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The purpose of this study was to assess the effect of tailored cognitive behavioral therapy (CBT) on depression and anxiety symptoms present in Mexican terminal cancer patients. A non-concurrent multiple baseline design was used across individuals. Nine patients participated in the study, each receiving four to six therapy sessions. The effect size of the intervention range (NAP and Tau indexes) in the nine patients indicates that CBT intervention resulted in weak to moderate impact for anxiety and depression symptoms in this population. The overall standardized mean difference is also moderate, with a reduction of 0.54 and 0.76 standard deviations in depression and anxiety symptoms, respectively. This study provides initial evidence to support a positive effect from CBT on patients with terminal cancer and with mood disorders when facing their impending death.
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Ansiedade/complicações , Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Depressão/complicações , Depressão/terapia , Neoplasias/complicações , Assistência Terminal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/psicologia , Depressão/psicologia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Neoplasias/psicologia , Resultado do TratamentoRESUMO
OBJECTIVE: The functional assessment of cancer therapy-bone marrow transplant (FACT-BMT) is a widely used instrument to assess quality of life (QOL) in hematopoietic stem cell transplant (HSCT) patients, but there is little evidence of its validity in Latin American populations. This study evaluated the psychometric properties of the Spanish language version of the FACT-BMT in Mexican patients. METHOD: First, the original version was piloted with 15 HSCT patients to obtain an adequate cultural version, resulting in the adaptation of one item. After that, the new version was completed by 139 HSCT patients. RESULTS: The results showed a FACT factor structure that explains 70.84% of the total variance, a factor structure similar to the original FACT structure, and with a high internal consistency (Cronbach's alpha = 0.867). For the BMT subscale, the best factor structure included 17 items which explain 61.65% of the total variance with an adequate internal consistency (Cronbach's alpha = 0.696). SIGNIFICANCE OF THE RESULTS: The FACT-BMT was found to be a valid and reliable instrument to evaluate QOL in Mexican patients. Our results constitute new FACT-BMT empirical evidence that supports its clinical and research uses.
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Transplante de Medula Óssea/normas , Neoplasias Ósseas/terapia , Pacientes/psicologia , Psicometria/normas , Qualidade de Vida/psicologia , Adulto , Transplante de Medula Óssea/métodos , Transplante de Medula Óssea/estatística & dados numéricos , Neoplasias Ósseas/psicologia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Pacientes/estatística & dados numéricos , Psicometria/instrumentação , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e Questionários , TraduçãoRESUMO
Anxiety and depression in people living with HIV (PLWH) are negatively associated with healthy sexual behaviours. We pilot-tested a Cognitive-Behavioural Therapy (CBT)-based intervention to reduce anxiety and depression, aimed to increase serostatus disclosure to sexual partners, quality of sexual life (QoSL) and condom use. The study had a single-case experimental design (AB) with follow-up measures. Eleven PLWH with moderate/severe anxiety/depression received six-module CBT intervention delivered in ten one-hour individual weekly sessions. Anxiety, depression, consistent/correct condom use and QoSL were measured. Depression and anxiety decreased after the intervention (depression baseline [BL] Mdn = 21, final [F] Mdn = 3, z = -2.934, p = .003; anxiety BL Mdn = 30, F Mdn = 4, z = -2.941, p = .003). QoSL improved (BL Mdn = 28, F Mdn = 13, z = -2.625, p = .009), along with participants' ability to use condoms (57.14 vs.100, z = -2.937, p = .003). Effect size was large, changes were maintained at follow-up measurements. The CBT intervention had positive effects in reducing anxiety and depression, which could facilitate the acquisition of healthy sexual behaviours. Further studies are important to clarify the benefits of targeting emotional variables to improve wellbeing and prevention behaviours in PLWH.
