Objective
The prevalence of depressive symptoms immediately after the diagnosis of colorectal cancer (CRC) is high and has important implications both psychologically and on the course of the ...disease. The aim of this study is to analyse the association between depressive symptoms and CRC survival at 5 years after diagnosis.
Methods
This multicentre, prospective, observational cohort study was conducted on a sample of 2602 patients with CRC who completed the Hospital Anxiety and Depression Scale (HADS‐D) at 5 years of follow‐up. Survival was analysed using the Kaplan–Meier method and Cox regression models.
Results
According to our analysis, the prevalence of depressive symptoms after a CRC diagnosis was 23.8%. The Cox regression analysis identified depression as an independent risk factor for survival (HR = 1.47; 95% CI: 1.21–1.8), a finding which persisted after adjusting for sex (female: HR = 0.63; 95% CI: 0.51–0.76), age (>70 years: HR = 3.78; 95% CI: 1.94–7.36), need for help (yes: HR = 1.43; 95% CI: 1.17–1.74), provision of social assistance (yes: HR = 1.46; 95% CI: 1.16–1.82), tumour size (T3–T4: HR = 1.56; 95% CI: 1.22–1.99), nodule staging (N1–N2: HR = 2.46; 95% CI: 2.04–2.96), and diagnosis during a screening test (yes: HR = 0.71; 95% CI: 0.55–0.91).
Conclusions
There is a high prevalence of depressive symptoms in patients diagnosed with CRC. These symptoms were negatively associated with the survival rate independently of other clinical variables. Therefore, patients diagnosed with CRC should be screened for depressive symptoms to ensure appropriate treatment can be provided.
Aim
To determine and describe the experiences of pregnant women who receive a diagnosis of chromosomopathy and/or foetal malformation during a prenatal check‐up and who decide to legally terminate ...the pregnancy.
Background
When a pregnancy is terminated, the woman must cope with frustrated motherhood. The psychological consequences of this will largely depend on the care and support provided by health professionals. When a congenital anomaly is diagnosed, a patient‐centred communication helps understanding, influences adaptation to the new situation and ensures the person concerned has sufficient (autonomy or independence or ability) to make appropriate decisions.
Methods
A qualitative study, based on a phenomenological approach, was carried out through nonparticipant observation and semi‐structured interviews with 27 obstetric patients. NVivo 11 software was used, and content analysis was performed. The manuscript was developed using the COREQ guidelines to inform qualitative studies.
Results
The clinical relationship may be affected by communication problems such as patients' perceptions of scarce emotional involvement by obstetricians, by poor psychosocial support during the termination of the pregnancy and by insufficient follow‐up after discharge.
Conclusion
Nurses are in a privileged position to promote the empowerment of affected women. It is necessary to improve aspects related to the privacy of patients and the awareness and training of the interdisciplinary team in interpersonal communication. Post‐loss follow‐up is recommended to assess individual needs, thus facilitating an optimal approach to ease the grieving process.
Relevance to clinical practice
During the prenatal diagnosis, the existence of a fetal anomaly is emphasized, but support and follow up of the mother may be neglected; therefore, exhaustive knowledge about the obstetric history, the state of health and the expectations of patients is as important as a multidisciplinary team trained in counseling strategies and with a comprehensive care plan that covers all areas, especially those that control maternal emotions.
