302) from one Middle European (Austria) and two Southern European (Italy, Spain) countries completed the NCCN Distress Thermometer (DT), the Mini-Mental Adjustment to Cancer (Mini-MAC) Anxious Preoccupation (AP) and Hopelessness (H) sub-scales, and the Physician Patient Satisfaction with Doctors Questionnaire (PSQ).Results:The prevalence of emotional distress (DT caseness) was 60% (26.1% mild, 18.8% moderate, and 14.9% severe distress). Maladaptive coping (Mini-MAC cases) was found in 22.8% (hopeless cases), and 22.5% (anxious preoccupation cases). PSQ-MD was significantly correlated with Mini-MAC/H and Mini-Mac/AP, while PSQ-PS was negatively correlated with Mini-MAC/H. DT cases and those with higher levels of hopelessness reported higher scores on PSQ-MD and lower on PSQ-PS than non-cases. Some differences were found between countries both as far as patients' coping and perception of the interaction with doctors. In hierarchical multiple regression analysis, after adjusting for socio-demographic and medical variables, Mini-MAC/H significantly predicted the scores on PSQ-MD (positive direction) and PSQ-PS (negative direction).Significance of results:The study confirms that about one out of three cancer patients have moderate to high level of emotional distress and about one out of four, clinically significant maladaptive coping. Also, patients showing hopelessness and distress tended to perceive their doctors as both disengaged and less supportive. These results highlights the need for physicians to monitor their patient's level of distress and coping mechanisms and to adjust their own relational and communication style according to patients' psychological condition. Also, cross-cultural issues should be taken into account when exploring psychosocial variables and cancer patients' perception of and satisfaction with the interaction with their doctors.

Background: Chemotherapy-induced nausea and vomiting (CINV) continue to be a distressing problem still reported by cancer patients, with negative consequences on quality of life (QoL). Aims: To prospectively explore the association of psychosocial variables, including emotional distress, maladaptive coping styles and the doctor-patient relationship, with CINV and QoL among cancer outpatients. Methods: A prospective study was conducted on 302 consecutive cancer patients (response rate 80.9%) in Austria, Italy and Spain. The Distress Thermometer (DT), the Mini-Mental Adjustment to Cancer (Mini-MAC), and the Patient Satisfaction with Doctor Questionnaire (PSQ) were used to assess psychosocial variables before chemotherapy. In the 5 days after chemotherapy, CINV was examined by using a daily diary, and the Functional Living Index for Emesis (FLIE) was used to assess QoL. Results: More than half of the patients reported nausea (54%), and a small percentage reported vomiting (14%). CINV had a negative impact on QoL (FLIE caseness, p < 0.01). Maladaptive coping (i.e. hopelessness-helplessness and anxious preoccupation) and emotional distress were associated with CINV (p < 0.05) and poorer QoL (p < 0.05). In logistic regression analysis, nausea was predicted by Mini-MAC/H (OR = 1.1, p = 0.03) and younger age (OR = 0.97, p = 0.04); negative impact on QoL was predicted by grade of chemotherapy emetogenesis (OR = 1.7, p < 0.01) and Mini-MAC/H (OR = 1.2, p = 0.04). Conclusions: Screening and assessment of psychological variables, especially coping, could help in identifying cancer patients at risk for chemotherapy-induced nausea, in spite of the use of antiemetic treatment.

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: 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. Objetivo: Conocer las vivencias, expecta­tivas y satisfacción percibida de un grupo de mujeres diagnosticadas de cáncer de mama con mastectomía con reconstrucción en el mismo acto quirúrgico. Material y Métodos: La metodología utili­zada en esta investigación ha sido la cualitativa y las técnicas para la recogida de la informa­ción fueron la entrevista en profundidad (cua­tro mujeres) y el grupo focal (dos grupos de 8 pacientes cada uno). Resultados: se exploraron cinco áreas 1) El impacto del diagnóstico del cáncer 2) In­formación recibida ante la intervención 3) Las experiencias en el postoperatorio. 4) Cumpli­miento de expectativas y 5) Satisfacción con la decisión tomada. El diagnóstico fue impactante para la mayoría de las mujeres. Inicialmente, la información recibida se consideró buena y suficiente pero hemos comprobado que poste­riormente, una vez superada la convalecencia de la intervención, aparecen más quejas sobre todo relacionadas con las complicaciones pos­teriores y con el dolor. Las expectativas sobre la reconstrucción inmediata estuvieron muy li­gadas con los resultados estéticos finales. Algunas mujeres volverían a pasar por lo mismo a pesar de las complicaciones y otras dan mucho valor a los inconvenientes y no se lo volverían a hacer. Conclusiones: No aparece una postura cla­ra y unánime entre las pacientes de si se vol­verían a reconstruir y si se han cumplido sus expectativas. La paciente necesita una infor­mación real, ecuánime y adaptada para poder tomar una decisión compartida. Por eso, cree­mos necesario elaborar herramientas de toma de decisiones compartidas que faciliten que la información llegue a la paciente.

