Adaptation and validation of a patient-reported compassion measure in the Spanish population: The Spanish version of the Sinclair Compassion Questionnaire (SCQesp).

International practice guidelines and policies recognize compassion as a fundamental dimension of quality care. A key element in enhancing compassion in healthcare settings is having reliable patient-reported experience measures. In the Spanish context, there is a need for a valid Spanish patient-reported compassion measure for use in both research and clinical practice. The Sinclair Compassion Questionnaire (SCQ) represents the gold standard for patient-reported compassion measures in English-speaking settings. The primary aim of this study is to culturally adapt and validate the SCQ in a Spanish population. A Spanish version of the SCQ (SCQesp) was used to collect data from 303 Spanish patients (in two contexts: hospitalized and medical visit). Confirmatory factor analysis confirmed a one-factor solution in the 15-item (SCQesp) and five-item (SCQesp-SF) short form version. The SCQesp showed excellent values of reliability: Cronbach's α = 0.98; composite variance = 0.98 (0.905-0.854); and stratified variance = 0.78. The SCQesp-SF showed similar values of reliability. The SCQesp has excellent psychometric properties, making it a valid and reliable measure for assessing compassion in healthcare research and clinical care. This scientifically rigorous and psychometrically robust compassion measure in Spanish could allow healthcare providers, researchers, and leaders to routinely assess compassion.

Quality of life in cancer survivorship: Sociodemographic and disease-related moderators.

RATIONALE: To identify high-risk survivors in order to provide appropriate care. PURPOSE: To analyse the quality of life (QOL) of cancer survivors using an instrument designed specifically for this population and considering different sociodemographic and disease-related characteristics as possible modulating variables. METHODS: The Quality of Life in Adult Cancer Survivors (QLACS) was filled out by a large and heterogeneous sample of disease-free post-treatment Spanish cancer survivors (N = 1862). RESULTS: QLACS scores were comparable to those obtained in other studies and indicative of worse QOL as a function of shorter elapsed time since the end of primary treatment. The best QOL was shown by prostate, and the worst by hematologic cancer survivors. Both systemic treatments (chemotherapy and hormone therapy) and the combination of radiotherapy and chemotherapy were associated with worse QOL. Likewise, younger age, female sex, unemployment status and not having a stable partner were associated with worse QOL. CONCLUSION: Greater understanding of the QOL experienced by the already large and continuously growing population of cancer survivors is relevant for guiding both clinical practice and health policy. In addition, knowing the risk factors associated with worse QOL facilitates the development of targeted prevention programmes for those survivors who need it the most.

Colorectal cancer survival: prevalence of psychosocial distress and unmet supportive care needs.

PURPOSE: The aim of this study was to determine the prevalence of distress and unmet supportive care needs in post-treatment colorectal cancer (CRC) survivors. Also, to explore the association between both variables and to identify potential associated sociodemographic and cancer-related risk factors. METHODS: A cross-sectional study of 200 CRC survivors who at least 1 month before had completed the primary treatment for CRC was conducted. The Brief Symptom Inventory-18 (BSI-18) and the Spanish version of Cancer Survivors' Unmet Needs (S-CaSUN) were used. RESULTS: One in five CRC survivors showed clinical distress and 86% expressed at least one unmet need. Distress was positively associated with the prevalence of needs in all domains. All comprehensive care and information needs were expressed by at least 20% of survivors and some by more than 50%. Other needs also mentioned by 20% of survivors were financial support, ongoing case manager, and concerns about cancer recurrence. The risk factors associated were lower socioeconomic status, younger age, and a primary treatment that includes more than surgery. CONCLUSIONS: The findings highlight the relevance of extending psychosocial care beyond the CRC primary medical treatment. A person-centered approach that addresses informational, emotional, social, and physical needs can increase satisfaction with care and also prevent psychological morbidity in CRC survivors.

Psychometric Properties of the Spanish Version of the Cancer Survivors' Unmet Needs (CaSUN-S) Measure in Breast Cancer.