Abstract Background To consider the thoughts and actions of healthcare personnel in situations when an adverse prenatal diagnosis must be communicated, including appropriate strategies and skills to ...respond to information needs and to manage the emotional responses of patients. Methods Descriptive qualitative study using non-participant observation and semi-structured interviews to analyse the discourses of physicians, midwives, nurses and nursing assistants who provide healthcare to obstetric patients. Results There may be barriers to effective communication between healthcare personnel and patients, depending on the characteristics of the persons involved, the organisation of healthcare, biotechnological progress and cultural factors. Conclusions The human quality of healthcare has deteriorated due to excessive workloads and to the growing role played by technology. In order to improve communication, more attention should be paid to human and spiritual dimensions, prioritising empathy, authenticity and non-judgmental listening. An appropriate model of clinical relationship should be based on shared decision making, clarifying the functions of the multidisciplinary team to alleviate a mother’s suffering when a pregnancy is interrupted. To do so, protocols should be implemented to ensure the provision of comprehensive care, not only addressing biological issues but also providing psychosocial attention. Finally, training should be provided to healthcare staff to enhance their social skills and cultural competence. This study identifies potential improvements in the interventions made by healthcare personnel and in the organisation of the institution, concerning the attention provided to pregnant women when an adverse prenatal diagnosis must be communicated.
Background: For effective prevention and intervention, and reduction of dependency, it is essential to determine the presence of frailty in the community.
Objectives: To describe the prevalence of ...frailty among elderly persons living independently, in two primary healthcare areas in Spain; to identify factors correlated with its presence.
Methods: This descriptive cross-sectional study was conducted between May 2015 and July 2016 among non-institutionalized individuals aged ≥70 years living in the primary healthcare areas of Gipuzkoa and Costa del Sol (Spain). The main outcome variable was the prevalence of frailty (determined by modified Fried criteria). The independent study variables were sociodemographic characteristics, anthropometric data and health-related life habits.
Results: The study population consisted of 855 individuals (53% women). The overall prevalence of frailty was 26.2% (Gipuzkoa 14.2%, Costa del Sol 38.0%). Using multiple logistic regression, the following factors were associated with frailty: female sex (OR: 1.98; 95%CI: 1.37-2.86); cumulative illness rating scale (OR: 1.05; 95%CI: 1.00-1.10); self-perceived health status (OR: 0.96; 95%CI: 0.95-0.97); self-perceived unhealthy lifestyle (OR: 3.37; 95%CI: 2.05-8.87); dissatisfaction with the domestic environment (OR: 2.11; 95%CI: 1.18-3.76); and cognitive impairment (OR: 4.10; 95%CI: 2.05-8.19). In the multivariable model, 'geographical area' differences persisted, with an OR of 3.51 (95%CI: 2.29-5.36) for the Costa del Sol area, using Gipuzkoa as reference.
Conclusion: In this population of community-dwelling persons aged 70 years and over, the prevalence of frailty was 26%. Factors correlated with frailty were female sex, comorbidity, poorer self-perceived lifestyle and health status, and dissatisfaction with the domestic environment.
the aim of this study was to examine the possible association between the type of hospital admission and subsequent survival of the patient, as well as the pathological features recorded in a large ...population of patients with colorectal cancer.
the study included 1,079 patients diagnosed with colon or rectal cancer in the Hospital Costa del Sol (Marbella, Spain). The relationship between patient survival rate and type of first admission to the hospital (elective or emergency admission) was assessed. The following variables were studied: age, gender, tumor location, pathological stage, differentiation grade, chemotherapy before surgery and survival.
colon tumors are more common in patients admitted to hospital for the first time via the emergency service (63.7%) and the tumors tend to be poorly differentiated (64.2%) and metastatic (70%). These patients also present a more aggressive disease and a poorer prognosis than patients with an elective admission. With regard to patients from the Emergency Department, a Cox regression analysis showed a risk-ratio (RR) of 1.36 (confidence interval CI 95%: 1.11-1.66) for disease-free survival and of 1.41 (95% CI: 1.14-1.76) for overall survival.
hospital admission via the Emergency Department is an indicator of aggressiveness and poorer prognosis compared to patients who enter via programmed routes.
