ABSTRACT
OBJECTIVES: To evaluate the sensitivity and specificity of the Distress Thermometer (DT) as a screening tool for emotional distress in oncological palliative care patients and to compare the DT with the Edmonton Symptom Assessment System-revised (ESAS-r) and the gold standard to determine the most appropriate assessment method in palliative psychological care. METHODS: Data were collected from psychological screening tests (ESAS-r and DT), and clinical interviews (gold standard) were conducted by a clinical psychologist specialist in palliative oncology from January 2021 to January 2022 in an oncology palliative care service. RESULTS: The sample consisted of 356 first-time patients with a diagnosis of advanced cancer in palliative care. The most frequently reported oncological diagnoses were gastrointestinal tract (49.3%) and breast (18.3%). Most patients were female (n = 206; 57.9%), 60.4% were married/with a partner, 55.4% had between 6 and 9 years of schooling, and a median age of 57 (range, 46-65) years. The cutoff of the DT was 5, with a sensitivity of 75.88% and specificity of 54.3%. Emotional problems (sadness and nervousness) had a greater area under the curve (AUC) when measured using the DT than the ESAS-r; however, only in the case of the comparative sadness and discouragement was the difference between the AUC marginally significant. SIGNIFICANCE OF RESULTS: The use of the DT as a screening tool in oncological palliative care is more effective in the evaluation of psychological needs than the ESAS-r. The DT, in addition to evaluation by an expert psychologist, allows for a more comprehensive identification of signs and symptoms to yield an accurate mental health diagnosis based on the International Classification of Diseases-11th Revision and/or Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition.
Subject(s)
Neoplasms , Psychological Distress , Humans , Female , Middle Aged , Aged , Male , Palliative Care/psychology , Symptom Assessment/methods , Thermometers , Stress, Psychological/diagnosis , Stress, Psychological/etiology , Neoplasms/complications , Neoplasms/psychologyABSTRACT
Introducción. Los psicólogos tienen un papel relevante en el manejo integral en la atención de pacientes en cuidados paliativos y su familia, por lo que deben contar con competencias específicas para proporcionar la atención psicológica en los diferentes niveles de atención en salud. Objetivo: Diseñar un Instrumento de Detección de Necesidades de Capacitación en Psicología de Cuidados Paliativos (IDNCPsic-CP), analizar su validez y confiabilidad. Método: Se realizó un estudio prospectivo, transversal mediante una encuesta en línea para psicólogos que laboraran en Unidades/Servicios de Cuidados Paliativos en México. Se utilizó un muestreo por conveniencia. Resultados: La muestra total fue de 132 profesionales del Psicología. El IDNCPsic-CP en su versión final fue de 122 reactivos divididos en características generales del psicólogo y la institución, proceso de atención y la Detección de Necesidades de Capacitación se conformó por 3 subescalas: a) Relevancia donde en el Análisis Factorial Exploratorio (AFE) se agrupó en 7 factores (alpha de Cronbach de ,930), y en el Análisis Factorial Confirmatorio (AFC) se confirmaron sólo 4. b) Frecuencia donde el AFE identificó 4 factores, (alpha de cronbach de .977), y en el AFC los siguientes índices de ajuste: χ2/gl= 1,784; CFI=0,917; TLI=0,908, SRMR=0,054 y RMSEA =0,077; y c) Autopercepción de habilidades con un solo factor, (alfa de Cronbach=0.945), el AFC con índices de ajuste: χ2/gl= 1,519; CFI=0,994; TLI=0,987, SRMR=0,023 y RMSEA=0,063. Conclusiones: El IDCNPsic-CP cuenta con puntuaciones altas de validez, confiabilidad y ajuste, que confirman que el instrumento cuenta con las propiedades psicométricas para su uso (AU)
Introduction. Psychologists have a relevant role in the comprehensive management of palliative care patients and their families, so they must have specific competencies to provide psychological care at different levels of health care. Objective: To design an Instrument for the Detection of Training Needs in Palliative Care Psychology (IDNCPsic-CP) and to analyze validity and reliability. Methods: A prospective, cross-sectional study was conducted through an online survey for psychologists working in Palliative Care Units/Services in Mexico. Convenience sampling was used. Results: The total sample was 132 psychology professionals. The final version of the IDNCPsic-CP consisted of 122 items divided into general characteristics of the psychologist and the institution, process of care and Detection of Training Needs was made up of 3 subscales: a) Relevance, where in the Exploratory Factor Analysis (EFA) it was grouped into 7 factors (cronbachs alpha of .930), and the Confirmatory Factor Analysis (CFA) only 4 were confirmed. b) Frequency where EFA identified 4 factors, (cronbachs alpha of .977), and in CFA the following adjustment indexes: χ2/gl= 1.784; CFI .917; TLI=.908, SRMR=.054 and RMSEA =.077; and c) Self-perception of skills with a single factor, (Cronbachs alpha=0.945), the AFC with fit indices: χ2/gl= 1.519; CFI=0.994; TLI=0.987, SRMR=0.023 and RMSEA=0.063. Conclusions: The IDCNPsic-CP has high validity, reliability, and fit scores, which confirm that the instrument has the psychometric properties for use (AU)
Subject(s)
Humans , Male , Female , Adult , Health Human Resource Training , Needs Assessment , Palliative Care/psychology , Health Care Surveys , Reproducibility of Results , Prospective Studies , Cross-Sectional StudiesABSTRACT
No disponible.
