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A2 - Detection of Psychosocial22 - Lerma12314
A2 - Detection of Psychosocial22 - Lerma12314
Sitio web:
https://www.tandfonline.com/action/journalInformation?jo
urnalCode=wjpo20
Journal of Psychosocial Oncology
Oscar Galindo Vázquez, Samuel Rivera, Abel Lerma, Germán Calderillo
Ruiz, Marcos Espinoza Bello, Abelardo Meneses & Claudia Lerma (2022)
Detection of psychosocial distress in cancer patients: A survey of Mexican
oncologists, Journal of Psychosocial Oncology, 40:6, 708-723, DOI:
10.1080/07347332.2021.1986765
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/wjpo20
Oscar Galindo Vázquez, Samuel Rivera, Abel Lerma, Germán Calderillo Ruiz,
Marcos Espinoza Bello, Abelardo Meneses & Claudia Lerma
To cite this article: Oscar Galindo Vázquez, Samuel Rivera, Abel Lerma, Germán Calderillo Ruiz,
Marcos Espinoza Bello, Abelardo Meneses & Claudia Lerma (2022) Detection of psychosocial
distress in cancer patients: A survey of Mexican oncologists, Journal of Psychosocial Oncology,
40:6, 708-723, DOI: 10.1080/07347332.2021.1986765
Article views: 91
ARTICLE
ABSTRACT KEYWORDS
Purpose: Identification of patients’ distress is relevant for an cancer; distress;
on-time referral to psychosocial treatment. The objective was to Mexico; oncology;
assess the implementation of the guidelines for distress managing patients
in Mexican oncologists based on the NCCN guidelines.
Design: The study was non-experimental and cross-sectional.
Sample: Two hundred thirty-one oncologists participated with
an average age of 38 ± 11 years.
Methods: The likelihood of distress assessment was quantita-
tively evaluated.
Findings: A high percentage of oncologists knew and used
procedures to assess psychosocial discomfort. However, a
smaller percentage used a valid and reliable instrument. Factors
associated with performing distress identification procedures
were knowing the distress guidelines and lack of time. Factors
for questionnaire usage are the availability of brief instruments
and the percentage of patients suffering from stress.
Implications for Psychosocial Providers: Psychosocial providers
should develop strategies to educate and ensure that oncologists
are familiar with guidelines on distress in oncology. More dis-
semination of screening procedures and referral to psychosocial
programs in oncology is required. Integrating a distress screening
program involving psychosocial providers and oncologists should
be approached as a routine in high-quality cancer care, to reduce
the stigma associated with mental health services.
Introduction
Cancer diagnosis accompanies severe psychosocial problems for the patient,
their relatives, and society.1 In this context, oncologists play an essential
role in identifying psychological distress and its prevention by providing
Design
The study design was nonexperimental and cross-sectional.
Sample
The study included 231 professionals who care for cancer patients. They
had a median age of 38 (32–46) years, 98 women (42%) and 133 men
(58%), the highest percentage with subspecialty and specialty. The most
prevalent disciplines were oncological surgery, radiation oncology, and
medical oncology.
Participants
Procedure
Instruments
Identification Card
A participant identification card was designed that included sociodemo-
graphic data such as age, sex, level of studies, specialty, and health insti-
tution where they work.
Statistical analysis
odds ratios (OR) with their confidence intervals, beta estimator, and the
separate constant were estimated. Also, the explained variance (Nagelkerke
index), the goodness of fit index of the model (Hosmer-Lemeshow test),
the sensitivity, the specificity, and the total variance percentage explained
by each model were calculated. The level of statistical significance was
established at p < 0.05.
Results
The total sample includes 231 oncologists: 98 women (42%) and 133 men
(58%), median age = 38 years (32–46), most of them (59%) with subspe-
cialty studies. On average, they dedicated 40 hours per week to attend
patients and they identified distress in 80% of the patients (Table 1).
