Joaquín T. Limonero

Suffering and distress at the end-of-life

Suffering frequently occurs in the context of chronic and progressive medical illnesses and emerges with great intensity at end‐of‐life. A review of the literature on suffering and distress‐related factors was conducted to illustrate the integrative nature of suffering in this context. We hope it will result in a comprehensive approach, centered in the patient‐family unit, which will alleviate or eliminate unnecessary suffering and provide well‐being, when possible.

Spanish Adaptation of the Collett-Lester Fear of Death Scale

The Collett-Lester Fear of Death Scale (CL-FODS) consists of 4 subscales: Death of Self, Dying of Self, Death of Others, and Dying of Others. The aim of this study was to develop a Spanish version of the CL-FODS and to explore its psychometric properties. The revised version of the scale was translated into Spanish from English. Then, the back translation technique was carried out. A sample of 281 Spanish nursing students and professionals responded to the Spanish CL-FODS, along with 2 instruments assessing death anxiety and general anxiety. Good internal consistency and satisfactory test–retest reliability of the 4 subscales of the Spanish CL-FODS were achieved. Its correlations with death anxiety were higher than that with general anxiety, supporting its discriminant validity. The principal component analysis forced to 4 components provided a distribution of loadings that is more coherent with the theoretical formulation of the 4 components than those obtained in previous studies. These results justify the use of the CL-FODS in Spanish-speaking health care professionals for the purpose of assessing attitudes toward death and dying in self and others.

Suffering assessment: a review of available instruments for use in palliative care.

BACKGROUND The prevention and relief of suffering in palliative care are critical to the well-being and quality of life of patients and families facing life-threatening diseases. Many tools to assess different issues in health care are available, but few are specifically designed to evaluate suffering, which is essential for its prevention, early management, and treatment. OBJECTIVE The purpose of this review was to identify and describe existing instruments developed to assess suffering in palliative care, as well as to comment on their psychometric properties. METHODS A review of articles indexed in MEDLINE, PsycINFO, and SciELO up to June 2011 was conducted. All articles reporting the development, description, or psychometric properties of instruments that assess suffering were included. An assessment of their psychometric quality was performed following a structured checklist. RESULTS Ten instruments that assess suffering were identified. Their main features and psychometric properties are described in order to facilitate the selection of the appropriate one given each patients context. CONCLUSION By taking into consideration all features of the assessment instruments under review, the evaluation of suffering can be made easier. A wide and ever expanding range of approaches is now available, which facilitates the selection of the suffering-assessment instrument that is best suited to the needs of the specific patient. One of the challenges ahead will be to further analyze the psychometric properties of some existing instruments.

An International Consensus Definition of the Wish to Hasten Death and Its Related Factors

Background The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD. Methods Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy. Findings All 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD. Conclusions This international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention.

Predictors of Suffering in Advanced Cancer

Context: Suffering is a complex experience. Identifying its predictors is useful to signal at-risk patients. Objective: To identify suffering predictors in patients with advanced cancer in palliative care. Methods: A total of 98 patients participated in the study. A semistructured interview examining suffering levels and physical, psychological, social, and spiritual aspects was used. Instruments included Pictorial Representation of Illness and Self Measure (PRISM), Edmonton Symptom Assessment System (ESAS), Detection of emotional distress (DED), and Structured Interview of Symptoms and Concern (SISC). Variance-based structural equation model was used for the data analysis. Results: All measures were valid and reliable. The structural model explained 64% of the variance. Suffering levels were directly determined by psychological and adjustment problems and indirectly determined by physical, psychological, and spiritual aspects and coping strategies. Conclusion: Our study supports the proposed theoretical model and signals the important mediating effect of psychological and spiritual variables between physical symptoms and suffering.

The Death Anxiety Inventory: a revision.

This work was an analysis of responses to the Death Anxiety Inventory from 866 Spanish participants, 673 women and 193 men. Eliminating an item with a negative corrected item-total correlation and two more items which had low loadings on all factors yielded a 17-item inventory with a Cronbach coefficient alpha of .92 and a factorial structure of four significant factors which accounted for 65.8% of the total variance. These four factors were labeled Death Acceptance, Externally Generated Death Anxiety, Death Finality, and Thoughts About Death.

Evidence for validity of the brief resilient coping scale in a young Spanish sample.

The aim of the present study was to provide evidence of validity of the Brief Resilient Coping Scale for use in Spanish young population. A total of 365 university students responded to the Spanish version of the BRCS as well as to other tools for measuring personal perceived competence, life satisfaction, depression, anxiety, negative and positive affect, and coping strategies. Confirmatory factor analysis confirmed the unidimensional structure of the scale. Internal consistency reliability and temporal stability through Cronbachs alpha and test-retest correlations, respectively, were comparable to those found in the initial validation of the tool. The BRCS showed positive and significant correlations with personal perceived competence, optimism, life satisfaction, positive affect (p < .01), and some coping strategies (p < .05). Significant negative correlations were observed with depression, anxiety and negative affect. (p < .01). Multiple regression analysis with stepwise method showed that positive affect, negative affect, optimism and problem solving explained 41.8% of the variance of the BRCS (p < .001). The Spanish adaptation of the BRCS in a young population is satisfactory and comparable to those of the original version and with the Spanish version adapted in an elderly population. This supports its validity as a tool for the assessment of resilient coping tendencies in young people who speak Spanish and offers researchers and professionals interested in this area of study a simple tool for assessing it.

Emotional intelligence and recovering from induced negative emotional state

The aim of the present study was to examine the relationship between emotional intelligence (EI) and recovering from negative emotions induction, using a performance test to measure EI. Sixty seven undergraduates participated in the procedure, which lasted 75 min and was divided into three stages. At Time 1, subjects answered the State-Trait Anxiety Inventory (STAI)-S, Profile of Mood States (POMS)-A, and EI was assessed by Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT). At Time 2, negative emotions were induced by nine pictures taken from the International Affective Picture System and participants were asked to complete a second STAI-S and POMS-B questionnaires. At Time 3 participants were allowed to rest doing a distracting task and participants were asked to complete a third STAI-S and POMS-A questionnaires. Results showed that the branches of the MSCEIT emotional facilitation and emotional understanding are related to previous mood states and mood recovery, but not to mood reactivity. This finding contrasts nicely with studies on which emotional recovery was assessed in relation to EI self-reported measures, highlighting the perception and emotional regulation.

Comparación de los niveles de ansiedad ante la muerte en estudiantes de enfermería de Egipto y España

Resumen El objetivo de este trabajo ha sido realizar la comparacion intercultural de la ansiedad ante la muerte que presentan dos muestras de estudiantes de enfermeria pertenecientes a las culturas arabe y espanola. Una muestra de estudiantes de enfermeria egipcias (n = 132) y otra de estudiantes espanolas (n = 126) respondieron al Inventario de Ansiedad ante la Muerte en sus respectivos idiomas, arabe y espanol. Los resultados ponen de manifiesto puntuaciones generales de ansiedad ante la muerte significativamente superiores en las estudiantes egipcias. A nivel factorial, las estudiantes egipcias puntuan significativamente mas alto que las espanolas en los factores relacionados con generadores externos de ansiedad ante la muerte, pensamientos sobre la muerte y la vida despues de la muerte, mientras que las espanolas puntuan significativamente mas alto en el factor relacionado con el significado y aceptacion de la muerte Las diferencias observadas se interpretan en terminos de las caracteristicas religiosas y sociales que presentan las respectivas sociedades a las que pertenecen las estudiantes

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.