Women with a family history of breast cancer (FHBC) are at increased risk for developing this disease. In this study, we have investigated the differences between two groups of women; those with family history of breast cancer (N=42) and women at population risk (N=42) in a Spanish cohort. Questionnaires assessed distress, perception of breast cancer risk, screening behaviours, coping skills, personality and quality of life. Neither group received genetic counselling before or after this study. Women with FHBC overestimated their risk of developing breast cancer. They report a subjective risk of developing breast cancer of 50%, with their actual risk, using the risk tables elaborated by Claus et al., being only 15% (p

Purpose The objective of this study is to determinate the relationship between the accurate information related to the diagnosis and the information that the patients know about it

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.

Fundamento y objetivo El principal objetivo del estudio ha sido determinar la prevalencia y los predictores de trastornos mentales en pacientes con cancer. Pacientes y metodo Se entrevisto a 400 pacientes oncologicos ambulatorios. A aquellos con una puntuacion igual o mayor de 14 en la Escala de Ansiedad y Depresion Hospitalaria (HADS) se les administro la Entrevista Clinica Estructurada para los Trastornos del Eje I (SCID-I) del Manual Diagnostico y Estadistica de los Trastornos Mentales, cuarta edicion (DSM-IV), con el fin de determinar la prevalencia de trastornos mentales en la muestra estudiada. Resultados Un 24% de los pacientes con cancer presentaba criterios de trastorno mental. En el analisis multivariante los predictores de presencia de trastorno mental fueron: haber recibido radioterapia, estar en tratamiento psicofarmacologico y la presencia de dolor. Conclusiones LOS datos aportados por el estudio senalan la necesidad de realizar un adecuado cribado de los posibles sintomas ansiosos y depresivos que el paciente puede desarrollar durante el proceso oncologico y que le incapacitan para su adaptacion emocional a este. El uso de los predictores hallados puede ayudar a identificar posibles casos de trastorno mental entre los pacientes con cancer.

Objetivo: El principal objetivo es describir el rendimiento cognitivo previo al tratamiento oncológico sistémico en mujeres con cáncer de mama dentro de un estudio longitudinal. Método: A 35 mujeres diagnosticadas de cáncer de mama no metastásico, con una edad media de 48,6 años, se les ha realizado una evaluación neurocognitiva, sobre diferentes dominios cognitivos, y psicológica (malestar emocional y percepción subjetiva de fallos cognitivos) antes de iniciar el tratamiento. Resultados: El 22,9% de la muestra precisa quimioterapia, el 28,6% hormonoterapia y el 48,6% un tratamiento combinado. Los resultados muestran que: (1) Entre un 62% y un 100% presenta un rendimiento normal en los distintos dominios cognitivos, excepto en memoria visual donde sólo un 43% cumple criterios de normalidad. (2) Aparece deterioro cognitivo leve en atención selectiva (23,5%) y memoria visual (14,4%), y deterioro cognitivo severo en atención y velocidad de procesamiento (28,6%) y memoria visual (22,9%). (3) Un porcentaje reducido de mujeres presenta niveles elevados de depresión y ansiedad (2,9% y 14,5%, respectivamente). (4) El 71% manifiesta baja percepción subjetiva de fallos cognitivos. (5) Los tests neurocognitivos y las variables psicológicas son independientes. (6) La percepción subjetiva del funcionamiento muescognitivo correlaciona con la ansiedad (r = – 0,409). Conclusión: Un número reducido de pacientes presenta deterioro cognitivo, antes de iniciar el tratamiento, de estos un porcentaje muestra deterioro severo. Es indispensable contar con una línea base de funcionamiento cognitivo para evaluar correctamente a estos pacientes y habría que revisar la metodología usada y la idoneidad de las pruebas neurocognitivas administradas 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

