Validation of a German version of the Caregiver Quality of Life Index-Cancer (CQOLC) in a sample of significant others of breast and gynaecologic cancer patients

There is no disease-specific instrument to measure the quality of life of significant others of cancer patients in Germany. In this study, we evaluated the reliability and construct validity of a German version of the Caregiver Quality of Life Index-Cancer (CQOLC) in a sample of 212 caregivers of breast and gynaecologic cancer patients. The CQOLC was administered along with the World Health Organization Quality of Life short version (WHOQOL-BREF) to caregivers of patients taking part in a randomized-controlled intervention study. Data of 212 caregivers were gained at the baseline of the study. Internal consistency was determined by Cronbach's α. Construct validity was examined by conducting a confirmatory factor analysis (CFA) and hypothesis testing. Correlations between change scores with patients' global health-related quality of life (HRQoL) were calculated for three time points to evaluate the responsiveness. The three subscales "burden", "disruptiveness", and "financial concerns" indicate to a good reliability of the instrument (Cronbach's α ranged between 0.754 and 0.832), while the subscale "positive adaptation" demonstrated low reliability ( α = 0.579). A CFA based on data from the whole set of CQOLC items resulted in CFI levels < .90, and a CFA without problematic items resulted in CFI levels also < .90. The construct validity of the CQOLC could be approved by a moderate to high convergence with close variables as the global HRQoL. Mean differences between caregivers of curatively or palliatively treated patients were nonsignificant ( p = 0.959) at T1. Correlations for responsiveness were low with correlation coefficients ranging from 0.030 to 0.326. These data indicate that additional research is needed to further verify the validity of the instrument. The German scale of the CQOLC might be appropriate for clinical and research use, if the wording of some items is refined and if content validity is also assessed by caregivers themselves. The assessment of cancer patients' caregiver's quality of life can contribute to a better understanding of the effects of patient-oriented interventions including also closely involved next of kin's around the cancer patients.

Fatores que interferem na adesão da mulher idosa a programas de prevenção do câncer ginecológico / Factors affecting adhesion by older women to gynecological cancer prevention programs / Factores que influyen en la adhesión de mujeres mayores a los programas de prevención de cáncer ginecológico

Objetivo: discutir os fatores que interferem na adesão da mulher idosa a programas de prevenção do câncer ginecológico. Método: revisão da literatura, realizada na base de dados LILACS, SCIELO e BIREME (2006-2017), em documentos oficiais do Ministério da Saúde e da Sociedade Brasileira de Cancerologia. Foram encontrados 142 artigos, permanecendo no estudo19 artigos, após aplicados os critérios de inclusão. Resultados: foram encontrados cinco fatores que interferem na adesão da mulher a programas de prevenção do câncer ginecológico: a dificuldade de acesso e acessibilidade aos serviços de saúde; os preconceitos da sociedade em geral em relação à velhice; a disponibilidade de uma pessoa para acompanhar a mulher idosa ao serviço de saúde; a insuficiente capacitação dos profissionais de saúde para atuar com a mulher idosa e; pouco investimento em ações de educação em saúde nesta área. Conclusão: para garantir a adesão da mulher idosa aos programas de prevenção de doenças oncológicas, é necessário romper o preconceito de muitos profissionais em relação ao envelhecimento, trabalhando a educação em saúde, a prevenção e a detecção precoce.

Objective: to discuss the factors that affect older women's adhesion to gynecological cancer prevention programs. Method: a literature search of the LILACS, SCIELO and BIREME databases (published in 2006-2017) and in official documents of the Ministry of Health and the Brazilian Cancerology Society found 142 articles, 19 of which were retained for review after applying the inclusion criteria. Results: women's adherence to gynecological cancer prevention programs was found to be affected by five factors: health service access and accessibility difficulties; social prejudices in relation to old age; availability of a person to accompany the older woman to the health service; insufficient training for health professionals to work with older women; and inadequate investment in health education in this area. Conclusion: health education to break down health professionals' prejudice towards aging will help to ensure that older women adhere to cancer prevention programs and facilitate the prevention, early detection and treatment of oncological diseases.

