Termômetro de Distress: validação de um instrumento breve para avaliação diagnóstica de pacientes oncológicos

Abstract

ResumoA literatura especializada disponibiliza instrumentos de medida de estresse de aplicação geral, os quais vêm sendo empregados em diferentes contextos ocupacionais e em saúde. Mas, desde 1997, a National Comprehensive Cancer Network (NCCN) recomenda a adoção de uma medida específica para pacientes oncológicos. Considerando, portanto, o interesse clínico e científico de desenvolver futuros estudos de meta-análise em Oncologia, que incluam amostras brasileiras, realizaram-se a adaptação e a validação do Termômetro de Distress (TD). A eficácia de avaliação do TD foi verificada por meio da comparação com a Escala de Ansiedade e Depressão (HAD), um instrumento clinicamente estabelecido de avaliação de distress. Para tanto, avaliou-se uma amostra de 83 pacientes, que responderam ao TD e ao HAD. Os dados foram submetidos ao SPSS 15.0. Os resultados indicam uma sensibilidade de 82% e uma especificidade de 98%, o que indica que o TD é viável e eficiente para avaliar o distress psicológico.Palavras-chave: Termômetro de Distress; Validade; Estresse; Psico-oncologia. AbstractThe specialized literature provides instruments measuring stress for general application. Those instruments have been employed in occupational and health contexts. But since 1997, the National Comprehensive Cancer Network (NCCN) recommends the adoption of a specific measuring instrument for the assessment of cancer patients. Considering the existence of clinical and scientific interest to develop future meta-analysis studies in the field of Oncology, which will include Brazilian samples, the adaptation and validation of the Distress Thermometer (TD) was undertaken. The effectiveness of the TD in assessing distress was verified by comparison with the Anxiety and Depression Scale (HAD), a clinically established tool for evaluating distress. In order to that, a sample of 83 patients answered the TD and the HAD. The data were analyzed using SPSS 15.0. Results of the analysis indicated 82% for sensitivity and 98% for specificity. Using the TD appeared feasible and effective for psychological distress screening.Keywords: Distress thermometer; Validation; Stress; Psycho-oncology. INTRODUÇÃOAinda hoje, o câncer é uma doença cujo significado é ameaçador para a maioria das pessoas, pois está associado ao risco de morte e possibilidade de interrupção da trajetória existencial, que exige do indivíduo acometido força e criatividade para suportar mudanças, muitas vezes drásticas, em seu estilo de vida (Werebe, 2000). Segundo Coenson e Dimsdale (1994), a alta prevalência de transtornos psiquiátricos em oncologia pode ser compreendida em razão da intensidade com que os enfermos convivem com a angústia, a dor, o desfiguramento, a dependência, o isolamento, o luto, a separação, as perdas e a morte, além de terem de suportar os efeitos colaterais da quimioterapia e da radioterapia, as frequentes internações hospitalares, os altos gastos financeiros e as mudanças que atingem também suas famílias.

Course of distress, anxiety, and depression in hematological cancer patients: Association between gender and grade of neoplasm

“…This comprises a selfreport screening measure for distress and is composed of two parts. A cutoff score of 4 (sensitivity 0.82 and specificity 0.98) was used to indicate clinically significant distress (Decat et al, 2009). In the second part (PL), patients were given a list and asked to check all the problems that they have experienced during the past week.…”

A prospective study of changes in anxiety, depression, and problems in living during chemotherapy treatments: effects of age and gender

“…Problems in living The list of 35 problems in daily living [5], which was translated/back-translated in Brazilian Portuguese [27], was used to assess emotional (6 problems e.g., fears, nervousness), practical (5 problems e.g., housekeeping, transportation), physical (21 problems e.g., fever, pain), spiritual (1 problem), and family (2 problems e.g., dealing with partner, dealing with children) problems at T1, T2, and T3. Participants evaluated presence or absence of each problem.…”

Distress levels in patients undergoing chemotherapy in Brazil

“…It includes a Problem List of 35 items to which the patient notes the causes of his or her distress 26. The DT was translated into Portuguese 10, 24. For our study, the cutoff score of 4 (sensitivity 0.82 and specificity 0.98) was used to indicate clinically significant distress 24.…”

“…Assessment by the DT also included the tool's 35‐item Problem List. Scores obtained in the HADS were compared to the level of distress found by the DT 23, 24.…”