ResumenObjetivoCon el fin de valorar y aliviar el malestar emocional al final de la vida, se necesitan instrumentos de cribado sencillos, de fácil uso por los sanitarios y comprensibles por los enfermos. En el presente estudio multicéntrico se analiza la utilidad clínica del cuestionario de Detección del Malestar Emocional (DME) en enfermos hospitalizados con cáncer avanzado.MétodosPara determinar las propiedades psicométricas de la escala se administró, a la vez que otros instrumentos y procedimientos, a 105 pacientes con enfermedad oncológica avanzada ingresados en unidades de cuidados paliativos de cinco hospitales de Cataluña.ResultadosSe observó que el 58,3% presentaba malestar emocional moderadoo muy intenso, similar al objetivado con otras escalas, como el termómetro emocional. El análisis estadístico de las curvas ROC sugiere que el punto de corte para la detección de malestar emocional que muestra el DME equivale a una puntuación ≥ 9 puntos, con una sensibilidad y una especificidad superiores al 75%.ConclusionesEl DME es útil y de fácil manejo para la identificación del malestar emocional en los enfermos oncológicos avanzados ingresados en unidades de cuidados paliativos. Se sugiere que esta escala también se podría aplicar a otros enfermos y ámbitos de la atención sanitaria, por ejemplo la atención domiciliaria o la atención primaria en enfermos crónicos.AbstractObjectiveTo evaluate and alleviate the emotional distress suffered by advanced cancer patients, simple screening methods that can be easily used by health staff and easily understood by patients are required. The objective of this multicenter study was to analyze the psychometric properties and clinical utility of the Detection of Emotional Distress (DED) scale in advanced cancer patients attending a palliative care unit.MethodsThe DED scale was administered to 105 advanced cancer patients attended in five palliative care units in Catalonia (Spain).ResultsA total of 58.3% of the patients had moderate to severe emotional distress, a result similar to those of other scales such as the emotional thermometer. Statistical analysis of ROC curves suggested that the cutoff for the detection of emotional distress by the DED scale was equivalent to a score of ≥ 9 points, with a sensitivity and specificity above 75%.ConclusionsThe DED scale is useful and easy to use in the identification of emotional distress in advanced cancer patients attended in palliative care units. This scale could also be applied in other patients and health care fields, such as patients with chronic diseases, home care, and primary care.

To evaluate and alleviate the emotional distress suffered by advanced cancer patients, simple screening methods that can be easily used by health staff and easily understood by patients are required. The objective of this multicenter study was to analyze the psychometric properties and clinical utility of the Detection of Emotional Distress (DED) scale in advanced cancer patients attending a palliative care unit.The DED scale was administered to 105 advanced cancer patients attended in five palliative care units in Catalonia (Spain).A total of 58.3% of the patients had moderate to severe emotional distress, a result similar to those of other scales such as the emotional thermometer. Statistical analysis of ROC curves suggested that the cutoff for the detection of emotional distress by the DED scale was equivalent to a score of ≥ 9 points, with a sensitivity and specificity above 75%.The DED scale is useful and easy to use in the identification of emotional distress in advanced cancer patients attended in palliative care units. This scale could also be applied in other patients and health care fields, such as patients with chronic diseases, home care, and primary care.

The main objective of this study was to determine the prevalence and the predictors of mental disorders in cancer patients.400 ambulatory cancer patients were included in the study. All the patients with a score of 14 or higher in the Hospital Anxiety and Depression Scale (HADS) received a structured clinical interview (SCID-I. DSMIV) with the objective of determining the prevalence of mental disorders.24% cancer patients had criteria for a mental disorder. The predictors of mental disorders were radiotherapy treatment, psychopharmacological treatment and pain.These results support the need to assess the possible anxious and depressive symptoms during cancer treatment and follow up. The predictors found can help to detect possible psychiatric cases in cancer patients.

Women with a family history of breast cancer (FHBC) are at increased risk for developing this disease. In this study, we have investigated the differences between two groups of women; those with family history of breast cancer (N=42) and women at population risk (N=42) in a Spanish cohort. Questionnaires assessed distress, perception of breast cancer risk, screening behaviours, coping skills, personality and quality of life. Neither group received genetic counselling before or after this study. Women with FHBC overestimated their risk of developing breast cancer. They report a subjective risk of developing breast cancer of 50%, with their actual risk, using the risk tables elaborated by Claus et al., being only 15% (p0.05). Discriminant function analysis revealed the patients' information about breast cancer, worries about breast cancer, perception of risk based on family history, perception of lifetime risk of breast cancer and quality of life were the five variables that distinguished between both groups. Only 34% of women in the FHBC group performed monthly breast self-examination, 24% (10 subjects) had never attended previously for clinical breast examination and 45% (19 subjects) had never undergone a mammogram. This group of women had a significantly lower level of general satisfaction (p0.05), an indicator of Quality of Life. The results support the need for developing psychological intervention for women with family history of breast cancer in order to increase adherence to surveillance behaviours, reduce distress, improve quality of life, and assure the earliest detection of breast cancer.

Objetivo: 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 Objective: To establish the methodology of work for a multidisciplinary group whose objective is to generate a tool to detect the emotional distress in patients at the end of their lives. Material and method: It describes the configuration and composition of the researching team as well as its method of work throughout 2007 and 2008. The combination of multiple face to face meetings, online conferences and the review of related bibliography formed the model and the criteria used as the basis for the debate that lead to the elaboration of the instrument. Results: The questionnaire DME is presented, and consists of two parts: 1) four questions addressed to the patient, and 2) observation by the health staff of signs that show the presence of emotional distress. At the moment, the instrument is under validation

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.