BACKGROUND: The Cancer Survivors' Unmet Needs (CaSUN) measure is an assessment tool developed specifically for this population but several issues about its structural properties still remain unresolved. METHOD: The present study tests the theoretical model, the original authors' empirical solution, and a new rational proposal of the CaSUN using Confirmatory Factor Analysis. Reliability and convergent validity are also analysed. 566 Spanish breast cancer survivors completed the CaSUN, the Brief Symptom Inventory-18 (BSI-18) and the Quality of Life in Adult Cancer Survivors questionnaire (QLACS). RESULTS: The proposed model of five domains (physical effects, psychological effects, comprehensive care and information, practical issues, and relationships) plus a total score provided better fit than the authors' theoretical proposal and some advantages over their empirical proposal. Internal consistency (α = .73 - .95; r item-total > .30) and test-retest reliability (r = .74 - 89) were adequate. The CaSUN correlated with high emotional distress (r = .43 - .77) and poor quality of life (r = .18 - .64). CONCLUSIONS: The CaSUN-S is an effective and complete instrument that can help health professionals to collect data about the impact of the disease beyond the diagnosis and treatment phase that is important for patient care.

COPD at the end of life: Predictors of the emotional distress of patients and their family caregivers.

BACKGROUND: Few studies have focused on patients' emotional distress with end-stage chronic obstructive pulmonary disease (COPD) and their main family caregivers. METHODS: Cross-sectional data about emotional, functional, and burden-related variables were collected from 85 patients with end-stage COPD and their 85 respective main family caregivers to determine the variables that could predict their emotional well-being. Descriptive analyses, comparison of means, hierarchical regression models, and comparative quali-quantitative analyses were carried out. RESULTS: Data show that the great majority of patients with COPD spend years with this diagnosis, and have been admitted to the hospital several times in advance stage of illness the previous year of the moment of end-of-life stage. Furthermore, only a tiny percentage of the patients were functionally independent in the advanced stage of illness. CONCLUSIONS: The emotional distress and the burden of the family caregiver play an essential role in the distress of the patient, in conjunction with the patient's own functional independence and the time living with the disease, and comorbidity. On the other hand, variables of the patient, such as time since diagnosis, number of hospital admissions, comorbidity, functional dependence, and emotional distress, play an important role in the family caregiver's emotional distress and burden. Understanding how these variables are related is key to designing appropriate programs to reduce the emotional distress the patients with COPD at the end of life and their family caregivers.

The Big Five and subjective wellbeing: The mediating role of optimism.

BACKGROUND: Previous literature has shown that personality is one of the most important predictors of Subjective Wellbeing. However, the mechanisms through which basic personality dispositions contribute to wellbeing have scarcely been explored. Therefore, in this study we examined the mediating role of Optimism in the relationship between the Big Five personality model (both factors and facets) and Subjective Wellbeing. Additionally, we assessed whether the results varied by sex. METHOD: A sample of 611 Spanish adolescents completed self-report measures of BFQ, LOT-R, and SHS. We conducted structural equation modeling to test the proposed mediating models. RESULTS: Optimism completely mediated the relationship between Extraversion and Emotional Stability factors and Subjective Wellbeing. Likewise, Optimism mediated the relationship between the personality facets Politeness, Perseverance, Emotion control, Impulse control, and Dynamism and Subjective Wellbeing. The findings were invariant by sex. CONCLUSIONS: These results provide help in identifying the possible mechanisms through which basic dispositions of personality contribute to wellbeing. These findings can be used to develop interventions that target the promotion of greater Subjective Wellbeing through Optimism, and thereby improve adolescents' adjustment.

Psychometric Properties of Spanish Version Student Utrecht Work Engagement Scale (UWES-S-9) in High-school Students.