Tables 2 and 3 show the comparison of the two outcomes (observed
variables) of this study: the first compares whether the professionals assess
distress and the second compares whether they will use a brief and
straightforward instrument to assess distress. Table 2 shows that the factors
associated with not evaluating distress are: not having time (p = 0.013),
perceiving that patients are unwilling to talk about distress (p = 0.022),
being unlikely to use a short questionnaire, and not being familiar with
the NCCN distress guidelines (p = 0.021). Table 3 shows that factors asso-
ciated with using a short and simple questionnaire to assess distress were:
(1) having more patients with indisposition to talk about distress
(p = 0.036), (2) being able to use short-term instruments in the waiting
room (p ≤ 0.001), (2) having the training to identify treatments for distress
(p = 0.013), and (4) having a higher percentage of patients with distress
(p = 0.035).
Tables 4 and 5 show the logistic regression analyses (both univariate
and multivariate) for each of the two outcomes observed in this study. In
both tables, the significant association described in the previous compar-
ative analysis can be monitored and confirmed by estimating the magnitude
of said association (i.e., the OR) for both models.
Table 4 shows the factors that independently explain why health pro-
fessionals do not evaluate distress: lack of time (OR = 1.99, 95% CI,
1.07–3.70, p = 0.029) and unfamiliarity with the guidelines of the NCCN
(OR = 1.83, 95% CI, 1.02–3.29, p = 0.043). The decision not to assess
distress in cancer patients is explained by the percentage (≥ 71%) of pro-
fessionals who do not assess distress. Variance explained for this model
is represented in the Nagelkerke R2 value = 0.107, sensitivity = 97%, and
specificity = 17% are shown at the bottom of the model. The goodness
of fit test is the Hosmer-Lemeshow, which indicates low or no error (the
chi squared was not significant, p-value = 0.885).
Journal of Psychosocial Oncology 713
Table 4. Logistic regression analysis of the variables associated with not evaluating distress
in a sample of oncologists (n = 231).
Simple regression Multivariate regression
Variables OR (CI95%) p-value OR (CI.95%) p-value
Barrier: lack of time (Yes) 2.13 (1.17–3.89) 0.014 1.99 (1.07–3.70) 0.029
Barrier: patients unwilling to 1.92 (1.10–3.36) 0.023 1.63 (0.91–2.92) 0.101
discuss distress (No)
Probability of using a 2.02 (1.06–3.87) 0.034 1.92 (0.98–3.79) 0.059
questionnaire on distress (No)
Familiarization with the NCCN 1.95 (1.10–3.44) 0.022 1.83 (1.02–3.29) 0.043
guidelines (No)
Note. For the multivariate model: constant = −1.922, Nagelkerke R2= 0.107, chi-squared = 3.68, 8 df., p = 0.885,
sensitivity = 97%, specificity = 17%, total percentage = 71%.
Table 5. Logistic regression analysis of the variables associated with the probability of using
a questionnaire assessing distress in a sample of oncologists (n = 231).
Simple regression Multivariate regression
Variables OR (CI95%) p-value OR (CI95%) p-value
Barrier: unwilling patients to talk 2.01 (1.04–3.89) 0.038 1.49 (0.74–3.01) 0.268
about distress (No)
Resources: brief instruments to 4.84 (2.36–9.93) ≤ 0.001 4.44 (2.05–9.61) ≤ 0.001
assess distress in the waiting
room (Yes)
Resources: training to identify 2.32 (1.18–4.57) 0.014 1.50 (0.72–3.12) 0.282
treatments for distress (Yes)
Percentage of patients suffering 1.02 (1.01–1.03) 0.023 1.02 (1.01–1. 04) 0.013
from distress
Note. For the multivariate model: constant = −1.143, Nagelkerke R2= 0.192, chi-squared = 13.57, 8 df, p = 0.094,
sensitivity = 98%, specificity = 13%, total percentage = 80%.
Table 5 shows the factors that independently explain the likelihood for
health professionals to use a short and simple questionnaire to assess
distress: the availability of short-term instruments (OR = 4.44, 95% CI,
2.05–9.61, p ≤ 0.001) and the higher percentage of patients presenting
distress (OR = 1.02, 95% CI, 1.01–1.04, p = 0.023). The use of the short
and simple instrument to assess emotional distress is explained by the
percentage (≥ 80%) of professionals who would use it. Variance explained
for this model is observed in the Nagelkerke R2 value = 0.192, with sen-
sitivity = 98% and specificity = 13%, as shown at the model’s bottom. The
goodness of fit test was the Hosmer-Lemeshow, which indicated low or
no error since the chi squared was nonsignificant (p = 0.094).