Subject(s)
Neoplasms , Palliative Care , Humans , National Cancer Institute (U.S.) , United StatesABSTRACT
Abstract Introduction Suicide represents a major public health problem worldwide, and cancer patients might have vulnerability factors which increase suicide risk. There are multiple factors associated with this tragic outcome, including those stemming from the disease itself, mental illness and social, personal and spiritual factors. Although previous reports have identified a suicide rate which ranges from .03-7% among cancer patients undergoing palliative care, this has not been studied in Mexico. Objective This study sought to report the cases of suicide in patients with cancer undergoing palliative care at a large cancer reference center. Method A retrospective review of records was performed between 2018-2019 for patients treated at the Palliative Care Service of the Instituto Nacional de Cancerología in Mexico City. Records for patients who committed suicide were reviewed to describe factors associated with this outcome. Results Among all deaths identified during the record review, two were due to suicide (.09%). The patients were one female and one male, 60 and 42 years of age, diagnosed with breast cancer and gastroesophageal junction cancer, respectively, associated with tobacco and alcohol consumption, as well as several economic, social, and familial stress factors. One of the patients was identified as likely having major depressive disorder. Discussion and conclusion Deaths might be underreported in our population. A systematic evaluation is required in order to establish and detect suicidal behavior risk factors, and a follow-up plan for all these patients.
Resumen Introducción El suicidio representa un problema de salud pública en todo el mundo. Los pacientes con cáncer pueden tener factores de vulnerabilidad para presentar conducta suicida. Hay múltiples factores asociados con este fenómeno, incluidos los derivados de la enfermedad en sí, enfermedades mentales y factores sociales, personales y espirituales. Aunque hay reportes previos que describen una tasa de suicidio que va del .03 al 7% entre los pacientes con cáncer que reciben cuidados paliativos, esto no se ha estudiado en México. Objetivo Reportar los casos de suicidio en pacientes oncológicos que reciben cuidados paliativos en un centro oncológico de referencia. Método Se trata de un estudio retrospectivo, donde se revisaron los expedientes de los pacientes atendidos en el Servicio de Cuidados Paliativos del Instituto Nacional de Cancerología entre 2018-2019. Se revisaron los expedientes de los pacientes que se suicidaron para describir los factores de riesgo que presentaban. Resultados Entre todas las muertes identificadas durante la revisión de expedientes, dos se debieron a suicidio (.09%). Los pacientes fueron una mujer y un hombre, de 60 y 42 años, diagnosticados de cáncer de mama y de una unión gastroesofágica, respectivamente. Los factores asociados fueron el consumo de tabaco y alcohol, así como varios factores de estrés económico, social y familiar. Se identificó, asimismo, que uno de los pacientes padecía trastorno depresivo mayor. Discusión y conclusión Es posible que los suicidios estén infrarreportados en nuestra población. Se requiere una evaluación sistemática para establecer y detectar factores de riesgo de conducta suicida, y un plan de seguimiento para todos estos pacientes.