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Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Preservativos , Depressão/terapia , Infecções por HIV , Comportamentos Relacionados com a Saúde , Sexo Seguro , Parceiros Sexuais , Revelação da Verdade , Adulto , Feminino , Infecções por HIV/prevenção & controle , Humanos , Masculino , México , Pessoa de Meia-Idade , Projetos Piloto , Resultado do TratamentoAssuntos
Ansiedade/psicologia , Cuidadores/psicologia , Efeitos Psicossociais da Doença , Depressão/psicologia , Relações Interpessoais , Neoplasias/enfermagem , Autoeficácia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários , Fatores de Tempo , Adulto JovemRESUMO
Abstract Introduction Cognitive assessment is the process whereby individuals assess the effect an adverse circumstance has on their well-being (primary assessment) and their ability to cope with it (secondary assessment), which is closely related to the emotional and behavioral response they show as a result. Objective To determine the validity and internal consistency of the Spanish version of the Cognitive Assessment Inventory (CAI) for patients with chronic pain for Mexican population. Method A total of 191 adults with chronic pain completed the Spanish version of the CAI, as well as self-report measures of disability, daily activities, anxiety, and depression. Results The confirmatory factor analysis for each type of primary cognitive assessment included in the CAI yielded models with satisfactory goodness of fit and Cronbach's α indices (loss/damage: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .73; threat: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .81; and challenge: CMIN/DF = 1.567, NFI = .939, CFI = .977, AGFI = .926, SRMR = .044, RMSEA = .055, α = .86). Cognitive assessments of loss/harm and threat were positively associated with the degree of disability, depression, and anxiety, and negatively associated with the performance of daily activities. The opposite occurred with the cognitive assessment of challenge. Discussion and conclusion The Spanish version of the CAI is a valid, quick, easy, and reliable tool for evaluating the primary cognitive assessment of pain, a construct closely related to physical disability and emotional suffering in response to this experience, which may be modified through brief cognitive interventions.
Resumen Introducción La evaluación cognoscitiva es el proceso mediante el cual un individuo valora el efecto que ejerce una circunstancia adversa en su bienestar (evaluación primaria) junto con las capacidades con que cuenta para afrontarla (evaluación secundaria), con ello guarda una estrecha relación con la respuesta emocional y conductual que despliega en consecuencia. Objetivo Determinar la validez y consistencia interna de la versión en español del Inventario de Evaluación Cognoscitiva (IEC) para pacientes con dolor crónico en población mexicana. Método Un total de 191 adultos con dolor crónico completaron la versión en español del IEC, así como medidas de autorreporte de discapacidad, actividades cotidianas, ansiedad y depresión. Resultados El análisis factorial confirmatorio para cada tipo de evaluación cognoscitiva primaria incluida en el IEC arrojó modelos con índices de bondad de ajuste y α de Cronbach satisfactorios (pérdida/daño: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .73; amenaza: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .81; y desafío: CMIN/DF = 1.567, NFI = .939, CFI = .977, AGFI = .926, SRMR = .044, RMSEA = .055, α = .86). Las evaluaciones cognoscitivas de pérdida/daño y de amenaza se asociaron positivamente con el grado de discapacidad, depresión y ansiedad, y de forma negativa con la ejecución de actividades cotidianas. Lo contrario ocurrió con la evaluación cognoscitiva de desafío. Discusión y conclusión La versión en español de la IEC es una herramienta fácil, rápida, válida y confiable para evaluar la evaluación cognoscitiva primaria del dolor, constructo íntimamente relacionado con la discapacidad física y el sufrimiento emocional ante esta experiencia susceptible de modificación mediante intervenciones cognoscitivas breves.
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Resumen: En este trabajo se presenta el proceso de traducción al español, adaptación y validación del Teachers Job Satisfaction Questionnaire (Lester, 1987). Se aplicaron 66 reactivos en escala Likert con cinco opciones de respuesta en una muestra de 392 profesores mexicanos de educación básica, media superior y superior; 188 mujeres y 204 hombres. A través del análisis de discriminación, confiabilidad y estructura factorial de los reactivos se obtuvieron 33 válidos con un alfa de Cronbach de .910, agrupados en siete factores: Supervisión, Actitudes negativas hacia la docencia, Progreso, Responsabilidad, Trabajo en sí mismo, Clima social y Condiciones laborales.