Discussion
This study is the first one that reports the knowledge, attitudes, and
behaviors of medical oncologists in Mexico with a national sample regard-
ing the NCCN guidelines for managing distress. Although most oncologists
report knowing about the policies on distress, performing some screening
procedures, and considering that this was beneficial for their practice,
Journal of Psychosocial Oncology 717
few use valid and reliable instruments. These findings are similar to a
study by Pirl et al.,6 in which 32.3% reported knowing the NCCN distress
guidelines and 65.0% performed screening routinely but only 14.3% used
a screening instrument. Similarly, the study by Brintzenhofe Szoc 12
reported that only half of the oncologists used a standardized tool (54%).
The current study identified that the lack of time and not perceiving the
patients’ unwillingness to discuss distress are factors associated with lack
of distress screenings (Table 2). The probability of using a questionnaire
on distress and familiarization with the NCCN guidelines was positively
associated with carrying out distress screening. This implies limitations
in the health-system conditions that have been reported in several studies
in oncology and the need for integration of mental health professionals
in oncology. Institutional barriers, such as lack of ownership of the dis-
tress screening, no input into the protocol development, and lack of
support from the administration emerged in the current study but not
in the previous studies. A difference in the samples could explain these
discrepancies with previous studies.
While most health professionals working in cancer care are interested
in detecting mood problems, there is considerable uncertainty about which
instrument to use (if any), reflecting the lack of guidance on this theme.7
On the other hand, in an experimental study, doctors were trained in
communication skills and identifying distress using the HADS scale.13 The
study determined that the detection by doctors of the patient’s distress
was positively associated with doctors who communicated bad news, used
assessment skills, and applied support skills. According to our results in
Table 2, most oncologists who do not assess distress routinely deny per-
ceiving unwillingness of the patient to discuss distress (62%), with fewer
oncologists (38%) perceiving unwillingness of the patient to discuss distress.
This is likely related to communication barriers between the oncologist
and the patient. Some patients are reluctant to disclose problems and to
share emotional difficulties, particularly those with higher distress.14,15
Finally, our instrument covers interest in a health system from the following
questions:
What resources would help assess emotional distress among their patients?
718 O. GALINDO VÁZQUEZ ET AL.
Study limitations
The results in the present study depend on self-reports and are not actual
observations of the scope and effectiveness of psycho-oncology measures.
An alternative for future studies is to apply valid and reliable instruments
of distress, anxiety symptoms, or depression to the patients concurrently
with the physicians’ evaluations. There are currently various screening
instruments for cancer patients adapted for the Mexican population, which
could identify a correlation between the physician’s point of view and the
findings in the measurement instruments.
On the other hand, various psycho-oncology studies in Latin America20,21
recommend the following priorities based on the best available evidence
to standardize national care for cancer patients in the third level of care:
(1) identifying patients with clinical criteria of distress, (2) suggesting the
most effective psycho-oncological treatments for patient care, and (3)
establishing the criteria for referral in patients with a history of cancer
and psychological disorders. There are several advantages to treating the
psychosocial needs of this group of patients and their informal primary
caregivers. By reducing the emotional burden of cancer care, we can also
reduce its financial burden. Placing the needs of patients directly at the
center of the health-care model implies a fundamental change in the focus
of patient care.23
These priorities should lead to more rigorous work on clinical practice
and research from psychologists and psychiatrists to cancer patients and
informal primary caregivers, even more so in the Latin American popu-
lation where the mental health needs of the oncological patient remain a
priority yet to be addressed.
Journal of Psychosocial Oncology 721
Disclosure statement
No potential conflict of interest was reported by the author.
Funding
The author(s) reported there is no funding associated with the work featured in this article.
ORCID
Oscar Galindo Vázquez http://orcid.org/0000-0001-7929-0125
Samuel Rivera http://orcid.org/0000-0002-4921-4195
Abel Lerma http://orcid.org/0000-0001-7212-641X
Marcos Espinoza Bello http://orcid.org/0000-0003-3090-8098
Abelardo Meneses http://orcid.org/0000-0003-4032-4598
Claudia Lerma http://orcid.org/0000-0002-4679-7751
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