Objetivo: discutir los factores que interfieren en la adhesión de mujeres mayores a programas de prevención del cáncer ginecológico. Método: revisión de la literatura, realizada en las bases de datos LILACS, SCIELO y BIREME (publicadas en 2006-2017), en documentos oficiales del Ministerio de Salud y de la Sociedad Brasileña de Cancerología. Se encontraron 142 artículos, siendo que 19 de ellos permanecieron en el estudio, tras aplicar los criterios de inclusión. Resultados: se encontraron cinco factores que interfieren en la adhesión de la mujer a programas de prevención del cáncer ginecológico: la dificultad de acceso y accesibilidad a los servicios de salud; los prejuicios de la sociedad en general respecto a la vejez; la disponibilidad de una persona para acompañar a la anciana al servicio de salud; la insuficiente capacitación de los profesionales de salud para actuar con la mujer mayor y; baja inversión en acciones de educación en salud en esta área. Conclusión: para garantizar la adhesión de la mujer mayor, hace falta romper el prejuicio de muchos profesionales en relación al envejecimiento, trabajando la educación en salud, la prevención y la detección precoz.

Effect of PLISSIT Model Sexual Health Enhancement Program for Women with Gynecologic Cancer and Their Husbands

PURPOSE: The purpose of this study was to examine effects of the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model sexual health enhancement program on, and development in, sexual function, sexual distress, marital intimacy, and subjective happiness of women with gynecologic cancer and their husbands. METHODS: The comprehensive program (4 session, 90 minutes per session) was developed based on the PLISSIT model. Participants were 43 couples, 21 assigned to the experimental group who attended the 4-week program, and 22 to the control group. Sexual function, sexual distress, marital intimacy, subjective happiness of the women, marital intimacy, subjective happiness of husbands were determined by a questionnaire that was completed by the participants before and after the program. The control group received the intervention post experiment. Chi-square test, t-test, Fisher's exact test were used to test the effectiveness of the program. RESULTS: Post intervention results showed significant differences between the groups for sexual function, sexual distress, and marital intimacy in the women and for subjective happiness in the husbands. CONCLUSION: Results indicate that the sexual health enhancement program is effective in improving sexual function, lowering sexual distress, increasing marital intimacy, and subjective happiness in women with gynecologic cancer and their husbands.

Quality of life in women with gynecologic cancer: a concept analysis / Calidad de vida en mujeres con cáncer ginecológico: análisis de concepto

Quality of life (QOL) must be an important consideration in the evaluation of the effectiveness of healthcare. Walker and Avant’s method for concept analysis was used for working “QOL and gynecologic cancer” concept. Articles from different data bases were used. The principal attributes of QOL are that it is an individual perception, has dimensions, is affected by different factors, varies or fl uctuates, and is measured by the impact on daily life functioning. The antecedents related with QOL were characteristics of the women, diseas and treatment; concerns and fears; coping style; and symptoms. The consequences of QOL are not explicit. The review provided us with a great deal of information about the antecedents of QOL, but not about its attributes and the consequences. To understand and working in the concept is an important step in development theories and working in the nursing research area.

Calidad de vida (CV) debe tener una importante consideración en la evaluación de la efectividad de cuidado. EL método de análisis de concepto de Walker y Avant fue utilizado. Artículos de diferentes bases de datos fueron utilizados. Los principales atributos de la CV son que es una percepción individual, tiene dimensiones, es afectada por diferentes factores, varía o fluctúa, y es medida de acuerdo al impacto en el funcionamiento de la vida diaria. Los antecedentes de la CV fueron las características de las mujeres, de la enfermedad y del tratamiento, preocupación y temor, estilo de afrontamiento, y síntomas. Las consecuencias no están explicitas en los artículos. La presente revisión nos entrega una gran cantidad de información acerca de los antecedentes de la calidad de vida, pero no mucha información acerca de los atributos o sus consecuencias. Comprender y trabajar en el concepto es un importante paso en el desarrollo de teorías y trabajo de enfermería en el área de investigación.