Abstract: In this paper, the Spanish translation, adaptation, and validation processes of the Teachers Job Satisfaction Questionnaire (Lester, 1987) are described. 66 items with a five-option answer Likert scale were applied to 392 Mexican teachers (188 female, 204 male). Discrimination, reliability, and factor analyses were undertaken to obtain 33 items in seven factors: Supervision, Negative attitudes to teaching, Progress, Responsibility, Work itself, Social climate, and Working conditions. The internal consistency of the questionnaire was calculated (coefficient alpha) in .91 for the total score.
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ANTECEDENTES: La comunicación enfermera-paciente es fundamental para la aplicación de los cuidados en salud. El presente estudio aborda la percepción de pacientes sobre la comunicación verbal y no verbal con sus enfermeras. Entre los instrumentos para su evaluación destaca la Herramienta para la Evaluación del Cuidado (CAT por sus siglas en inglés), pero diferencias culturales y educativas de la población mexicana limitan su aplicabilidad en nuestro contexto.OBJETIVO: Diseñar y validar un instrumento sobre la percepción de los pacientes sobre el comportamiento de comunicación de enfermeras (denominado CECOP), en función de lo que observan pacientes mexicanos.MÉTODO: Con base en una entrevista exploratoria a 29 pacientes, se diseñó el CECOP con 25 reactivos, se estableció validez de contenido con jueces expertos (eliminando dos reactivos) y se aplicó a 150 pacientes. Se empleó análisis factorial con método de extracción de análisis de componentes principales y rotación Varimax. Se estableció la validez convergente entre el CECOP y el CAT y entre el CECOP y escalas numéricas que valoraron comprensión empática y satisfacción del paciente.RESULTADOS: La validez de constructo lo redujo a diez reactivos en dos factores (empatía y respeto); con Kaiser-Meyer-Olkin (KMO) y prueba de Bartlett estadísticamente significativas (p≤.001). La varianza explicada fue de 54.58%. La correlación entre los puntajes totales del CECOP (10 reactivos) y el CAT fue .459, el CECOP y la escala de comprensión fue .419; el CECOP y la escala de satisfacción, .495; todas, estadísticamente significativas (p≤.001).DISCUSIÓN Y CONCLUSIÓN: El CECOP permite evaluar los cuidados profesionales en su dimensión humana, desde la percepción de los pacientes, y sugerir propuestas para mejorar la comunicación de las enfermeras.
BACKGROUND: Nurse-patient communication has been established as a key component of professional healthcare. The present study examined the patients' perception of the verbal and non-verbal communication skills of nurses. Although the Caring Assessment Tool (CAT) stands among the instruments available to evaluate these communication skills, cultural and schooling characteristics limit its direct applicability to the Mexican context.OBJECTIVE: The aim of this study was to design and validate an instrument on the patient-recorded Nurse Communication Behavior (CECOP, for its acronym in Spanish) based on the Mexican patient's experience.METHOD: Based on exploratory interviews with 29 patients, a first draft of the CECOP was designed. The instrument was validated by independent expert judges and after the elimination of two items it was used with 150 patients. The validity was assessed by a factor analysis extraction through Principal Component Analysis and Varimax Rotation. Convergence validity was established between the CAT and the CECOP and between the CECOP and numeric scales that evaluate empathy and patient satisfaction.RESULTS: Construct Validity reduced the CECOP to 10 items in two factors (empathy and respect) with statistically significant KMO (Kaiser-Meyer-Olkin) and Bartlett's Test (p≤.001). The explained variation was 54.58%. The correlation between the CECOP score (10 items) and the CAT was .459. Between the CECOP and the empathy scale and between the CECOP and the satisfaction scale the correlations were .419 and .495, respectively. All correlations were statistically significant (p≤.001).DISCUSSION AND CONCLUSION: The CECOP can be used to evaluate professional care in its human dimension from the patient's perspective and to suggest improvements in the nurses communication.
