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.

The psychological impact of a false-positive screening mammogram in Barcelona.

The purpose of this study was to ascertain the psychological impact of mammographic screening for women who receive negative results and for those who need additional non-invasive and invasive complementary investigations to exclude breast cancer (false positives). One hundred fifty women who attended a breast cancer screening programme in Barcelona, aged 50-69 years, were included in this study: 50 with negative results and 100 with false positive mammograms (50 underwent non-invasive and 50 underwent invasive complementary investigations). Participants worried little until they underwent mammography, but worries increased when a telephone call notified the women of the need for further testing. A substantial proportion of women requiring further assessment reported that they were at least somewhat worried about having breast cancer throughout the screening process (P < 0.0001). Nevertheless, levels of anxiety and depression, measured by the Hospital Anxiety and Depression Scale, showed no statistically significant differences among the three groups. In conclusion, although the women showed no psychological morbidity, there is a substantial psychological response in those with an abnormal screening mammogram.

Proper information during the surgical decision-making process lowers the anxiety of patients with high-grade gliomas.

PURPOSE: We aim to analyse the relationship between the quality of information during the decision-making process regarding surgery to treat high-grade gliomas and the level of anxiety of the patients. METHODS: This is a transversal, descriptive and correlational study on 26 patients with a clinical and radiological diagnosis of high-grade glioma. They scored the quality (in terms of comprehension and satisfaction) of information received about the treatment options and prognosis during the surgical decision-making process, and the Hospital Anxiety and Depression Scale questionnaire (HADS) was applied immediately afterward. RESULTS: Lower levels of anxiety were observed in patients who showed a desire to receive information regarding their illness, those with a higher degree of comprehension, and those with a higher level of satisfaction with the information provided. CONCLUSIONS: An improvement in the communication process contributes to a decrease in the levels of anxiety, and consequently to enhancement of the well-being of these patients.

Assessing self-reported adherence to HIV therapy by questionnaire: the SERAD (Self-Reported Adherence) Study.

The relationship between adherence to highly active antiretroviral therapy (HAART) and RNA-HIV viral load outcomes has been extensively shown. Although there are different procedures for assessing treatment adherence, there is no ideal method. We present the SERAD (Self-Reported Adherence) questionnaire, a qualitative and quantitative self-reported instrument designed to provide an easier adherence measurement. We also compared the questionnaire to three other methods to evaluate adherence to HAART regimens in HIV-infected patients. Two prospective, observational, longitudinal studies were developed: a single-center pilot study followed by a multicenter study. A total of 530 HIV-infected outpatients was prospectively included, 66 in the pilot study and 464 in the multicenter study. Four methods were used to study adherence to HAART regimens: the SERAD questionnaire, pill count, electronic monitoring, and plasma drug monitoring. Pearson's correlations and Bland and Altman's method were developed. The SERAD questionnaire showed good feasibility and significant validity. Adequate levels of agreement between methods were observed, particularly when adherence was high. Differences increased as adherence fell. Moreover, the questionnaire was completed correctly, the interviewers did not report uncovered aspects, and the information was collected easily. Our results suggest that the SERAD questionnaire is a feasible and useful instrument for assessing adherence to HAART regimens in HIV-infected patients, and makes it possible to obtain reliable qualitative and quantitative information related to treatment adherence.

[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.