Effectiveness of PLISSIT Model Sexual Program on Female Sexual Function for Women with Gynecologic Cancer

PURPOSE: The purpose of this study was to evaluate the effectiveness of the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model sexual program on female sexual function for women with gynecologic cancer. METHODS: The integrative 6-hr (two hours per session) program reflecting physical and psychosocial aspects of women's sexuality was developed based on Annon's PLISSIT model. Participants were 61 women with cervical, ovarian, or endometrial cancer. Of them, 29 were assigned to the experimental group and 32 to the control group. The women completed the Female Sexual Function Index (FSFI) including sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. Independent t-test and repeated measured ANOVA were used to test the effectiveness of the program. RESULTS: Significant group differences were found on FSFI sub-domain scores including sexual desire, arousal, lubrication, orgasm, and satisfaction but not pain. Significant time differences were found on all domains except for pain in the experimental group repeated measured ANOVA. CONCLUSION: The results indicate that the three-week PLISSIT model sexual program is effective in increasing sexual function for women with gynecologic cancer. Nurses may contribute to improving women's sexual function by utilizing the program. Strategies to relieve sexual pain need to be considered for greater effectiveness of the program.

Predictors of Sexual Desire, Arousal, Lubrication, Orgasm, Satisfaction, and Pain in Women with Gynecologic Cancer

PURPOSE: This study was done to identify psychosocial factors that might be predictive of sexual desire, arousal, lubrication, orgasm, satisfaction, and pain in women with gynecologic cancer. METHODS: Two hundred and twelve women with cervical, ovarian, or endometrial cancer completed questionnaires on the Female Sexual Function Index including sexual desire, arousal, lubrication, orgasm, satisfaction, and pain, and data on their psychosocial factors including body image, sexual attitude, sexual information, depression, and marital intimacy. Stepwise multivariable regression analysis was performed to explore psychosocial predictors of women's sexual function domains. RESULTS: Predictors were identified as sexual attitude, depression, sexual information, and body image for sexual desire; sexual information, depression, and sexual attitude for sexual arousal; sexual information, marital intimacy, and depression for lubrication; sexual information, marital intimacy, depression, and body image for orgasm; marital intimacy, sexual information, sexual attitude, and depression for satisfaction; sexual information, depression, and marital intimacy for pain. CONCLUSION: The results indicate that women's sexual function needs to be approached to domains of female sexual function psychosocially as well as to general sexual function. These factors should be considered in future interventions to positively promote sexual function in women with gynecologic cancer.

Análise ética da revelação do diagnóstico e tratamento em pacientes com câncer genital ou mamário / Ethical issues of diagnosis disclosure and treatment in patients with genital or breast cancer

OBJETIVO: Verificar como se dá a comunicação entre médicos e pacientes na informação sobre o diagnóstico, o tratamento e o prognóstico das pacientes com câncer genital ou mamário, utilizando a bioética como referência de análise. MÉTODOS: Estudo epidemiológico descritivo-analítico de corte transversal de 120 pacientes atendidas no Hospital de Base do Distrito Federal e selecionadas aleatoriamente. Foi aplicado um questionário fechado, composto por nove questões assim distribuídas: três relacionadas ao diagnóstico, quatro ao tratamento e duas ao prognóstico. RESULTADOS: Os resultados mostraram que 73,3 por cento das pacientes consideraram "negativa" a qualidade da primeira informação que receberam sobre o diagnóstico de câncer; 54,2 por cento das pacientes entenderam as informações recebidas a respeito do diagnóstico e do tratamento; aproximadamente 60 por cento sabem o prognóstico do câncer e menos de 10 por cento não querem ter mais outras informações. No entanto, para quase 40 por cento das pesquisadas, existe algum problema na comunicação com o médico sobre o processo que envolve o câncer. A idade e a extensão da doença não repercutiram no grau de entendimento das pacientes sobre o diagnóstico, o tratamento e o prognóstico. CONCLUSÃO: A comunicação da informação sobre o diagnóstico, o tratamento e o prognóstico das pacientes com câncer genital ou mamário é adequada em cerca de 60 por cento das vezes. Contudo foram percebidos problemas concernentes à linguagem utilizada pelos médicos, a não consideração sistemática da autonomia das pacientes e à ausência de mecanismos que pudessem proporcionar o poder de decisão destas.