The Utrecht Work Engagement Scale (UWES) is a self-report instrument widely used, both in the original and its abbreviated version of nine items, to assess the work -UWES, UWES-9- and academic engagement -UWES-S, UWES-S-9-. The present study examines factor structure of the UWES-S-9 using confirmatory factor analysis (CFA), its convergent validity and invariance across sex and age groups in a sample of 626 Spanish high school students. The results support an unidimensional conceptualization of engagement (S-Bχ2/df = 5.29; CFI = .96; NNFI = .94; RMSEA = .083; IFI = .96; AIC = 82.21; BIC = 267.38), revealed an essentially invariant structure of the UWES-S-9 across the sex, ΔS-Bχ2(Δ6) = 10.67; p ≤ .05, and age, ΔS-Bχ2(Δ7) = 9.67; p ≤ .05, and confirmed the positive association between academic engagement and achievement (r = .30; p ≤ .001), dispositional optimism (r = .21; p ≤ .001), and subjective well-being (r = .16; p ≤ .001), and the negative association with perceived stress (r =. -13; p ≤ .001). In short, the Spanish version of UWES-S-9 is presented as a brief, reliable and valid tool to measure academic engagement in high school students (α = .91, AVE = .52, Ω = .911).

The factor structure of the Medical Outcomes Study-Social Support Survey: A comparison of different models in a sample of recently diagnosed cancer patients.

OBJECTIVE: To analyse the factor structure and psychometric properties of the original and abbreviated versions of the Medical Outcomes Study-Social Support Survey (MOS-SSS) in recently-diagnosed cancer patients. METHOD: A sample of 128 newly-diagnosed cancer patients were assessed with the Spanish versions of the MOS-SSS and the Hospital Anxiety and Depression Scale (HADS). Confirmatory factor analyses were conducted to analyse six different factor structures. Internal consistency and convergent validity indexes were calculated. The models tested included all of the following: 1) the original five-factor model (comprised of the following dimensions: emotional, informational, and tangible support, positive social interaction, and affection); 2) a four-factor empirical solution; 3 & 4) two different three-factor structures obtained in studies conducted in cancer patients; and 5 & 6) a two-factor solution for the abbreviated 8-item form and a one-factor solution for the 6-item form. RESULTS: The original five-factor structure showed a better fit index than the three and four factor models. Both the 6- and 8-item versions showed excellent goodness-of-fit, with adequate internal consistency and convergent validity indexes. CONCLUSION: The MOS-SSS is a powerful, highly flexible instrument to assess social support in cancer patients. The full 19-item scale allows for a comprehensive assessment of the essential dimensions of social support, while the abbreviated versions permit a quick assessment that minimizes the burden on patients.

Acute stress trajectories 1 year after a breast cancer diagnosis.

PURPOSE: The purpose of this study was to evaluate the longitudinal trajectories of acute stress reactions over the course of diagnosis, treatment, and follow-up assessments in a group of non-metastatic breast cancer patients during five different moments of the illness process, and to identify psychological predictors of the trajectories. METHODS: The sample was formed by 102 non-metastatic breast cancer patients treated with adjuvant chemotherapy. Latent growth mixture models (LGMM) were used to identify latent classes, and we used multinomial logistic regression in a conditional model to examine predictors to differentiate between trajectories. RESULTS: We identified four different groups according to their trajectories: (1) a resilient group, (44.5 %); (2) a mild acute stress group, (40.6 %); (3) a delayed-recovery group (11.9 %); and (4) a chronic acute stress group (2.9 %). Moreover, anxious preoccupation showed the strongest significant effects in predicting each class, whereas cognitive avoidance and type C personality had moderate effects for participants in the mild acute stress group. CONCLUSIONS: This study demonstrates that the majority of breast cancer patients in our study were resilient, with only a small percentage showing chronic acute stress. Because coping strategies, specifically anxious preoccupation, and not more stable variables played a main role in the prediction of acute stress trajectories, future preventive interventions should center in promoting more adaptive coping strategies in breast cancer patients.

