Tiago Paredes

Development and psychometric properties of the World Health Organization Quality of Life Assessment Instrument (WHOQOL-100) in Portugal.

BackgroundAt the beginning of the 1990s, the World Health Organization (WHO) developed a project in order to create a cross-cultural instrument of quality of life assessment: the World Health Organization Quality of Life (WHOQOL).PurposeThis paper describes the development of the European Portuguese version of the WHOQOL-100, according to the methodology recommended by the WHO.MethodSpecial attention is given to the qualitative pilot study, which led to the development of the Portuguese Facet [Political P], and to the empirical pilot study and the psychometric studies, based on the application of the Portuguese version of the instrument to a sample of 315 subjects from the general population and 289 patients. The assessment protocol also included the Beck Depression Inventory and the Brief Symptom Inventory.ResultsThe Portuguese version of WHOQOL-100 showed acceptable internal consistency (α range 0.84–0.94) and test–retest reliability in all domains (r range 0.67–0.86). Discriminant validity was significant for all domains, except in Spirituality. Convergent validity with the Beck Depression Inventory and the Brief Symptom Inventory was satisfactory for most domains.ConclusionThe WHOQOL showed good psychometric characteristics, suggesting that the Portuguese version of WHOQOL is valid and reliable in the assessment of quality of life in Portugal.

A longitudinal study on emotional adjustment of sarcoma patients: the determinant role of demographic, clinical and coping variables

The present study examined change on emotional distress of sarcoma patients from the diagnostic to treatment phases, the distinct trajectories of adjustment and the influence of demographic, clinical and coping variables on anxiety and depression. Thirty-six sarcoma patients completed questionnaires on emotional distress (Hospital Anxiety and Depression Scale) and coping strategies (Brief Cope) at time of diagnosis, and again during treatment. No significant change in emotional distress levels was found from diagnostic to treatment phase, with mean anxiety and depression scores remaining below the clinical range. Over time, 52.8% and 66.7% of patients maintained non-clinical anxious and depressive symptoms respectively, and 25% and 11.1% remained with clinical anxiety and depression. Living with partner, less use of humour and more denial were associated with high emotional distress at time of diagnosis and during treatments, and high levels of distress at baseline were predictive of poorer emotional adjustment during treatments. Although sarcoma patients, in general, seem to exhibit good psychological adjustment, there is a significant minority that requires mental health services in order to help decrease their emotional distress following the diagnosis, and prevent psychological difficulties during treatments. Our findings are an important contribution to understanding the psychological adjustment of patients with a specific and rare type of cancer.

Social support and adjustment in patients with sarcoma: the moderator effect of the disease phase.

This study examined the association between different types of perceived social support and adjustment of patients with sarcoma, and if these relationships would differ depending on the outcome measure and phase of disease. Forty-nine patients in the diagnostic phase, 43 in the treatment phase, and 59 in the follow-up phase were recruited. Participants completed the Medical Outcomes Study Social Support Survey Questionnaire, the Hospital Anxiety and Depression Scale, and World Health Organization Quality of Life Assessment. Positive social interaction, emotional/informational, affectionate, and tangible supports were significantly associated with depression scores, but not with anxiety. Except for affectionate support, all the associations with overall quality of life were significant. A moderating effect of the phase of the disease was also found in the association between tangible support and anxiety, and between affectionate support, depression, and overall quality of life. In clinical practice it is important to implement phase-specific psychosocial interventions and to take into consideration other factors beyond perceived social support while handling patients with sarcoma.

Psychometric properties of the World Health Organization Quality of Life Questionnaire (WHOQOL-100) in Portuguese patients with sarcoma.

The purpose of this article is to report on the study of the psychometric properties of the European Portuguese version of the World Health Organization Quality of Life Questionnaire – WHOQOL-100, in a clinical sample of patients with bone and soft tissue cancer. Eighty-one participants, in different phases of the disease, were recruited from the Department of Orthopaedics of the Coimbra University Hospitals. After the informed consent was obtained, all patients responded to the European Portuguese version of WHOQOL-100 and the Portuguese versions of Beck Depression Inventory (BDI) and Brief Symptoms Inventory (BSI). The results show an acceptable internal consistency for the set of facets, domains, and 100 questions (alphas from 0.73 to 0.96) and across domains (alphas from 0.82 to 0.94), as well as an acceptable test–retest reliability (test–retest correlations from 0.71 to 0.88) of WHOQOL-100. Construct validity was demonstrated by moderate correlations between domains (r from 0.23 to 0.70) and with the general facet (r from 0.32 to 0.57), concurrent validity by its correlation with the total scores of BDI and Global Severity Index of BSI, and discriminant validity by its ability to discriminate between healthy individuals and cancer patients. In general, the European Portuguese version of WHOQOL-100 is a reliable and valid instrument for the assessment of quality of life in patients with bone and soft tissue cancer.

Impacto do cancro do osso e tecidos moles no ajustamento emocional e qualidade de vida

Resumo Introducao O presente estudo procurou comparar o ajustamento emocional e qualidade de vida (QdV) de doentes diagnosticados com cancro do osso e tecidos moles, que se encontravam em diferentes fases da trajectoria da doenca. Material e metodos Cinquenta e cinco doentes entre o diagnostico e o inicio dos tratamentos, 55 a realizarem tratamento e 74 em consultas de seguimento ou follow-up foram avaliados com recurso a questionarios de auto-resposta. Setenta individuos da populacao geral foram usados como grupo de controlo. Resultados Nas diferentes fases da doenca, a maioria dos doentes com sarcoma revelou niveis normais ou ligeiros de ansiedade e depressao mas, uma minoria consideravel exibiu niveis moderados a severos. De um modo geral, os doentes em cada fase da doenca revelaram um distress emocional sem relevância clinica e comparavel ao de individuos saudaveis. Apenas os doentes a realizarem tratamento exibiram niveis de depressao significativamente superiores aos manifestados pelos sobreviventes na fase de follow-up. Na fase de diagnostico e tratamento observou-se uma pior percepcao de QdV global e na dimensao fisica, quer comparativamente a fase de follow-up quer aos controlos saudaveis. O impacto na QdV, de um modo geral, parece ser mais evidente na fase de tratamento dados os piores niveis de funcionamento em diversas areas da vida e a maior experiencia de sintomas fisicos, principalmente em relacao a fase de follow-up. Os sobreviventes livres de doenca apresentam uma QdV comparavel a de individuos da populacao geral, nas suas diferentes dimensoes. Conclusoes O numero de doentes que exibe um distress emocional significativo (entre 25% e 29,6% para a ansiedade e 8,3% e 23,6% para a depressao) e o impacto do cancro do osso e tecidos moles na QdV, principalmente na fase de diagnostico e durante os tratamentos, apelam para a necessidade de implementar intervencoes multidisciplinares em individuos diagnosticados com este tipo especifico de patologia oncologica. Estas intervencoes deverao incluir um componente psicossocial e ser adaptadas a cada fase da trajectoria da doenca.