OBJECTIVE: To verify how the communication between physicians and patients takes place during diagnosis, treatment and prognosis of women with genital or breast cancer, utilizing bioethics as the reference for analysis. METHODS: A descriptive and analytical cross-sectional epidemiological study with 120 patients randomly selected at the Hospital de Base in the Federal District of Brasilia was conducted . Patients were given a questionnaire with the following nine questions three related to diagnosis, four related to treatment, and two questions related to prognosis. RESULTS: Results showed that 73.3 percent of the patients considered the quality of the initial information received on the diagnosis of cancer as negative; 54.2 percent understood the information given in relation to diagnosis and treatment; approximately 60 percent knew the prognosis of cancer while less than 10 percent did not want additional information. However, for almost 40 percent of the respondents, there were some problems in the physician - patient communication in relation to the process which involves cancer. Age and extent of the disease did not influence the patients' degree of understanding about diagnosis, treatment, and prognosis. CONCLUSION: Communication to patients with gynecological or breast cancer during diagnosis, treatment, and prognosis is adequate about 60 percent of the time. However, problems were perceived in relation to the language used by the physicians , the lack of systematic consideration towards autonomy of the patients and the absence of mechanisms that could support their power of decision.

Psychological repercussions related to brachytherapy treatment in women with gynecological cancer: analysis of production from 1987 to 2007: [review] / Repercusiones psicológicas relacionadas al tratamiento de braquiterapia en mujeres con cáncer ginecológico: un análisis de la producción de 1987 a 2007: [revisión] / Repercussões psicológicas relacionadas ao tratamento de braquiterapia em mulheres com câncer ginecológico: análise da produção de 1987 a 2007: [revisão]

One of the radiotherapeutic modalities for gynecological cancer treatment is brachytherapy, characterized by the placement of radioactive materials near the tumor. This treatment can bring side effects for patients. Due to the emotional issues involved, the objective of this research was to apprehend studies about psychological repercussions related to brachytherapy treatment in women with gynecological cancer, through a literature review. The results revealed an embryionic production, with only one study produced in Brazil. A higher concentration of studies was found in the Nursing area. Research focused on psychosocial repercussions, attempting to understand the patients' experiences before, during and after treatment, evidencing physical and psychological consequences that affect their quality of life. It is important to consider the expansion of this production through psychological research that furthers the comprehension about the experience of women submitted to brachytherapy.

Una de las modalidades de radioterapia para el tratamiento del cáncer ginecológico es la braquiterapia, caracterizada por la colocación de materiales radioactivos junto al tumor. Esta terapéutica puede traer efectos colaterales a los pacientes. Pensando en las cuestiones emocionales, este trabajo tuvo como objetivo, a través de la revisión de la literatura, revisar los estudios que se refiriesen a las repercusiones psicológicas relacionadas al tratamiento de braquiterapia en mujeres con cáncer ginecológico. Los resultados revelaron una producción embrionaria, con apenas un trabajo producido en Brasil. Hubo una mayor concentración de estudios en el área de Enfermería. Los trabajos se centraron en las repercusiones psicosociales, buscando comprender la experiencia de las pacientes antes, durante, y después del término de la aplicación del tratamiento, lo que colocó en evidencia consecuencias físicas y psicológicas que afectan la calidad de vida. Es importante pensar en un incremento de esta producción con investigaciones psicológicas que profundicen la comprensión de la vivencia de mujeres sometidas a la braquiterapia.

Uma das modalidades radioterápicas para tratamento do câncer ginecológico é a braquiterapia, caracterizada pela colocação de materiais radioativos junto ao tumor. Essa terapêutica pode trazer efeitos colaterais às pacientes. Pensando nas questões emocionais, este trabalho objetivou, através de revisão de literatura, apreender estudos que se referissem a repercussões psicológicas relacionadas ao tratamento de braquiterapia em mulheres com câncer ginecológico. Os resultados revelaram produção embrionária, com apenas um trabalho produzido no Brasil. Houve maior concentração de estudos na área de enfermagem. Os trabalhos centraram-se nas repercussões psicossociais, buscando compreender a experiência das pacientes antes da aplicação, durante essa, e após o término do tratamento, evidenciando conseqüências físicas e psicológicas afetando a qualidade de vida. É importante pensar no incremento dessa produção com pesquisas psicológicas que aprofundem a compreensão da vivência de mulheres submetidas à braquiterapia.