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ANTECEDENTES: La sintomatología ansiosa y depresiva es parte de los principales problemas de salud mental en pacientes oncológicos, lo cual afecta la calidad de vida y la adhesión al tratamiento, además de que se asocia con mayor número de síntomas y estancia hospitalaria. Mediante instrumentos de tamizaje válidos y confiables, como la Escala hospitalaria de ansiedad y depresión (HADS), ha sido posible detectar posibles casos en pacientes hospitalarios. Sin embargo, hasta ahora no se habían caracterizado las propiedades psicométricas en pacientes oncológicos en población mexicana.OBJETIVO: Determinar las propiedades psicométricas de la HADS en una muestra de pacientes oncológicos.MÉTODO: Participaron 400 pacientes del Instituto Nacional de Cancerología, de los cuales 226 eran mujeres (56.5%) y 174 eran hombres (43.6%); la edad promedio fue de 47.4 ± 14.1 años. Los participantes contestaron, además de la HADS, los siguientes inventarios: depresión de Beck, ansiedad de Beck, termómetro de distrés.RESULTADOS: Un análisis factorial ajustado a dos factores presentó un instrumento con 12 reactivos, similar a la versión original. La consistencia interna de la escala global mostró un índice satisfactorio (a=0.86). Los alfas de Cronbach de cada subescala tuvieron un valor de .79 y .80 que explicaron el 48.04% de la varianza. La validez, por medio de correlación con las medidas concurrentes, mostró resultados significativos (r de Pearson de .51 a .71, p<0.05).DISCUSIÓN Y CONCLUSIÓN: La HADS en pacientes con cáncer en población mexicana presentó adecuadas características psicométricas. La relevancia de los resultados obtenidos radica en que se trata de una población que puede llegar a requerir atención oportuna en salud mental en etapas tempranas de su tratamiento. La detección de sintomatología ansiosa y depresiva por medio de la HADS deriva en beneficios para la población oncológica y en estrategias funcionales de atención adecuada y costo-efectivas.
BACKGROUND: Symptoms of anxiety and depression are among the major mental health problems in cancer patients. These symptoms affect the quality of life and treatment adherence, and are associated with other symptoms and longer hospital stays. Valid and reliable screening instruments such as the Hospital Anxiety and Depression Scale (HADS), have made possible the detection of possible cases of depression and anxiety in medically ill patients. However, the psychometric properties of this instrument have not been documented in different types of cancer diagnoses in the Mexican population.OBJECTIVE: To determine the psychometric properties of the HADS in a sample of patients with cancer from the Mexican population.METHOD: Four hundred patients from the National Cancer Institute participated, of which 226 were women (56.5%) and 174 men (43.6%), with a mean age of 47.4 ±14.1 years. Participants completed concurrently the HADS as well as the following inventories: 1. Beck Depression, 2. Beck Anxiety and 3. Distress Thermometer.RESULTS: A factor analysis adjusted to two factors explained 48.04% of the variance, with 12 items loading on these two factors in a way similar to the original version. The internal consistency of the overall scale was satisfactory (α=0.86). Cronbach's alphas for each subscale were .79 and .80. The concurrent validity assessed by way of correlations with concurrent measures showed significant associations (Pearson r=51-71, p<0.05).DISCUSSION AND CONCLUSION: The HADS has adequate construct validity, internal consistency and concurrent validity for its use in cancer patients from the Mexican population. The relevance of these results is a cost effective tool to provide timely mental health care early in oncological treatment for those in need. Detecting anxiety and depression symptoms through the HADS may benefit cancer patients by ensuring appropriate care that may increase their quality of life and treatment adherence, and reduce their hospital stays.