ABSTRACT
Introducción: Los pacientes con cáncer avanzado tienen mayores necesidades espirituales como búsqueda de propósito y significado de vida. La Psicoterapia Individual Centrada en el Significado en Cuidados Paliativos (PICS-CP) ha demostrado alta satisfacción y evidencia científica en la atención de estas necesidades, ya que está dirigida a la comprensión y experiencia del significado de vida, a la búsqueda de su identidad antes y después de ser diagnosticado con cáncer, a sus valores, vivir el legado y encontrar una sensación de paz. Objetivo: Conocer el efecto de la PICS-CP en una paciente con cáncer avanzado en cuidados paliativos con necesidades emocionales y espirituales relacionadas con el significado de vida. Método: Diseño Applied Behavior Analysis (ABA) de caso único.Resultados: Con la PICS-CP se obtuvo una reducción de síntomas depresivos (pretratamiento = 18, postratamiento = 12), ansiosos (pretratamiento = 9, postratamiento = 7), disminución de desmoralización (pretratamiento = 23, postratamiento = 12) y en las correspondientes subescalas: afrontamiento y sentido; y un aumento en el bienestar espiritual (pretratamiento = 27, postratamiento = 37) y en las 3 subescalas: significado, paz y espíritu de lucha. Conclusiones: La PICS-CP ayuda a reducir la angustia, la ansiedad, la tensión, y a encontrar el significado de la vida en momentos críticos, como es el final de la vida. (AU)
Introduction: Patients with advanced cancer have greater spiritual needs such as the search for purpose and meaning in life. Individual meaning-centered psychotherapy in palliative care (IMCP-PC) has demonstrated high satisfaction and scientific evidence levels in addressing these needs as it is aimed at understanding and experiencing the meaning of life, at finding ones personal identity before and after being diagnosed with cancer and ones values, at living ones legacy, and at finding a sense of peace. Objective: To assess the effect of MCIP-PC on an advanced cancer patient in palliative care with emotional and spiritual needs in relation to the meaning of life. Method: Single-case ABA design. Results: With IMCP-PC we obtained a reduction in depressive symptoms (pre-treatment = 18, post-treatment = 12), anxiety symptoms (pre-treatment = 9, post-treatment = 7), and in demoralization (pre-treatment = 23 and post-treatment = 12) and its corresponding subscales: coping and meaning, as well as an increase in spiritual well-being (pre-treatment = 27, post-treatment = 37) and its 3 subscales: meaning, peace and fighting spirit. Conclusions: IMCP-PC helps to reduce distress, anxiety, and tension, and to find meaning in life at critical times such as the end of life. (AU)
Subject(s)
Humans , Female , Middle Aged , Neoplasms/psychology , Psychotherapy , Palliative Care , Spirituality , EmotionsABSTRACT
OBJECTIVE: The objective of this study was to assess the psychosocial distress and associated factors in advanced cancer patients consulting at the outpatient Palliative Care Unit at the National Cancer Institute in Mexico City. DESIGN: A retrospective study was conducted using electronic records (June 2015 to December 2016). SAMPLE: A total of 646 patients with advanced cancer during their first visit to the outpatient palliative care unit at the National Cancer Institute in Mexico were evaluated using the Distress Thermometer (DT) and ECOG performance status scores. FINDINGS: Overall, 62% were women, with a median age of 57 years, and married (54.8%). The most frequent diagnosis was gastrointestinal cancer (28.6%), and 38.9% had a functional performance status of ECOG 2. The median DT score was 4.0 (IQR = 2-6), with 56% reporting DT scores ≥4. The three most frequent problems ≥4 were sadness (82.6%), feeling weak (81.2%), worry (79.6%), and <4 were feeling weak (57.7%), fatigue (55.6%), and financial security (52.1%). The variables associated with distress according to the multiple logistic regression analysis were problems with housing (OR = 2.661, 95% CI = 1.538-4.602), sadness (OR = 2.533, 95% CI = 1.615-3.973), transportation (OR = 1.732, 95% CI = 1.157-2.591), eating (OR = 1.626, 95% CI = 1.093-2.417), nervousness (OR = 1.547, 95% CI = 1.014-2.360), and sleep (OR = 1.469, 95% CI = 1.980-2.203). CONCLUSION: The principal factors were related to distress levels, housing problems, transportation issues, and emotional problems such as sadness, nervousness, lower functionality, and younger age. Therefore, psychosocial support is of considerable relevance in palliative care. These findings will help clinicians understand the distress of patients with advanced cancer in palliative care in Latin American countries.
