Development and implementation of a comprehensive psychosocial screening program in a Brazilian cancer center.

OBJECTIVE: International guidelines recommend routine screening for distress as part of care practices. Accordingly, a Brazilian cancer center developed and implemented a distress screening program (DS) in 2007, which was enhanced in 2009 through the inclusion of a psychosocial care meeting group (DS + PCM) regarding patients' psychosocial needs. The current paper will provide an overview of the development and pilot implementation of this program and initial analyses to assess patient outcomes and report initial results to extend international research on this key aspect of cancer care. METHOD: Patients were assessed for distress, anxiety and depression, and in the DS+PCM phase for quality of life at the first day of chemotherapy infusion, at midpoint, and at treatment end. We compared data from program phases (DS vs DS + PCM), with a sequential cohort design and mixed effects modeling. RESULTS: Clinical and demographic characteristics were similar between groups. Patients receiving DS + PCM showed significantly lower distress and depression/anxiety upon chemotherapy initiation (Ps < .001). While both groups reported significantly lowered distress and total depression/anxiety scores across time (Ps < .003), patients receiving DS + PCM maintained the lowest distress and total anxiety/depression at all assessments. Patients from DS + PCM group also reported improvements in quality of life over time. CONCLUSIONS: The current study provides preliminary evidence that a multidisciplinary structured screening program utilizing validated measures and team meetings is associated with reduced impairment in patients' psychological well being. This program provided more opportunities for collaboration among providers with increased multidisciplinary meetings, enabled patients to more easily report problems, and ensured rapid access to relevant resources.

[Disability, public policies and bioethics: the perception of public administrators and legal counselors]. / Deficiência, políticas públicas e bioética: percepção de gestores públicos e conselheiros de direitos.

A descriptive study of the perception of public administrators and counselors regarding disability was conducted on the basis of bioethical reflections on human rights. The survey involved 50 participants, divided into two groups: 29 counselors on the rights of disabled people and 21 specialists in public policies and government administration. The data obtained was submitted to descriptive statistical analysis. In general, the results showed that for counselors disability is a social issue and should be shared by society, whereas for public administrators it is predominantly a personal tragedy limited to the individual and family sphere. It is considered that this differentiated view arises from different perspectives regarding the allocation of public resources. It is also necessary to stress the importance of living with a disability, or living with people with disabilities, to base the assessment of quality and satisfaction with life experienced by people with disabilities and contribute to the elaboration of public policies. Similar studies with more comprehensive and diversified samples are recommended, as well as the adoption of participative and qualitative methodologies.

Impact of the clinical management of pain: evaluation of stress and coping among health professionals.

The specialist literature highlights that the clinical management of pain involves psychological difficulties associated with the pursuit of the alleviation of the suffering of patients. Therefore, an investigation was conducted into the perception of stress and coping strategies of 31 professionals of different categories from a severe burns care center (acute pain) and a pain control and palliative care unit (chronic pain). For this, a sociodemographic questionnaire, the Job Stress Scale (short version) and the Coping Strategies Inventory were applied. Compared to other categories, the nursing technicians indicated more stress factors. In compensation, they reported a greater diversity of coping strategies with significant differences between the services. These results corroborate previous studies, which warn of the adverse conditions that interfere in nursing practice. However, they also reveal the availability of protective factors, indicating perspectives of preventive intervention for the nursing team.

Distress levels in patients undergoing chemotherapy in Brazil.

OBJECTIVE: The objective of this study was to measure distress at three points during the course of chemotherapy: beginning, middle, and the last day of therapy in a private cancer center in Brazil. METHODS: One hundred patients were assessed at three points during chemotherapy using the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS). The data were analyzed with the support of SPSS 15.0 software. RESULTS: At the beginning of chemotherapy, patients mean scores were distress (82%), anxiety (78%) and depression (55%). In the middle of treatment, the percentages of distress, anxiety and depression decreased to 36.4, 25 and 25.3%, respectively. On the last day, the levels were 18.2% for distress and 14.3% for both anxiety and depression. CONCLUSION: Distress is highest in these patients at the beginning of chemotherapy, suggesting that evaluation of patients for psychosocial needs is important. Screening with a simple rapid instrument such as the DT is feasible and useful.

[Persons with disabilities and Brazilian healthcare policies: thoughts about bioethics]. / Pessoas com deficiência e políticas de saúde no Brasil: reflexões bioéticas.

The purpose of this article is to analyze the dilemma of allocation of public funds to the healthcare of people with disabilities in Brazil from a bioethical standpoint. The concept of disability and the legal framework are presented; the question of budgetary constraints and theoretical bioethics references about this issue are discussed; and the role of Bioethics of Protection and Bioethics of Intervention is stressed. It is concluded that, because of their vulnerability, people with disabilities should be protected by the state and funds must be allocated to guarantee their access to healthcare services. However, in spite of the existing legal basis, the actual destination of public funds to people with disabilities still depends on other factors, among others social and political participation of the disabled persons themselves in the negotiation of healthcare policies.

Family perceptions and coping strategies in cases of intersexuality: understanding their significance.

Considering that the intersexual condition has a negative impact on the individual, their family, and society, health professionals and researchers have dedicated themselves to is to describe and understand the perceptions of primary caregivers regarding intersexuality and its developmental aspects. Six mothers and one grandmother of school age children were interviewed. The data indicated that living with the stigma of intersexuality can mean a permanent state of crisis within the family system. Issues such as guilt about the child's suffering and questions related to the choice of gender follow the family from the moment of diagnosis. It is suggested that the therapeutic follow-up should foster the necessary conditions for the family group to be organized as a model of competence, replacing the model of guilt.