Improving the Diagnostic Accuracy of the Distress Thermometer: A Potential Role for the Impact Thermometer.

CONTEXT: Screening for and management of distress in clinical practice is an important issue in the field of psycho-oncology. The Distress Thermometer (DT) is a common screening tool, but other methods recently have been proposed, with the aim of improving its diagnostic accuracy. OBJECTIVES: To investigate the diagnostic accuracy of the DT alone and combined with the Impact Thermometer (IT), via the use of two possible combination methods. METHODS: A heterogeneous sample of 385 adult patients with cancer completed the DT, the IT, and the Brief Symptom Inventory-18. RESULTS: The results of the DT were comparable with those found in previous studies, indicating that the DT was adequate for "screening" but had limited value for "case finding." The DT and the IT combined (summed or paired scores) showed minor differences in accuracy indexes compared with the DT alone. CONCLUSION: The results of this study suggest that the addition of the IT to the DT failed to improve its accuracy for identifying distress.

Posttraumatic stress symptoms in breast cancer patients: temporal evolution, predictors, and mediation.

This study (N = 102 women) evaluated the time course of posttraumatic stress symptomatology (PTSS) at different stages of nonmetastastic cancer diagnosis and treatment: during treatment, at the end of treatment, and at a 6-12 months follow-up. We also assessed the contribution of demographic, trait, and state predictors to PTSS, and coping processes as proximal mediators of the relation between Type C personality and PTSS. Results indicated that PTSS remained constant across all phases. There were significant correlations (range = .28 to .81) between PTSS and psychosocial variables and age, but not with other sociodemographic or medical factors. A linear growth curve model showed that hopelessness/helplessness (B = 1.45) and Type C personality (B = 1.40) were the best predictors of PTSD symptomatology, followed by trait dissociation (B = 0.55), and the coping strategies of anxious preoccupation (B = 1.20), cognitive avoidance (B = 0.91), and symptoms of acute stress disorder (B = 0.19). A mediation model showed that the coping strategies of anxious preoccupation, cognitive avoidance, and helplessness/hopelessness mediated the relationship between Type C personality and PTSS during treatment, posttreatment, and follow-up. These results clarify the contribution of different predictors of PTSS and can help develop prevention programs.

The Distress Thermometer in Spanish cancer patients: convergent validity and diagnostic accuracy.

PURPOSE: International organizations such as National Comprehensive Cancer Network and NICE recommend implementation of routine screening programs for detecting and managing psychosocial distress among cancer patients. The selection of an adequate screening tool is crucial to the effectiveness of these programs. The present study examines the emotional symptomatology captured by the Distress Thermometer (DT) and its accuracy and validity as a screening tool in cancer. It also explores the possible discrepancy between patient distress and the use of psycho-oncology resources. METHODS: A heterogeneous sample of 962 adult cancer patients completed the DT, the Problem List (PL), the Brief Symptom Inventory-18 (BSI-18), and the Psychosocial Questionnaire. RESULTS: The DT was significantly correlated with BSI-18 symptoms and the emotional problems listed on the PL. Receiver Operating Characteristic analysis showed good diagnostic accuracy for the DT (area under the curve = .82, 95 %CI [.79-.85]). For a selected DT cutoff of 5, standard measures (sensitivity = 90 %, specificity = 64 %, predictive positive value = 35 %, and negative predictive value = 97 %) and Clinical Utility Indexes (utility index negative = .62 and utility index positive = .32) indicated that the DT was adequate for "screening" while it was limited for "case finding." Finally, 81.30 % of patients with clinical distress had not sought or were not receiving professional psychosocial support at the time of the study. CONCLUSION: The DT is appropriate for use as a rapid screening instrument for cancer patients in a Spanish population because it assesses a broad concept of distress including both anxiety and depression symptoms. The diagnostic accuracy of the DT could be improved with minor proposed modifications to the DT and the inclusion of nonemotional ultrashort measures.