Subject(s)
Neoplasms , Stress, Psychological , Anxiety , Female , Humans , Middle Aged , Neoplasms/complications , Palliative Care , Retrospective Studies , Stress, Psychological/complicationsABSTRACT
INTRODUCCIÓN: Los pacientes con enfermedades crónicas en fase avanzada tienen numerosas necesidades psicológicas, sociales y espirituales, como resultado de su estado físico, condición, curso terapéutico y efectos secundarios del tratamiento, además de distrés psicológico y existencial por lo que la figura del psicólogo en Cuidados Paliativos tiene una gran relevancia. OBJETIVO: Realizar un análisis situacional de los psicólogos integrados a los equipos de cuidados paliativos del sector público en México. MÉTODO: Estudio prospectivo, descriptivo y transversal. Se diseño una encuesta ex profeso de 22 reactivos con respuesta dicotómica y opción múltiple. RESULTADOS: Se analizaron un total de 49 encuestas de psicólogos que prestan sus servicios en unidades de atención médica en México, a través de análisis de frecuencias y porcentajes, chi cuadrada y w de wilcoxon. CONCLUSIONES: Los psicólogos en cuidados paliativos requieren formación y capacitación formal para desarrollar habilidades y competencias específicas en este contexto; y de mayor sistematización y de protocolos de manejo en las evaluaciones e intervenciones psicológicas en el paciente de cuidados paliativos y su familia para evidenciar la contribución de la Psicología en Cuidados Paliativos
INTRODUCTION: Advanced chronic diseases patients have psychological, social and spiritual needs, as a result of their physical state, medical treatments, side effects, psychological and existential distress, so psychologists have great relevance in Palliative Care. OBJECTIVE: Analyze the situation of the psychologists in the palliative care teams of public health units in Mexico. Method. Prospective, descriptive and cross-sectional study. An express survey of 22 items was designed with dichotomous response and multiple choice. RESULTS: Analyzed 49 surveys of psychologists who provide services in medical care units in Mexico: analysis of frequencies, percentages, chi squared and ranks test ́ Wilcoxon. CONCLUSIONS: Palliative care psychologists require formal education and training to develop specific skills and competencies in this context; systematization and management protocols in evaluations and psychological interventions for patients and their families to demonstrate the contribution of psychologist in palliative care
Subject(s)
Humans , Palliative Care/psychology , Psychology , Cross-Sectional Studies , Prospective Studies , Public Sector , MexicoABSTRACT
Abstract Introduction The desire to hasten death (DHD) might be present in patients with advanced cancer. Multiple distressing physical and psychosocial symptoms may be related to it. There is limited literature about the characteristics of these patients in México. Objective To describe the prevalence and factors associated with DHD in advanced cancer patients evaluated by a palliative care psychiatrist. Method We conducted a cross-sectional study, including all patients referred to psychiatric assessment at the Servicio de Cuidados Paliativos of the Instituto Nacional de Cancerología in Mexico City, from January to December 2016. DHD was defined as the presence of death ideas, suicidal ideation, and/or request for euthanasia or medically assisted suicide. Patients with delirium, dementia, psychosis, or uncontrolled physical symptoms were excluded. Results Sixty-four patients were included in the study. Most of them were women (59%); the mean age was 49 years old (SD = 16). Of them, 64% met criteria for a major depressive disorder, 64% for generalized anxiety disorder and/or panic disorder, and 11% for substance use disorders. 44% expressed DHD. In a multivariate regression analysis predicting DHD, only one factor emerged: clinical depression (OR = 13.5, p = .002, 95% CI [02.562, 71.726]). Discussion and conclusion The desire to hasten death is a frequent issue for the patients evaluated at the psychiatric palliative care clinic. Depression and other distressing psychiatric pathologies were associated with DHD. Interdisciplinary interventions are needed to treat DHD. More research is warranted in order to understand the factors associated with the expression of DHD.
Resumen Introducción El deseo de acelerar la muerte (DHD, por sus siglas en inglés) es frecuente en pacientes con cáncer avanzado. Múltiples estresores físicos y psicosociales se asocian a la presencia de este fenómeno. En México es limitada la información sobre estos pacientes. Objetivo Describir la prevalencia y los factores asociados con la presencia del DHD en pacientes con cáncer avanzado evaluados por el psiquiatra de cuidados paliativos. Método Realizamos un estudio transversal, incluimos a todos los pacientes referidos a evaluación psiquiátrica en el Servicio de Cuidados Paliativos del Instituto Nacional de Cancerología en la Ciudad de México, de enero a diciembre de 2016. El DHD se definió como la presencia de ideas de muerte, ideación suicida y/o solicitud de eutanasia o suicidio médicamente asistido. Se excluyeron los pacientes con delirium, demencia, psicosis o algún síntoma físico descontrolado. Resultados Sesenta y cuatro pacientes fueron incluidos en el estudio; 59% fueron mujeres; la edad media era de 49 años (DE = 16). El 64% cumplieron criterios para un trastorno depresivo mayor, el 64% para el trastorno de ansiedad generalizada y/o trastorno de pánico y el 11% para los trastornos por uso de sustancias; 44% expresaron DHD. En un análisis de regresión multivariable, el factor depresión mayor (OR = 13.5; p = .002, IC 95% [02.562, 71.726]) fue el único significativo. Discusión y conclusión El DHD es frecuente en los pacientes valorados por psiquiatría de cuidados paliativos. La depresión mayor se asoció con DHD. Se necesitan intervenciones interdisciplinarias para tratar el DHD. Se requiere más investigación para comprender los factores asociados con la expresión de DHD.
