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- Relationship of Demoralization With Anxiety, Depression, and Quality of Life: a Southern European Study of Italian and Portuguese Cancer PatientsPublication . Nanni, MG; Caruso, R; Travado, L; Ventura, C; Palma, A; Berardi, A; Meggiolaro, E; Ruffilli, F; Martins, C; Kissane, D; Grassi, LBackground: Demoralization syndrome is a significant condition that has not been greatly studied in Southern European countries. Aims: To extend the knowledge of demoralization in Southern Europe by examining its prevalence according to different methods of assessment, its relationship with anxiety and depression, and its impact on quality of life (QoL) among cancer patients. Methods: A convenience sample of 195 cancer outpatients from two oncology centers (102 from Lisbon, Portugal, and 93 from Ferrara, Italy) participated in an observational, cross-sectional study using the Diagnostic Criteria of Psychosomatic Research-Demoralization interview (DCPR/D) and psychometric tools (Demoralization scale-DS; Patient Health Questionnaire-9/PHQ-9; Hospital Anxiety Depression Scale-HADS; and European Quality of Life-5-EQ-5D). Results: A 25.1% prevalence (CI 95%, 0.19-0.31) of clinically relevant demoralization was reported on the DCPR/D interview. A total demoralization score cutoff score ≥ 25 maximized sensitivity (81.6%), and specificity (72.6%) in identifying DCPR/D demoralized patients. The DCPR/D and DS were associated with poorer levels of QoL. About half of the patients who were demoralized were not clinically depressed (PHQ-9). Self-reported suicidal ideation (PHQ-9 item 9) was found in a minority of patients (8.2%), most of whom (77%) were cases of depression (PHQ-9), but one-quarter (23%) were not depressed, yet moderately/severely demoralized (DCPR/D and DS). Conclusions: This Southern European study confirms the importance of demoralization in cancer patients as a different condition with respect to depression and its relationship with poor QoL and suicidal ideation.
- Desenvolvimento do questionário CARATkidsPublication . Borrego, LM; Fonseca, J; Pereira, A; Reimão Pinto, V; Linhares, D; Morais-Almeida, MIntrodução: A asma e a rinite alérgica (ARA) são doenças inflamatórias crónicas das vias aéreas que frequentemente coexistem. O questionário para avaliação do controlo da asma e da rinite alérgica (CARAT) encontra‑se validado para o adulto. O objectivo foi desenvolver o questionário CARATkids para crianças entre os 4 e os 12 anos de idade, com o diagnóstico médico de ARA. Este trabalho pretende descrever o processo do desenvolvimento do questionário. Métodos: O desenvolvimento do questionário foi estruturado em três fases: 1) revisão da literatura sobre questionários pediátricos existentes; 2) realização de reuniões de consenso que permitiu a criação de uma versão preliminar do CARATkids, com duas versões (crianças e pais), composto por 17 itens. Para as crianças, as perguntas foram acompanhadas por ilustrações para cada questão, com formato de resposta dicotómica (sim / não). Para os pais o questionário manteve o formato de CARAT17, com questões com 4 pontos de Likert e outras questões com opção de resposta com escala dicotómica; 3) realização de um estudo transversal através de entrevistas cognitivas efectuadas a 29 crianças e respectivos pais. Resultados: Foram incluídas 29 crianças (11 do sexo feminino) e respectivos pais. A mediana de idades (P25‑P75) foi de 8 (6‑10) anos. As crianças com 4 a 5 anos não sabiam ler o questionário; com 6‑8 eram capazes de ler / compreender as perguntas, embora referindo dificuldades para algumas expressões. As crianças com mais de 9 anos consideraram o questionário muito simples e claro. O grau de concordância entre as crianças e seus pais foi de 61%, tendo ambos considerado as ilustrações muito claras e esclarecedoras quanto aos conceitos subjacentes. Os pais concordaram que a versão destinada aos pais estava muito completa, considerando a versão da criança muito clara e adequada. Consideraram ainda a escala dicotómica como mais apropriada para crianças, em comparação com a escala de Likert do questionário aplicado aos pais. As expressões identificadas como de difícil entendimento foram alteradas. Conclusão: O questionário CARATkids é o primeiro que avalia o controlo da asma e da rinite na criança. Os testes cognitivos demonstraram a sua aplicabilidade dos 6 aos 12 anos de idade.
