Do Patients and Physicians Agree When They Assess Quality of Life?

Patient and physician agreement on the most significant symptoms is associated with treatment outcomes and satisfaction with care. Thus, we sought to assess patient and physician agreement on patient-reported quality of life (QoL), and whether patient-related variables predict disagreement. In this cross-sectional, multisite study, patients and physicians completed the FACT-BMT at day 90. Agreement was analyzed with the intraclass coefficient correlation (ICC). Rates of underestimation and overestimation were calculated. Logistic regression models identified predictors of disagreement. We analyzed 96 pairs of questionnaires completed by 96 patients and 11 physicians. The patients' median age was 54 years, 52% were men, and 52% had undergone allogeneic hematopoietic cell transplantation (HCT). The physicians' median age was 42, 64% were men, and they had worked in the HCT field for an average of 12 years. Agreement on QoL was moderate (ICC = .436). Exploratory analyses revealed poor agreement for emotional (ICC = .092) and social (ICC = .270) well-being and moderate agreement for physical (ICC = .457), functional (ICC = .451), and BMT concerns (ICC = .445). Patients' well-being was underestimated by physicians in 41% to 59% of the categories of well-being parameters, and overestimated in 10% to 24%. Patient's anxiety predicted less disagreement in all scales except in social well-being, for which nonsignificant associations were observed. Patient-related variables explained 12% to 19% of the variance in disagreement across well-being scales. Patient and physician agreement on QoL was suboptimal, particularly in emotional and social well-being. The implementation of patient-reported outcomes in the daily care of HCT recipients may contribute to improving patient-centered care.

What factors may influence psychological well being at three months and one year post BRCA genetic result disclosure?

Genetic testing for breast cancer predisposition has been available in the clinical practice for more than a decade. How the result of genetic testing affects the psychological well-being of the individuals is an under-researched area in many populations. Follow-up analysis of psychological well-being via HADS scale was performed in 364 individuals at 3 months and 1 year after the disclosure of BRCA1/2 genetic result. We analyzed potential predictors for pathological anxiety and variables associated to the variation of HADS scores over time. At pre-test only 16% and 4% of individuals presented symptoms of anxiety and depression, respectively. Having a prior diagnosis of cancer and presenting a pathological HADS-A score at the baseline were associated with clinically significant anxiety scores at one year, but the genetic test result was not. Thus, BRCA genetic testing does not influence short and long term anxiety and depression levels among those identified as mutation carriers. It is our task to demystify the allegedly negative impact of BRCA testing on psychological well being to increase the uptake of genetic testing and benefit those who are at high risk of developing breast, ovarian and prostate cancer.

Validación de la escala de Calgary en pacientes con esquizofrenia crónica / No disponible

Antecedentes: La Escala de Depresión de Calgary para la Esquizofrenia (CDSS) es un instrumento válido para la medición de los síntomas depresivos tanto en primeros episodios y descompensaciones agudas como en esquizofrénicos estabilizados. Objetivo: Determinar la validez y fiabilidad de la versión española de la CDSS en una población de esquizofrénicos crónicos e institucionalizados. Métodos: Fueron incluidos 137 pacientes ingresados en la unidad de larga estancia y diagnosticados de esquizofrenia según criterios DSM-IV. Fueron evaluados por dos evaluadores, el primero confirmaba el diagnóstico mediante la entrevista SCID -IV y administraba la Escala de Síntomas Positivos y Negativos (PANSS), la escala de Depresión de Hamilton (HDRS -17 y HDRS -21 ítems), la escala de depresión de Montgomery-Åsberg (MADRS), la escala de Síntomas Extrapiramidales (ESRS), y la escala de acatisia de Barnes. El segundo evaluador pasaba, ciego a los resultados previos y en un intervalo no superior a las 48 horas, la CDSS-S. Resultados: La fiabilidad (consistencia interna) fue buena (alfa de Cronbach 0.81) y sólo el ítem C7 (Despertar precoz) no fue consistente con el resto de ítems. La validez mostró una buena validez de constructo con correlaciones estadísticas con las escalas de depresión y no con las PANSS total ni sus subescalas. La estructura interna mostró un factor único que acumulaba el 42,4% de la variancia. Conclusiones: La CDSS es un instrumento válido para medir los síntomas depresivos en los esquizofrénicos crónicos

Backgroud: The Calgary Depression Scale for Schizophrenia (CDSS) has emerged as a valid instrument for measuring depressive symptoms in first episodes, acute exacerbations and stabilized schizophrenics. Objective: To determine the validity and reliability of CDSS in a population of chronic schizophrenics. Methods: One hundred and thirtyseven in -patients in the long-stay unit with diagnoses of schizophrenia according to DSM-IV criteria were included. The diagnosis was confirmed using the SCID-IV interview and the patients were evaluated with the Positive and Negative Syndrome Scale (PANSS), the Hamilton Depression Rating Scale (HDRS -17 and HDRS-21 ítems), the Montgomery-Åsberg Depression Rating Scale (MADRS), the Extrapyramidal Symptoms Rating Scale (ESRS), the Barnes Akathisia Rating Scale and the CDSS. Results: The reliability (internal consistency) was good (Cronbach’s alpha 0,81) and inconsistency was found only on item C7 (Early morning waking). Construct validity was high; statistically significant correlations were found with depression scales, and there was no correlation with the PANSS subscales or total score. The internal structure showed a single factor that accounted for 42,4% of the variance. Conclusions: The CDSS is a valid instrument for assessing depressive episodes in chronically ill, institutionalized schizophrenics