ABSTRACT
Introducción: La relación existente entre el personal de salud y la muerte, tienen una inevitable implicación emocional, ya que se vive y convive cotidianamente con la muerte. Objetivo: Conocer el efecto de un Programa Educativo sobre Muerte y Cuidados Paliativos (PEMyCP), fundamentado a partir de la noción de enfermedad y muerte en México. Método: Estudio cuasiexperimental comparativo, muestreo no probabilístico por conveniencia, diseño pretest-postest de un solo grupo, con profesionales de la salud en México. Los instrumentos utilizados fueron: Escala de actitudes ante los cuidados paliativos, Cuestionario de competencias profesionales y Escala de ansiedad ante la muerte de Templer. A través de análisis de frecuencias, pruebas t para muestras relacionadas y análisis de varianza ANOVA. Resultados: El PEMyCP tuvo un impacto positivo en las actitudes ante los cuidados paliativos (t=-2,0050, p=0,44), en las capacidades profesionales (t=6.969, p<0.0001), y ansiedad ante la muerte (t=2,991, p=0,15). Se realizó un ANOVA, encontraron cambios significativos en conocimientos (F=8,5988, p <0,0001) y habilidades (F=6,1197, p<0,0001); sin embargo, no se identificaron cambios en actitudes (F=0,76131, p=0,63738). En la ansiedad ante la muerte, se aprecian diferencias estadísticamente significativas (F=4,0048, p=0,00919). Conclusiones: El PEMyCP tuvo un impacto favorable en conocimientos, habilidades y ansiedad ante la muerte, no siendo así en las actitudes ante la muerte y los cuidados paliativos, ya que se requiere de mayor tiempo para lograr modificarlas debido a que se adquieren no solo aspectos cognitivos, sino también afectivos y conductuales a través de la propia experiencia
Introduction: The existing relationship between health personnel and death, have an inevitable emotional involvement, since they live and coexist daily with death. OBJECTIVE: To know the effect of an Educational Program on Death and Palliative Care (PEMyCP), based on the notion of illness and death in Mexico. Method: Comparative quasi-experimental study, non-probabilistic sampling for convenience, pretest-posttest design of a single group, with health professionals in Mexico. The instruments used were: Scale of attitudes before the palliative care, Questionnaire of professional competences and Scale of anxiety before the death of Templer. Through frequency analysis, tests t for related samples and analysis of variance ANOVA. Results: The PEMyCP had a positive impact on the attitudes towards palliative care (t = -2.0050, p = 0.44), on professional abilities (t = 6.969, p= 0.00), and anxiety about death (t=2.991, p=0.15). ANOVA was performed, found significant changes in knowledge (F=8.5988, p= 0.0000) and abilities (skills) (F= 6.1197, p=0.0000); however, no changes in attitudes were identified (F= 0.76131, p= 0.63738). In the anxiety before death, are observed statistically significant differences (F=4.0048, p=0.00919). Conclusions: The PEMyCP had a favorable impact on knowledge, abilities and anxiety in the face of death, but not in the attitudes towards death and palliative care, since it takes more time to modify them because not only cognitive aspects are acquired, but also affective and behavioral through the own experience
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Hospice Care , Education, Continuing , Attitude to Death , Health Personnel/education , Prospective Studies , Mexico , Surveys and Questionnaires , Socioeconomic FactorsABSTRACT
OBJECTIVE: Depression in palliative advanced cancer patients is common, but often goes unrecognized. One of the first steps toward improving detection is the development of tools that are valid in the specific language and setting in which they are to be used. The Brief Edinburgh Depression Scale (BEDS) is a sensitive case-finding tool for depression in advanced cancer patients that was developed in the United Kingdom. There are no validated instruments to identify depression in Mexican palliative patients. Our aim was to validate the Spanish-language version of the BEDS in Mexican population with advanced cancer. METHOD: We conducted a cross-sectional study with outpatients from the palliative care unit at the Instituto Nacional de Cancerología in Mexico City. The Mexican BEDS was validated against a semistructured psychiatric clinical interview according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, classification criteria for major depressive disorder. The interviewer was blind to the BEDS score at the time of the assessment. RESULT: Seventy subjects completed the scale and interview. Women represented 71.4% of the sample and median age of subjects was 56.5 years (range, 20-85 years). The prevalence of major depressive disorder according to the psychiatric interview was 20%. The most valid cutoff for defining a case of depression was a score ≥5 of 18 on the Mexican BEDS, which gave a sensitivity of 85.7% and specificity of 62.5%. The scale's Cronbach's alpha was 0.71. SIGNIFICANCE OF RESULTS: Major depressive disorder is frequent in Mexican palliative patients. The Spanish-language Mexican version of the BEDS is the first valid case-finding tool in advanced cancer patients in this setting.