- Physician-Patient Communication Among Southern European Cancer Physicians: the Influence of Psychosocial Orientation and BurnoutPublication . Travado, L; Grassi, L; Gil, F; Ventura, C; Martins, CPhysician-patient communication is a critical factor for comprehensive care in oncology. Although a number of studies have been carried out in Northern Europe and the US on this subject, no data are available in Southern European countries. As a part of a multicenter Southern European Psycho-Oncology study (SEPOS), the present investigation was conducted to examine communication skills and related variables (i.e. psychosocial orientation, and burnout) among 125 physicians from Italy, Portugal, and Spain. The Self-Confidence in Communication Skills (SCCS) scale was given to assess physicians' perception of their communication skills and the Expected Outcome of Communication (EOC) scale was administered to examine the physicians' expectations about the effects of communicating with their patients. Doctors' psychosocial orientation was measured by using the Physician Belief Scale (PBS) and burnout was measured by using the Maslach Burnout Inventory (MBI). Although the physicians reported receiving minimal training in communication during their education, they tended to perceive themselves as skilled in patient communication, apart from some areas (e.g. dealing with denial, managing uncertainty, assessing anxiety and depression, and promoting patient-family openness). Low psychosocial orientation and burnout symptoms (i.e. emotional exhaustion, depersonalization, and poor personal accomplishment in their job) were associated with lower confidence in communication skills and higher expectations of a negative outcome, following physician-patient communication. The results suggest that there is a need for training cancer physicians in communication and for increasing a more definite psychosocially oriented approach in cancer care in Mediterranean countries.
- Visualização: Uma Intervenção Possível em Psicologia da SaúdePublication . Cabete, D; Cavaleiro, AM; Pinteus, MT
- Women's Attachment as a Predictor of Pain During Labour and Post-Delivery: a Prospective Observational StudyPublication . Costa Martins, JM; Fernandes da Silva, C; Pereira, M; Martins, H; Oliveira, C; Puga, A; Coelho, R; Tavares, JINTRODUCTION: Labour is considered to be one of the most painful and significant experiences in a woman's life. The aim of this study was to examine whether women's attachment style is a predictor of the pain experienced throughout labour and post-delivery. MATERIAL AND METHODS:Thirty-two pregnant women were assessed during the third trimester of pregnancy and during labour. Adult attachment was assessed with the Adult Attachment Scale ' Revised. The perceived intensity of labour pain was measured using a visual analogue scale for pain in the early stage of labour, throughout labour and post-delivery. RESULTS:Women with an insecure attachment style reported more pain at 3 cm of cervical dilatation (p < 0.05), before the administration of analgesia (p < 0.01) and post-delivery (p < 0.05) than those securely attached. In multivariate models, attachment style was a significant predictor of labour pain at 3 cm of cervical dilatation and before the first administration of analgesia but not of the perceived pain post-delivery. DISCUSSION: These findings confirm that labour pain is influenced by relevant psychological factors and suggest that a woman's attachment style may be a risk factor for greater pain during labour. CONCLUSION:Future studies in the context of obstetric pain may consider the attachment style as an indicator of individual differences in the pain response during labour. This may have important implications in anaesthesiology and to promote a relevant shift in institutional practices and therapeutic procedures.
- The Role of Psychological Adjustment in the Decision-Making Process for Voluntary Termination of PregnancyPublication . Sereno, S; Leal, I; Maroco, JBACKGROUND: This study's objective was to evaluate the role of psychological adjustment in the decision-making process to have an abortion and explore individual variables that might influence this decision. METHODS: In this cross-sectional study, we sequentially enrolled 150 women who made the decision to voluntarily terminate a pregnancy in Maternity Dr. Alfredo da Costa, in Lisbon, Portugal, between September 2008 and June 2009. The instruments were the Depression, Anxiety and Stress Scale (DASS), Satisfaction with Social Support Scale (SSSS), Emotional Assessment Scale (EAS), Decision Conflict Scale (DCS), and Beliefs and Values Questionnaire (BVQ). We analyzed the data using Student's T-tests, MANOVA, ANOVA, Tukey's post-hoc tests and CATPCA. Statistically significant effects were accepted for p<0.05. RESULTS: The participants found the decision difficult and emotionally demanding, although they also identified it as a low conflict decision. The prevailing emotions were sadness, fear and stress; but despite these feelings, the participants remained psychologically adjusted in the moment they decided to have an abortion. The resolution to terminate the pregnancy was essentially shared with supportive people and it was mostly motivated by socio-economic issues. The different beliefs and values found in this sample, and their possible associations are discussed. CONCLUSION: Despite high levels of stress, the women were psychologically adjusted at the time of making the decision to terminate the pregnancy. However, opposing what has been previously reported, the women presented high levels of sadness and fear, showing that this decision was hard to make, triggering disruptive emotions.
