Family caregiver emotional distress in advanced cancer: the DME-C scale psychometric properties.

BACKGROUND: Family 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. AIM: This 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). DESIGN: Multicentre, cross-sectional study. SETTINGS/PARTICIPANTS: Family 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). RESULTS: 138 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. CONCLUSIONS: The 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.

An exploratory study in breast cancer of factors involved in the use and communication with health professionals of Internet information.

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.

Evaluación de las propiedades psicométricas de la Escala de Detección de la Soledad Existencial en pacientes con enfermedades avanzadas / Assessment of the psychometric properties of the Scale of Detection of Existential Loneliness in patients with advanced diseases

Objetivo: Analizar las propiedades psicométricas y la utilidad clínica de la Escala de Soledad Existencial (EDSOL) en enfermos hospitalizados con enfermedad avanzada. Método: Para determinar las propiedades psicométricas de la escala, se administró 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 través del alfa de Cronbach (0,902) y una adecuada estabilidad temporal (r=0,71). La escala mostró correlaciones positivas y significativas con ansiedad y depresión de la escala HADS y con la suma total de la misma, así como con la valoración clínica psicológica (p<0,01). A través del análisis estadístico de las curvas ROC se determinó que la escala presentaba una sensibilidad del 79,8% y una especificidad del 74,6% y se sugiere que el punto de corte para la detección de la EDSOL sea una puntuación de 5. Conclusiones: La EDSOL presenta unas buenas propiedades psicométricas, es sencilla, breve, fiable y fácil de administrar. Consideramos que es una escala útil para detectar la presencia de soledad existencial en enfermos hospitalizados que padecen enfermedades avanzadas

Aim: To analyze the psychometric properties and the clinical utility of the Scale of Existential Loneliness (EDSOL) in hospitalized patients with advanced disease. Method: To determine the psychometric properties of the scale, the EDSOL scale was administered along with other instruments to 103 adult patients with advanced diseases admitted to 5 palliative care units of Catalan hospitals. Results: The scale presents an excellent reliability measured through Cronbach’s alpha (0.902) and adequate temporal stability (r = 0.71). The scale showed positive and significant correlations with anxiety and depression of the HADS scale and with the overall score of HADS, as well as with the clinical psychological assessment (p <0.01). Through the statistical analysis of the ROC curves, it was determined that the scale had a sensitivity of 79.8% and a specificity of 74.6% and it is suggested that the cut-off point for the detection of EDSOL be a score of 5. Conclusions: The EDSOL scale has good psychometric properties, is simple, brief, reliable and easy to administer. We consider that is an useful scale to detect the presence of existential loneliness in hospitalized patients suffering from advanced diseases

Desarrollo de la escala DME-C: una escala para la detección del malestar emocional de los cuidadores principales de personas con enfermedad avanzada o al final de la vida / Development of the DME-C: A scale for detecting emotional distress in primary caregivers of patients living with advanced illness or approaching end of their lives

Se presenta el desarrollo de la Escala de Detección de Malestar Emocional de los Cuidadores principales de pacientes con enfermedad avanzada o terminal que reciben cuidados paliativos (DME-C). Se describe el proceso de elaboración de la escala. Para ello, se ha revisado la bibliografía existente sobre el tema, se ha establecido un marco teórico de referencia y los criterios que debía cumplir el instrumento de cribado que se iba a elaborar. La escala DME-C consta de 2 partes: 1) 3 preguntas dirigidas a los cuidadores, y 2) la observación realizada por el personal sanitario de la presencia de signos externos de malestar emocional del cuidador. La escala final fue revisada tanto por expertos como por cuidadores. La escala DME-C es una herramienta apropiada para la identificación del malestar emocional de los cuidadores. Proponemos el uso sistemático de la DME-C para una detección precoz e intervención específica del sufrimiento emocional

This paper presents the development of the Detection of Emotional Distress Scale in primary Caregivers (DED-C) of patients living with advanced disease or terminal illness who are receiving palliative care. The scale development process is described. For this purpose, literature has been reviewed and a theoretica framework of study as well as the characteristics of the screening tool have been established. The DED-C scale consists of 2 parts: 1) 3 questions addressed to primary caregivers, and 2) the health care professional’s appreciation or observation of any external signs of emotional distress on behalf of the caregivers. The final scale was reviewed by experts and caregivers. The DED-C scale will be an appropriate tool for identifying caregivers’ emotional distress. We propose the systematic use of DED-C for early detection of and specific intervention on emotional distress

Cancer patients' emotional distress, coping styles and perception of doctor-patient interaction in European cancer settings.