Subject(s)
Depression/diagnosis , Mass Screening/standards , Neoplasms/psychology , Palliative Care/standards , Psychometrics/standards , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Depression/classification , Depression/psychology , Female , Humans , Male , Mass Screening/methods , Mexico , Middle Aged , Neoplasms/complications , Palliative Care/methods , Psychiatric Status Rating Scales , Psychometrics/instrumentation , Psychometrics/methods , Reproducibility of Results , TranslatingABSTRACT
Este estudio instrumental presenta los criterios de confiabilidad y análisis factorial como parte de la adaptación en español de la Escala de Actitudes ante los Cuidados Paliativos (EACP). Se realizó con el objetivo de conocer si la escala cuenta con las propiedades psicométricas para poder ser utilizado para evaluar las actitudes que tienen el personal de salud hacia los cuidados paliativos. Se contó́ con una muestra de 132 profesionales de la salud (80,3% mujeres), con edades comprendidas entre los 20 y 40 años (M = 30; DT = 9,11). Los análisis exploratorios y confirmatorios mostraron un índice de fiabilidad satisfactorio (Alfa de Cronbach: 0,807) que expliquen el 65,063% de la varianza y la solución factorial que contiene las correlaciones entre las variables originales y cada uno de los factores. Dentro de los factores más relevantes consideramos: El Factor 1 que hacen referencia al proceso o directrices de atención en las unidades de Cuidados Paliativos, el Factor 2 que se relacionan con las experiencias personales ante la muerte; y el Factor 5 que se refieren al apoyo social que tienen los Cuidados Paliativos. Concluyendo que la escala cumple con las propiedades psicométricas para ser utilizada tanto en el campo clínico como en la investigación
This instrumental study presents the reliability and factor analysis as part of the Spanish adaptation of the Scale of Attitudes Palliative Care (PSST). I was done with the aim of knowing if the scale has psychometric properties, to be used to assess attitudes with health staff towards palliative care. He had a sample of 132 health professionals (80.3% women), aged between 20 and 40 years (M = 30, SD = 9.11). Exploratory and confirmatory analysis showed a satisfactory rate of reliability (Cronbachs alpha: 0.807) to explain the 65,063% of the variance and factorial solution containing the correlations between the original variables and each of the factors. Among the most important factors we consider: Factor 1 refers to the process and guidelines for care units Palliative Care Factor 2 that relate personal experiences with death; and Factor 5 which relate to social support have Palliative Care. Concluding that the scale fulfills the psychometric properties for use in both clinical and research field
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Adaptation, Psychological , Resilience, Psychological , Health Knowledge, Attitudes, Practice , Palliative Care/methods , Palliative Care/psychology , Hospice Care/psychology , Psychometrics/instrumentation , Psychometrics/methods , Psychometrics/standards , Factor Analysis, Statistical , Health Personnel/psychology , Health Personnel , Retrospective Studies , Cross-Sectional Studies/instrumentation , Cross-Sectional Studies/methods , Surveys and Questionnaires , Brief Psychiatric Rating Scale/standardsABSTRACT
Introducción: Los cuidadores primarios representan un papel crucial en la atención de los pacientes con cáncer, lo que comúnmente representan tareas complejas de cuidado. Los cuidadores de los pacientes pueden experimentar diversas afectaciones físicas y psicológicas, así como un funcionamiento social deficiente. Objetivo: Proporcionar a los servicios de psicooncología un algoritmo con los elementos suficientes que faciliten el diagnóstico y tratamiento psicosocial de cuidadores primarios de pacientes con cáncer. Método: Se realizó una búsqueda de la literatura en PsycInfo, LatinIndex y Medline en el período de 2005-2014. Resultados: El presente algoritmo se divide en dos momentos clave: 1). Evaluación y 2). Tratamiento del cuidador primario. Los instrumentos más empleados para ansiedad y depresión son: CES-D, BDI, IDARE, HADS y POMS. Para carga el ECCZ y CRA; las intervenciones psico-educativa, capacitación y orientación terapéutica presentan efectos benéficos para esta población. Conclusiones: El algoritmo ofrece un proceso de toma de decisiones para el diagnóstico y tratamiento psicooncológico del cuidador primario informal
Introduction: The primary caregivers play a crucial role in the care of cancer patients, which commonly represent complex care tasks. Caregivers of patients may experience various physical and psychological effects, and poor social functioning. Objective: To provide at psychooncology services of an algorithm with sufficient elements for diagnosis and psychosocial treatment of primary caregivers of patients with cancer elements. Method: A literature search in PsycInfo, Medline LatinIndex in the period of 2005 to 2014. Results: This algorithm is divided into two key points: 1) Evaluation and 2) Treatment of primary caregiver. More used instruments are CES-D, BDI, IDARE, HADS and POMS. For Burden ECCZ and CRA; the psycho-educational interventions, training and therapeutic orientation have beneficial effects for this population. Conclusions: The algorithm provides a process of decision making for the diagnosis and psychooncologic treatment of the primary caregiver
Subject(s)