Enhancing the efficacy of treatment for temporomandibular patients with muscular diagnosis through cognitive-behavioral intervention, including hypnosis: a randomized study.

OBJECTIVE: This study evaluated the efficacy of a cognitive-behavioral therapy (CBT), including hypnosis, in patients with temporomandibular disorders (TMDs) with muscular diagnosis. STUDY DESIGN: Seventy-two patients (65 women and 7 men with an average age of 39 years) were selected according to the Research Diagnostic Criteria for TMD, and assigned to the experimental group (n = 41), receiving the 6-session CBT program, and the control group (n = 31). All patients received conservative standard treatment for TMD. The assessment included pain variables and psychologic distress. RESULTS: There were significant differences between the groups, the experimental group showing a higher improvement in the variables evaluated. Specifically, 90% of the patients under CBT reported a significant reduction in frequency of pain and 70% in emotional distress. The improvement was stable over time, with no significant differences between posttreatment and 9-month follow-up. CONCLUSIONS: CBT, including hypnosis, significantly improved conservative standard treatment outcome in TMD patients.

A longitudinal study of psychosocial distress in breast cancer: prevalence and risk factors.

This longitudinal study was conducted among 102 women with non-metastasic breast cancer to identify the time evolution and prevalence of distress at specific times through diagnosis and treatment of disease: preliminary diagnosis, surgery, definitive diagnosis and chemotherapy. Additionally, the study aimed to examine the role of demographic, medical and psychosocial factors on distress. The results indicated that prevalence of distress was higher at initial diagnosis (25%) than the following time points (approximately 17%). The differences inter-individuals in the levels of distress were observed over the four assessments. No relation between distress and demographic and medical factors was found. However, psychosocial aspects were significant risk factors. Patterns of emotional suppression and specific coping responses like helplessness/hopelessness, anxious preoccupation, cognitive avoidance and fatalism were positively related to distress, whereas fighting spirit and perceived social support showed a protective role. Moreover, helplessness/hopelessness and anxious preoccupation jointly predicted 75% of cases and 98% non-cases of distress. Finally, a mediational model between emotional suppression and distress through helplessness/hopelessness was tested. Results support the necessity of routine distress screening all through the illness. Implications of data for psychosocial interventions with breast cancer patients are highlighted.

Emotional suppression and breast cancer: validation research on the Spanish Adaptation of the Courtauld Emotional Control Scale (CECS).

Emotional suppression has played an important role in the research on psychosocial factors related to cancer. It has been argued to be an important psychological factor predicting worse psychosocial adjustment in people with cancer and it may mediate health outcomes. The reference instrument in the research on emotional suppression is the Courtauld Emotional Control Scale (CECS). The present study analysed construct validity of a new Spanish adaptation of the CECS in a sample of 175 breast cancer patients. The results confirmed the proposal by Watson and Greer claiming that the CECS is composed of three subscales that measure different dimensions, but not independent, from emotional control. The present Spanish version of the CECS showed high internal consistency in each subseale as well as the total score. According to Derogatis (BSI-18) criteria, emotional suppression predicts clinically significant distress. In short, our results support the reliability, validity and utility of this Spanish adaptation of the CECS in clinical and research settings.

Psychometric properties of the Brief Symptom Inventory-18 in a Spanish breast cancer sample.

OBJECTIVE: The objective of this work was to study the psychometric and structural properties of the Brief Symptom Inventory-18 (BSI-18) in a sample of breast cancer patients (N=175). METHODS: Confirmatory factor analyses were conducted. Two models were tested: the theoretical model with the original structure (three-dimensional), and the empirical model (a four-factor structure) obtained through exploratory factor analysis initially performed by the authors of the BSI-18. RESULTS: The eligible structure was the original proposal consisting of three dimensions: somatization, depression, and anxiety scores. These measures also showed good internal consistency. CONCLUSION: The results of this study support the reliability and structural validity of the BSI-18 as a standardized instrument for screening purposes in breast cancer patients, with the added benefits of simplicity and ease of application.