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.

Role of psychosocial variables on chemotherapy-induced nausea and vomiting and health-related quality of life among cancer patients: a European study.

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.

Evaluación de las propiedades psicométricas del cuestionario de Detección de Malestar Emocional (DME) en pacientes oncológicos / Assessment of the psychometric properties of the Detection of Emotional Distress Scale in cancer patients

Objetivo Con 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. Métodos Para 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. Resultados Se observó que el 58,3% presentaba malestar emocional moderado o 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 (AU)

Objective 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. Methods The DED scale was administered to 105 advanced cancer patients attended in five palliative care units in Catalonia (Spain).Results 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%.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 (AU)

[Assessment of the psychometric properties of the Detection of Emotional Distress Scale in cancer patients]. / Evaluación de las propiedades psicométricas del cuestionario de Detección de Malestar Emocional (DME) en pacientes oncológicos.

OBJECTIVE: 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. METHODS: The DED scale was administered to 105 advanced cancer patients attended in five palliative care units in Catalonia (Spain). RESULTS: 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%. CONCLUSIONS: 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.

Valoración del funcionamiento cognitivo en mujeres con cáncer de mama antes de iniciar el tratamiento oncológico / No disponible

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 (AU)

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 (AU)

Are the patient preferences for communication related with personality variables? A multicentric study in a spanish cancer sample

Objetivo: El objetivo del estudio era describir la relación entre las preferencias de comunicación y variables socio-demográfi cas, médicas y de personalidad, en una muestra española de pacientes oncológicos. Método: Una muestra de 168 pacientes completaron la siguiente batería de cuestionarios: (1) la adaptación española del Measure of Patients’ Preferences, que incluye tres escalas: contenido (el tipo y la cantidad de información que desea recibir), facilitación (variables del contexto) y apoyo (apoyo emocional durante la interacción); (2) las escalas de Extraversión y Neuroticismo del EPQ-RS; (3) el EORTC QLQ-3.0; y (4) el HADS. Resultados: Los análisis de regresión mostraron que los pacientes que obtuvieron mayores puntuaciones en la escala contenido eran mujeres, jóvenes, cuya enfermedad se hallaba en estado avanzado, o habían recibido el diagnóstico por primera vez y aquéllas con elevadas puntuaciones en la escala de Extraversión. Los pacientes que obtuvieron mayores puntuaciones en la escala de apoyo fueron aquellos que habían recibido el diagnóstico por primera vez y con elevadas puntuaciones en Extraversión. Las mujeres, con elevadas puntuaciones en Extraversión, obtuvieron mayores puntuaciones en la escala de Facilitación que el resto de pacientes. Conclusiones: La personalidad, edad, género y el estadío de la enfermedad son variables importantes a tener en cuenta en los estudios sobre comunicación médico-paciente (AU)

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

Deterioro cognitivo inducido por los tratamientos oncológicos sistémicos en el cáncer de mama no metastático: revisión de estudios / Cognitive impairment induced by systemic oncological treatments in nonmetastatic breast cancer: A review

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

Breast cancer women complain of cognitive problems after systemic oncological treatments. This has lead to study the effect of these treatments on the cognitive functioning of these patients. Aims and Method: To expose the conclusions obtained about cognitive impairment induced by systemic oncological treatments in breast cancer after reviewing available literature. Results: 24 studies on cognitive impairment associated to chemotherapy and 5 studies on the cognitive impairment associated to hormone therapy have been found. Chemotherapy studies find a subtle and specifi c cognitive impairment in a variable percentage of patients. Hormone therapy studies do not agree about its negative or neuroproctetive effect. Conclusions: 1) New studies that overcome the methodological limitations of previous studies are needed, and also more variables need to be assessed; 2) Importance to introduce neuroimaging techniques; 3) Importance of the cognitive complaints verbalized by patients; 4) Development of cognitive rehabilitation programmes to alleviate the cognitive deficits (AU)

[Psychological adjustment and prevalence of psychiatric disorders in cancer patients]. / Adaptación psicológica y prevalencia de trastornos mentales en pacientes con cáncer.