Quality of life in gynecologic cancer patients.

OBJECTIVE: A descriptive study for evaluating the variables which influence the quality of life was performed in women with gynecologic cancer undergoing various kinds of treatment. METHODS: The study was based on a chart review of 104 women with gynecologic cancer and analyses of their compiled FACT-G (V4); (Functional Assessment of Cancer Therapy-General) questionnaires. Patients were assessed before and 3 months after treatment.The relationship of a number of biomedical variables with quality of life outcomes was tested. RESULTS: The mean age of patients was 50.13 years. The most involved organ was ovary (42.3%).The mean of socio-familial, emotional, functional well-being and overall quality of life 3 months after the treatment were greater than previously. The mean of physical well-being after 3 months of treatment was lower than before that (p<0.05). There were no statistical difference between the mean of overall quality of life before treatment and that 3 months after treatment for variables such as marital status, qualification, job, parity, co-morbidity diseases, organ involved, and stage of cancer (p>0.05). CONCLUSIONS: More studies must utilize quality of life as a primary endpoint. As gynecologic cancers are usually discovered in late stages, strategies for supportive care need to focus on symptom management.

Sleep quality of women with gynecological and breast cancer

Subjective sleep quality has been recognized as a valuable indicator of health and quality of life. This exploratory and descriptive study aimed at describing habitual sleep quality of women suffering from gynecological and breast cancer and comparing habitual versus sleep quality during hospitalization. Twenty-five women admitted in hospital for clinical treatment of cancer completed the Pittsburgh Sleep Quality Index (PSQI) within 72 hours after admission and again just before discharge. Fifty-two percent of subjects reported habitual bad sleep quality, and this proportion increased to 80 percent of subjects during hospital stay. Subjects indicated the following most frequent causes of night sleep disturbance: need to go to the toilet, waking up early and receiving nursing care during the night. Results point to the importance of including careful assessment of sleep quality and environment in nursing care planning for oncology patients, mainly during hospitalization.

Actualmente, la calidad de sueño referida por el propio individuo es reconocida como un indicador de salud y calidad de vida. Esto estudio exploratorio y descriptivo describe la calidad habitual del sueño de mujeres con cáncer ginecológico y mamario y la confronta con la hospitalización. Se desarrolló con 25 mujeres hospitalizadas para tratamiento clínico del cáncer ginecológico. Se colectaron informaciones mediante el Pittsburgh Sleep Quality Index (PSQI) y se verifico que el 52 por ciento de los sujetos poseía mala calidad del sueño habitualmente, mientras el 80 por ciento hubiera mala calidad en la hospitalización. Las orígenes de las perturbaciones del sueño nocturno apuntadas más frecuentemente fueron: usar el baño, despertarse temprano y ser cuidado por las enfermeras durante la noche. Los resultados muestran la necesidad de que el planeamiento de cuidados de enfermería para mujeres con cáncer ginecólogo incluya la evaluación de la calidad del sueño de las pacientes, inclusive en la hospitalización.

A qualidade de sono referida pelo próprio indivíduo é reconhecida atualmente como um indicador de saúde e de qualidade de vida. Este estudo exploratório e descritivo teve por objetivo descrever a qualidade habitual do sono de mulheres com câncer ginecológico e mamário e compará-la à qualidade do sono das mesmas na hospitalização. Participaram 25 mulheres hospitalizadas para tratamento clínico do câncer que responderam ao índice de Qualidade de Sono de Pittsburgh (PSQI) até 72 horas após a admissão e quando prevista a alta hospitalar. Verificou-se que 52 por cento das mulheres apresentavam má qualidade de sono habitual e que, na hospitalização, esse percentual elevou-se para 80 por cento. Como causas mais freqüentes de perturbação do sono na hospitalização destacaram-se: necessidade de usar o banheiro; despertar precoce; cuidados prestados pela equipe de enfermagem. Os resultados apontam para a necessidade de cuidados oncológicos que englobem a qualidade de sono destes pacientes, sobretudo na hospitalização.