Psychometric properties of the Brief Symptoms Inventory-18 (Bsi-18) in a Spanish sample of outpatients with psychiatric disorders.

This study analyzes the psychometric and structural properties of the BSI-18 in a sample of Spanish outpatients with psychiatric disorders (N = 200), with three basic objectives: (a) to study the structural validity of the instrument; (b) to analyse reliability (internal consistency and test-retest stability) and validity (convergent and discriminant) of the instrument, and (c) to evaluate sensitivity to change in a therapeutic context. Using confirmatory factor analysis, two models were tested: the three-dimensional theoretical model proposed by its authors, and the empirical four-factor model obtained by the same authors through exploratory factor analysis. Our results showed that the best structure was a four-dimensional model, with the General Distress index and Somatization, Depression, General Anxiety and Panic scores. These four scales showed good internal consistency, test-retest reliability, validity and sensitivity to therapeutic change. The BSI-18 has been shown to be a reliable and useful tool for psychiatric assessment of patients, with the added advantage provided by its simplicity and ease of application.

An examination of the psychometric structure of the Multidimensional Pain Inventory in temporomandibular disorder patients: a confirmatory factor analysis.

BACKGROUND: This paper seeks to analyse the psychometric and structural properties of the Multidimensional Pain Inventory (MPI) in a sample of temporomandibular disorder patients. METHODS: The internal consistency of the scales was obtained. Confirmatory Factor Analysis was carried out to test the MPI structure section by section in a sample of 114 temporomandibular disorder patients. RESULTS: Nearly all scales obtained good reliability indexes. The original structure could not be totally confirmed. However, with a few adjustments we obtained a satisfactory structural model of the MPI which was slightly different from the original: certain items and the Self control scale were eliminated; in two cases, two original scales were grouped in one factor, Solicitous and Distracting responses on the one hand, and Social activities and Away from home activities, on the other. CONCLUSION: The MPI has been demonstrated to be a reliable tool for the assessment of pain in temporomandibular disorder patients. Some divergences to be taken into account have been clarified.

Multidimensional approach to the differences between muscular and articular temporomandibular patients: coping, distress, and pain characteristics.

OBJECTIVE: This study analyzes the differences in psychological variables and symptomatology between temporomandibular disorder diagnosis subgroups. STUDY DESIGN: The sample included 114 temporomandibular disorder patients that were evaluated in coping, distress, and temporomandibular characteristics. Diagnostic muscular (n = 58) and articular (n = 56) subgroups were compared in these variables through a MANCOVA. RESULTS: Muscular patients show a higher level of general distress, specifically in the anxiety and somatization subscales and a more active coping style, with a tendency of a minor use of humor and a higher number of parafunctional habits, specifically, biting nails, hangnails, and lips. CONCLUSION: We discuss the differences found in order to design the targets of the psychological intervention of temporomandibular patients.

Psychological assessment of patients with temporomandibular disorders: confirmatory analysis of the dimensional structure of the Brief Symptoms Inventory 18.

OBJECTIVE: This article analyzes the psychometric and structural properties of the Brief Symptoms Inventory 18 in a sample of patients with temporomandibular disorders (TMDs), given the convenience of a brief evaluation of distress in these patients. METHODS: Confirmatory factor analysis was carried out in a sample of 114 patients with TMDs. Two models were tested: the theoretical model with the original structure proposed--which considers three dimensions--and the empirical model obtained through the exploratory factor analysis initially carried out by Leonard R. Derogatis--which consists of the four-factor structure. RESULTS: Both models reached satisfactory indexes in confirmatory factor analysis. Empirical and theoretical reasons led us to prefer the original proposal of three dimensions: somatization, depression and anxiety, and general distress. CONCLUSION: The Brief Symptoms Inventory 18 has been demonstrated to be a reliable and valid tool for the assessment of distress in patients with TMDs, with the advantage of its simplicity and ease of application.