BACKGROUND AND OBJECTIVE: The main objective of this study was to determine the prevalence and the predictors of mental disorders in cancer patients. PATIENTS AND METHOD: 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. RESULTS: 24% cancer patients had criteria for a mental disorder. The predictors of mental disorders were radiotherapy treatment, psychopharmacological treatment and pain. CONCLUSIONS: 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.

Adaptación psicológica y prevalencia de trastornos mentales en pacientes con cáncer / Psychological adjustment and prevalence of psychiatric disorders in cancer patients

Fundamento y objetivo: El principal objetivo del estudio ha sido determinar la prevalencia y los predictores de trastornos mentales en pacientes con cáncer. Pacientes y método: Se entrevistó a 400 pacientes oncológicos ambulatorios. A aquellos con una puntuación igual o mayor de 14 en la Escala de Ansiedad y Depresión Hospitalaria (HADS) se les administró la Entrevista Clínica Estructurada para los Trastornos del Eje I (SCID-I) del Manual Diagnóstico y Estadística de los Trastornos Mentales, cuarta edición (DSM-IV), con el fin de determinar la prevalencia de trastornos mentales en la muestra estudiada. Resultados: Un 24% de los pacientes con cáncer presentaba criterios de trastorno mental. En el análisis multivariante los predictores de presencia de trastorno mental fueron: haber recibido radioterapia, estar en tratamiento psicofarmacológico y la presencia de dolor. Conclusiones: Los datos aportados por el estudio señalan la necesidad de realizar un adecuado cribado de los posibles síntomas ansiosos y depresivos que el paciente puede desarrollar durante el proceso oncológico y que le incapacitan para su adaptación emocional a éste. El uso de los predictores hallados puede ayudar a identificar posibles casos de trastorno mental entre los pacientes con cáncer

Background and objective: The main objective of this study was to determine the prevalence and the predictors of mental disorders in cancer patients. Patients and method: 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. Results: 24% cancer patients had criteria for a mental disorder. The predictors of mental disorders were radiotherapy treatment, psychopharmacological treatment and pain. Conclusions: 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

Perception of breast cancer risk and surveillance behaviours of women with family history of breast cancer: a brief report on a Spanish cohort.

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<0.05). 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 (p<0.05), 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.

Intervenção psicologica em cirurgia / Psychological intervention in sugery

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 como 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(AU)

Analise de tracos psicologicos em enfermidade inflamatoria intestinal

Existe um acordo generalizado entre os especialistas medicos que os pacientes com (EII) se caracterizam por um. Descrevem o paciente prototipico como 'neurotico, ancioso, com tedencia a depressao e a auto-exigencia'. Foram avaliados um total de 84 pacientes com diagnostico confirmado de EII atentidos na unidade de Enfermidade Inflamatoria Intestinal do Hospital Geral Universitario 'Gregorio Maranon' de Madri. Para a avaliacao se utilizou o Minnessota Multiphasic Personality Inventory (MMPI) (Hathaway e McKinley, 1942) e uma entrevista clinica semi-estruturada. Os pacientes com EII mostram altas pontuacoes nas escalas clinicas de Hipocondria, Depressao e Neuroticismo. Os dados coincidem com os extraidos da entrevista clinica.

Ansiedade aos exames: um problema atual

Este breve artigo enfatiza o problema da ansiedade aos exames no mundo escolar. E necessario sensibilizar pais e professores ante este problema amplamente reconhecido no mundo atual, no qual a competitividade e inerente a cultura e ante a qual o aluno esta exposto desde os primeiros anos de escolaridade. E importante esclarecer que este problema e reversivel depois da aplicacao de apropriados programas de tratamento, levados a cabo por profissionais especialistas, que permitirao ao aluno alcancar as realizacoes academicas almejadas de acordo com sua capacidade intelectual e esforco pessoal, de um modo saudavel e adaptativo.