Humans , Caregivers/psychology , Neoplasms/psychology , Anxiety/epidemiology , Depression/epidemiology , Workload/statistics & numerical data , Stress, Psychological/epidemiologyABSTRACT
La espiritualidad, es una necesidad fundamental en el cuidado paliativo, sin embargo, la literatura reporta que existen inconsistencias en la definición de los términos «espiritualidad» y «religiosidad», lo que genera confusión en su abordaje con los pacientes. El presente estudio fue exploratorio, con el objetivo de conocer la concepción de espiritualidad y religiosidad que tiene un equipo multidisciplinario en una unidad de cuidados paliativos oncológicos. El estudio fue no experimental, transversal y descriptivo; con 34 profesionales de la salud. Para la obtención del concepto se empleó la técnica de redes semánticas naturales, utilizando dos palabras estímulo: Espiritualidad y Religiosidad. Dentro de los resultados se encontraron semejanzas entre ambas palabras, al ser definidos como: fe, dios, creencia, amor, religión, esperanza, creencias. Sin embargo, se presentan diferencias en el concepto de espiritualidad; definida como paz, alma, tranquilidad, armonía, meditación, bondad, espíritu; y trascendencia; mientras que el concepto de religiosidad; fue definida como iglesia, ritos, fanatismo, espiritualidad, compromiso, oración, reglas, y sacerdote. Concluyendo que los conceptos resultan confusos para el equipo de cuidados paliativos, sin embargo, cuentan con recursos personales para identificar las necesidades espirituales aunque carecen de información y entrenamiento formal para su abordaje
Spirituality is a fundamental need in palliative care; however, the literature reports that there are inconsistencies in the definition of the terms «spirituality» and «religiosity», which creates confusion in how to approach these issues with the patients. The present study was exploratory, with the aim to better understand the concept of spirituality and religiosity that a multidisciplinary team has in an oncology palliative care unit. The study was not experimental, cross-sectional and descriptive, with 34 health professionals. To obtain each concept, the natural semantic networks technique was used; using two stimulus words: spirituality and religiosity. Among the results, similarities between the two concepts were found, being both defined as faith, god, belief, love, religion, hope. However, there are differences that distinguish the concept of spirituality; defined as peace, soul, tranquility, harmony, meditation, kindness, spirit, and transcendence; from the concept of religiosity; defined as church, rituals, bigotry, spirituality, commitment, prayer, rules, and priest. Concluding that the concepts are confusing to the palliative care team, however they have personal resources to identify the spiritual needs although they lack of information and formal training to address this
Subject(s)
Humans , Spirituality , Religion and Psychology , Palliative Care/psychology , Patient Care Team , Terminally Ill/psychology , Health Personnel/psychologyABSTRACT
En el ámbito de la salud, se ha puesto en evidencia la necesidad de profundizar en las actitudes y creencias ante la muerte en los propios profesionales ya que pueden influir en la calidad de los cuidados, especialmente las derivadas de procesos de muerte y duelo, por lo que el objetivo de la investigación fue explorar y analizar actitudes y creencias ante la muerte en el personal de salud en Cuidados Paliativos Oncológicos. Fue un estudio, transversal y descriptivo; se utilizó un muestreo intencional, los instrumentos utilizados fueron: Formato de datos personales y profesionales, Escala de Ansiedad ante la muerte de Templer, Creencias con relación al paciente terminal y Cuestionario de Actitudes ante la Muerte (CAM). Se analizaron los datos estadísticamente: análisis de frecuencias y correlación de Spearman, con una alta tendencia en considerar que es mejor que el paciente terminal fallezca en casa, en el uso de la morfina como tratamiento para el dolor en cáncer avanzado y recibir una atención integral. Dentro de las principales actitudes del personal de salud hacia el paciente terminal y la muerte se encontraron: mayor responsabilidad y atención hacia la vida, y promoción del crecimiento personal para aceptar su propia muerte
In the field of health, has highlighted the need to delve into the attitudes and beliefs about death in the professionals because they can influence the quality of care, especially those derived from processes of death and mourning, for what the objective of the research was to explore and analyze attitudes and beliefs about death in health personnel Oncology Palliative Care. The study was a cross-sectional and descriptive, purposive sampling was used, the instruments used were format personal and professional, Anxiety Scale Templers death, beliefs regarding the terminal patient and Attitudes Questionnaire Death (CAM ). Data were analyzed statistically: Frequency analysis and Spearman correlation, with a high tendency to consider that is better than the terminal patient dies at home, in the use of morphine as a treatment for pain in advanced cancer and receiving comprehensive care. Among the main attitudes in the health staff towards the patient and death were found: more responsibility and attention to the promotion of life and personal growth to take his own life
Subject(s)