- Cancer Rehabilitation Indicators for EuropePublication . Baili, P; Hoekstra-Weebers, J; Van Hoof, E; Helge Bartsch, Hans; Travado, L; Garami, M; Di Salvo, F; Micheli, A; Veerus, P; EUROCHIP-3Little is known of cancer rehabilitation needs in Europe. EUROCHIP-3 organised a group of experts to propose a list of population-based indicators used for describing cancer rehabilitation across Europe. The aim of this study is to present and discuss these indicators. A EUROCHIP-3 expert panel reached agreement on two types of indicators. (a) Cancer prevalence indicators. These were proposed as a means of characterising the burden of cancer rehabilitation needs by time from diagnosis and patient health status. These indicators can be estimated from cancer registry data or by collecting data on follow-up and treatments for samples of cases archived in cancer registries. (b) Indicators of rehabilitation success. These include: return to work, quality of life, and satisfaction of specific rehabilitation needs. Studies can be performed to estimate these indicators in individual countries, but to obtain comparable data across European countries it will be necessary to administer a questionnaire to randomly selected samples of patients from population-based cancer registry databases. However, three factors complicate questionnaire studies: patients may not be aware that they have cancer; incomplete participation in surveys could lead to bias; and national confidentiality laws in some cases prohibit cancer registries from approaching patients. Although these studies are expensive and difficult to perform, but as the number of cancer survivors increases, it is important to document their needs in order to provide information on cancer control.
- Development Process and Cognitive Testing of CARATkids - Control of Allergic Rhinitis and Asthma Test for ChildrenPublication . Borrego, LM; Fonseca, JA; Pereira, AM; Reimão Pinto, V; Linhares, D; Morais-Almeida, MBackground: Allergic rhinitis and asthma (ARA) are chronic inflammatory diseases of the airways that often coexist in children. The only tool to assess the ARA control, the Control of Allergic Rhinitis and Asthma Test (CARAT) is to be used by adults. We aimed to develop the Pediatric version of Control of Allergic Rhinitis and Asthma Test (CARATkids) and to test its comprehensibility in children with 4 to 12 years of age. Methods: The questionnaire development included a literature review of pediatric questionnaires on asthma and/or rhinitis control and two consensus meetings of a multidisciplinary group. Cognitive testing was carried out in a cross-sectional qualitative study using cognitive interviews. Results: Four questionnaires to assess asthma and none to assess rhinitis control in children were identified. The multidisciplinary group produced a questionnaire version for children with 17 questions with illustrations and dichotomous (yes/no) response format. The version for caregivers had 4-points and dichotomous scales. Twenty-nine children, 4 to 12 years old, and their caregivers were interviewed. Only children over 6 years old could adequately answer the questionnaire. A few words/expressions were not fully understood by children of 6 to 8 years old. The drawings illustrating the questions were considered helpful by children and caregivers. Caregivers considered the questionnaire complete and clear and preferred dichotomous over the 4-points scales. The proportion of agreement between children and their caregivers was 61%. The words/expressions that were difficult to understand were amended. Conclusion: CARATkids, the first questionnaire to assess a child’s asthma and rhinitis control was developed and its content validity was assured. Cognitive testing showed that CARATKids is well-understood by children 6 to 12 years old. The questionnaire’s measurement properties can now be assessed in a validation study.
- Epilepsia de Ausências: Caracterização Cognitiva de um Grupo de Crianças e AdolescentesPublication . Pestana, R; Carruço, S; Sa, I; Lobato-Faria, T; Dias, AI
- A Communication Intervention for Training Southern European Oncologists to Recognize Psychosocial Morbidity in Cancer. I - Development of the Model and Preliminary Results on Physicians' SatisfactionPublication . Grassi, L; Travado, L; Gil, F; Campos, R; Lluch, P; Baile, WBACKGROUND: The detection of psychosocial distress is a significant communication problem in Southern Europe and other countries. Work in this area is hampered by a lack of data. Because not much is known about training aimed at improving the recognition of psychosocial disorders in cancer patients, we developed a basic course model for medical oncology professionals. METHODS: A specific educational and experiential model (12 hours divided into 2 modules) involving formal teaching (ie, journal articles, large-group presentations), practice in small groups (ie, small-group exercises and role playing), and discussion in large groups was developed with the aim of improving the ability of oncologists to detect emotional disturbances in cancer patients (ie, depression, anxiety, and adjustment disorders). RESULTS: A total of 30 oncologists from 3 Southern European countries (Italy, Portugal, and Spain) participated in the workshop. The training course was well accepted by most participants who expressed general satisfaction and a positive subjective perception of the utility of the course for clinical practice. Of the total participants, 28 physicians (93.3%) thought that had they been exposed to this material sooner, they would have incorporated the techniques received in the workshop into their practices; 2 participants stated they would likely have done so. Half of the doctors (n = 15) believed that their clinical communication techniques were improved by participating in the workshop, and the remaining half thought that their abilities to communicate with cancer patients had improved. CONCLUSIONS: This model is a feasible approach for oncologists and is easily applicable to various oncology settings. Further studies will demonstrate the effectiveness of this method for improving oncologists skills in recognizing emotional disorders in their patients with cancer.