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La depresión es uno de los problemas emocionales más frecuentes en pacientes con cáncer terminal. Debido a la evolución de la enfermedad, varios síntomas físicos presentes en los pacientes se pueden yuxtaponer y confundir con los síntomas que permiten identificar de manera taxonómica la depresión, lo cual dificulta la evaluación del problema. El objetivo de este artículo es realizar una revisión de los principales instrumentos utilizados para evaluar la depresión en pacientes con cáncer terminal, junto con sus implicaciones en el contexto mexicano. Con base en la información recabada se puede decir que es más pertinente realizar una evaluación de la depresión enfocada en los aspectos emocionales que en los somáticos. Actualmente existe una gran cantidad de instrumentos para evaluar la depresión que dan mayor énfasis a los aspectos de la anhedonia y las emociones que a los aspectos somáticos de la depresión. En México existe un enorme rezago en el desarrollo de instrumentos que permitan identificar estos síntomas. Se concluye señalando instrumentos alternativos para evaluar la depresión en pacientes con cáncer terminal, estos instrumentos podrían ser evaluados y considerados en un futuro en el contexto de la medicina paliativa.
Depression is one of the most common emotional problems in palliative patients. Due to the advanced nature of the disease, several physical symptoms presented by patients overlap with symptoms of depression, making it difficult to evaluate and diagnose the problem. The aim of this paper was to conduct a narrative review of the main instruments used to assess depression when it is present in palliative patients, with a special consideration of the Mexican context. Based on the available data and the scholarly literature, it is more appropriate to conduct an assessment of depression focused on emotional aspects than somatics aspects in palliative patients. Internationally, a number of depression assessments place greater emphasis on anhedonia and emotions, such as hopelessness, than on somatic aspects of depression. In Mexico, a considerable gap remains in the development of instruments to identify depression in the palliative setting. Finally, we describe alternative assessments of depression, which could be evaluated and considered in the future in the palliative care setting.
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Se realizó una amplia búsqueda en diversas bases de datos a partir de los descriptores: Interacción o comunicación enfermera-paciente, satisfacción por el cuidado de enfermería y entrenamientos en técnicas de comunicación, con el fin de profundizar en el tema de la interacción enfermera-paciente por la importancia que esta tiene en el ejercicio de la práctica profesional de las enfermeras. Se establecen tres ejes de estudio: Interacción o comunicación enfermera-paciente, calidad y satisfacción derivada del cuidado, y efectividad de los entrenamientos en habilidades para la comunicación. La revisión permite identificar que este tema ha sido analizado desde hace mucho tiempo y en diferentes países, los estudios se han relacionado con la calidad de los servicios de enfermería y han motivado el planteamiento de estrategias educativas para desarrollar y mejorar la interacción enfermera-paciente como actitud profesional esencial. Los estudios realizados ofrecen elementos de apoyo para el desarrollo de investigaciones en esta área, pero en algunos casos muestran limitaciones o carencias, así como resultados contradictorios que pueden ser tomadas en cuenta por las personas interesadas en el diseño de estudios relacionados con el tema.
In order to deepen into the highly important topic nurse-patient interaction for the professional practice of nurses, a database search using the descriptors; nurse-patient interaction/communication, nurse healthcare satisfaction, and communication skills training, was conducted. As a result, three study axes were established; nurse-patient interaction/communication, care-derived quality and satisfaction, and communication skills training effectiveness. This review reveals that this topic has been extensively analyzed throughout time and among different countries. These studies have been related to quality in nursing services, and have motivated the design of strategies to develop and improve the nurse-patient interaction as an essential professional attitude. Furthermore, although these studies offer elements to support the research development in this area, some of them have shown limitations o deficiencies, as well as contradictory results, which should be considered by researchers interested in the design of studies related to this topic.