Humans , Attitude to Death , Anxiety/psychology , Psychometrics/instrumentation , Adaptation, Psychological , Palliative Care , Attitude of Health Personnel , Surveys and QuestionnairesABSTRACT
Cuidar de un familiar con cáncer avanzado trae consigo una serie de problemas familiares, laborales, económicos, y sociales que impactan negativamente sobre la calidad de vida y la salud física y psicológica de los cuidadores primarios. El objetivo de la presente investigación fue evaluar la eficacia de una intervención basada en la terapia de solución de problemas sobre la adquisición de habilidades de autocuidado, la calidad de vida, y la sintomatología ansiosa y depresiva en cuidadores primarios de pacientes que reciben cuidados paliativos. Se utilizó un diseño de N=1 de medidas repetidas, con evaluación pre y post- test con los inventarios de ansiedad y depresión de Beck, el inventario de calidad de vida WHOQol Bref y un cuestionario de conductas de autocuidado diseñado ex profeso para esta investigación. Se identificaron mejorías clínicamente significativas en las medidas de sintomatología ansiosa y depresiva, un incremento en la calidad de vida y la identificación de la Terapia de Solución de Problemas como una herramienta útil para afrontar las problemáticas derivadas de las actividades de cuidado. La principal limitante para el desarrollo de la intervención fue que el tiempo propuesto no correspondió con el promedio de sobrevida de los pacientes atendidos en el servicio (AU)
Caring for a relative with terminal cancer brings a series of problems in the family, work, financial and social arenas. These problems, in turn, cause a negative impact on the Quality of Life (QOL) of the patients primary caregivers, including their physical and psychological health. The purpose of the present study was to examine the effects of an intervention based on Problem Solving Therapy on QOL, anxious and depressive symptoms and on the acquisition of self-care skills by terminal cancer patients primary caregivers. A repeated measures N=1 design was used on pre and post intervention measurements on Becks anxiety and depression inventories, the WHOQOL-Bref and a questionnaire on self-care expressly designed for the study. Results revealed clinically significant improvements on anxious and depressive symptoms and improvement on the participants QOL. Problem Solving Therapy resulted a viable and effective approach to cope with the problems posed by caring for a terminal patient and improving self-care skills. A possible drawback of the procedures includes a lengthy intervention howhich was not always commensurate with the survival time of the terminal patients (AU)
Subject(s)
Humans , Problem Solving , Self Care , Caregivers/psychology , Terminal Care/psychology , Depression/epidemiology , Anxiety/epidemiology , Risk Factors , Quality of LifeABSTRACT
Enfrentarse a un cáncer avanzado implica un gran malestar físico y emocional para el paciente y su familia, es por ello que la atención psicológica es una prioridad en los cuidados paliativos. La terapia cognitivo-conductual es uno de los marcos teóricos más aplicados en la atención del paciente paliativo y tiene por objetivo la modificación de pensamientos y conductas respecto a la enfermedad que resultan disfuncionales y que impactan negativamente en el bienestar del paciente y sus familiares. El objetivo del estudio fue describir el proceso de atención psicológica en el Programa de Atención y Cuidados en Oncología del Instituto Nacional de Cancerología, así como las caracteristicas generales, diagnósticos oncológicos y psicológicos; y las técnicas de intervención psicológica más empleadas. Se realizo un estudio retrospectivo, trasnversal y descriptivo de la población atendida de febrero del 2011 a marzo del 2013. Con una muestra total de 5.588 pacientes. Se procesaron los datos a traves del análisis de frecuencias, obteniendo que dentro de los diagnósticos oncológicos más frecuentes el cáncer de estómago, mama y cervicouterino; encontrando en la mayoría de ellos, impacto emocional y procesos adaptativos al encontrarse fuera de tratamiento oncológico y cuyas técnicas psicológicas más aplicadas fueron: a) Psicoeducación, b) Expresión y regulación emocional c) Validación emocional, d) Contención emocional, y e) Solución de problemas (AU)
Coping in advanced cancer involves physical problems and emotional discomfort for the patient and his family, which is why psychological care care is a priority in palliative care. Cognitive behavioral therapy is one of the theoretical frameworks applied in the care of palliative patients and aims modifying thoughts and behaviors regarding the disease that are dysfunctional and negative impact the welfare of the patient and family. The aim of the study was to describe the psychological process in Program of Care in Oncology in The National Cancer Institute, general characteristic, cancer and psychological diagnoses and psychological techniques most used. We performed a retrospective study trasnversal and descriptive in population attended from February 2011 to March 2013. Total sample was 5588 patients. Data were processed with frequency analysis. The types of cancer most frequently attended were: gastrointestinal, breast and cervical, finding most of them with impact and adaptive processes are outside the oncology treatment. The most widely used psychological techniques were:a) Psychoeducation, b) Emotional expression and regulation c) emotional validation, d) Emotional containment, and e) Problem-solving (AU)