Compreendendo o estar com câncer ginecológico avançado: uma abordagem heideggeriana / Understanding women with advanced gynecological cancer: a heideggerian approach

A trajetória deste estudo voltou-se para a compreensão da vivência das mulheres com câncer ginecológico avançado. Optou-se por uma pesquisa qualitativa com abordagem fenomenológica, com base na questão norteadora: “Gostaria que você me contasse a sua experiência; Como é ser mulher com câncer ginecológico?” Obtiveram-se seis depoimentos dos quais emergiram as unificações ontológicas analisadas e interpretadas, segundo o referencial filosófico de Martin Heidegger. Tais unificações permitiram vislumbrar caminhos para cuidar dessas mulheres que vão além do conhecimento técnico científico. É necessário compreender o vivido, assegurando um cuidar que contemple a subjetividade e intersubjetividade.

This qualitative phenomenologicalresearch was carried out inorder to understand how womenexperience living with advancegynecological cancer. We chose tomake a qualitative survey in aphenomenological approach,based on the following directivequestion: “I’d like you to tell meyour experience: ‘How is it to bea woman with gynecologicalcancer?’” Six women were interviewed.The ontological unificationwhich emerged from thespeeches were analyzed andinterpreted according to MartinHeidegger’s philosophical referential.These unifications madepossible to see ways to care forthese women that go far beyondtechnical and scientific knowledge.It is necessary to understandwhat has been lived by theother, thus ensuring a quality ofcare that contemplates subjectivityand inter-subjectivity.

La trayectoria de este estudio se orientó a la comprensión de la vivencia de las mujeres con cáncer ginecológico avanzado. Se optó por una investigación cualitativa con abordaje fenomenológico, con base en la pregunta norteadora: “Desaría que Ud. me contase su experiencia: ¿cómo es ser mujer con cáncer ginecológico?” Se obtuvieron seis discursos de los cuales emergieron las unificaciones ontológicas analizadas e interpretadas, según el referencial filosófico de Martin Heidegger. Tales unificaciones permitieron vislumbrar caminos para cuidar a esas mujeres que van más alládel conocimiento técnico científico. Es necesario comprender lo vivido, asegurando un cuidar que contemple la subjetividad e intersubjetividad.

Estudo preliminar sobre reaçäo emocional em pacientes com câncer genital feminino em fase terminal / Preliminary study on emotional reactions amony patients with femali genital cancer of terminal stage

Entre 18 pacientes portadoras de câncer genital feminino submetidas a avaliaçäo psicológica, constatou-se que predominaram os estados de depressäo e negaçäo. Por depressäo entende-se o estágio psíquico caracterizado por sensaçäo de perda de valores sentimentais, quer passados, presentes ou futuros. Na fase de negaçäo, o doente foge e distancia-se da realidade, interpretando os eventos de forma oposta ao percebido. Menos freqüentemente notou-se raiva, barganha ou aceitaçäo. A raiva caracteriza-se pelo inconformismo frente à situaçäo vigente, com forte sentimento de injustiça e comparaçöes com pessoas sadias. Em geral, tais pacientes sentem-se revoltadas com Deus. No estado definido por barganha, a mulher tenta adiar o presumível final estabelecendo trocas, acordos e concessöes a Deus, mesmo näo acreditando na existência divina. Na aceitaçäo, conformada com suas perdas, a doente aguarda o fim com certo grau de tranqüilidade. Notamos que estes cinco estágios emocionais podem associar-se entre si e que, na mesma doente, pode haver a passagem de um estado para outro. Entre as 18 doentes, 13 (72,2%) apresentaram ou passaram pela fase de depressäo; 12 (66,6%) pela de negaçäo; 8 (44,4) tornaram-se raivosas; 7 (38,8%) procuraram barganhar; e o mesmo número (38,8%) aceitou os fatos