IntroductionBreast cancer has become a chronic disease due to survival improvement and the need to monitor the side effects of treatment and the disease itself. The aim of the SURBCAN study is to ...describe comorbidity, healthcare services use and adherence to preventive recommendations in long-term breast cancer survivors and to compare them with those in women without this diagnosis in order to improve and adapt the care response to this group of survivors.Methods and analysisPopulation-based retrospective cohort study using real-world data from cancer registries and linked electronic medical records in five Spanish regions. Long-term breast cancer survivors diagnosed between 2000 and 2006 will be identified and matched by age and administrative health area with women without this diagnosis. Sociodemographic and clinical variables including comorbidities and variables on the use of health services between 2012 and 2016 will be obtained from databases in primary and hospital care. Health services use will be assessed through the annual number of visits to primary care professionals and to specialists and through annual imaging and laboratory tests. Factors associated with healthcare utilisation and comorbidities will be analysed using multilevel logistic regression models. Recruitment started in December 2018.Ethics and disseminationThis study was approved by the Ethics Committee of Parc de Salut Mar. The results of the study will be published in a peer-reviewed journal and will be presented at national and international scientific conferences and at patient associations.Trial registration numberThis protocol is registered in Clinical Trials.gov (identifier: NCT03846999).
The delayed diagnosis of colorectal cancer (CRC) may be attributable to sociodemographic characteristics, to aspects of tumour histopathology or to the functioning of the health system. We seek to ...determine which of these factors most influences prolonged patient-attributable delay (PPAD) in the diagnosis and treatment of CRC.
A prospective, multicentre observational study was conducted in 22 Spanish hospitals. In total, 1,785 patients were recruited to the study between 2010 and 2012 and underwent elective or urgent surgery. PPAD is considered to occur when the time elapsed between a patient presenting the symptom and him/her seeking attention from the primary care physician or hospital emergency department exceeds 180 days. A bivariate analysis was performed to assess differences in variables segmented by tumour location and patient delay. Multivariate logistic regression analysis was performed on the outcome variable, PPAD.
The rate of PPAD among this population was 12.1%. PPAD was significantly associated with altered bowel rhythm (odds ratio OR, 1.36; 95% confidence interval CI, 1.02 to 1.83) and with adenocarcinoma histology, in comparison with mucinous adenocarcinoma (OR, 2.03; 95% CI, 1.11 to 3.71). Other sociocultural factors and clinicopathological features were not independent predictors of PPAD.
Many patients do not consider altered bowel rhythm an alarming symptom, warranting a visit to the doctor. PPAD could be reduced by improving health education, raising awareness of CRC-related symptoms.
Functional performance in older adults is a predictor of survival and other health outcomes and its measurement is highly recommended in primary care settings. Functional performance and frailty are ...closely related concepts, and frailty status is associated with the use of health care services. However, there is insufficient evidence on the utilization of services profile according to the functional performance of older adults. The aim of this study was to assess the relationship between functional performance and the use of a wide range of health services in community-dwelling older adults. Generalized additive models for location, scale and shape were used to study these complex data of services utilization, from primary to hospital care. A total of 749 participants from two Spanish regions were followed up for 2 years. Of those, 276 (37%) presented low functional performance and 473 (63%) normal performance according to the Timed Up and Go test. The results showed that even after adjusting for burden of comorbidity and polypharmacy, participants with low functional performance used primary and secondary care health services more intensively, visited emergency rooms more often, and were hospitalized more frequently and for longer periods of time. A negative binomial distribution and a variant thereof were found to be the best models to describe health service utilization data. In conclusion, functionality should be considered as an important health indicator for tailoring the provision of health services for older adults.
Purpose
Breast cancer is one of the most common diseases, affecting many thousands of women. Although more than 80% of women survive the experience, very few studies have been conducted to examine ...the question of resilience among long-term survivors of breast cancer. The aim of this study is to describe the clinical and sociodemographic factors that correlate with greater resilience in women survivors of breast cancer, in the Costa del Sol Health Area (Spain).
Methods
Accordingly, a descriptive cross-sectional study was conducted, with respect to 59 survivors of breast cancer, who each completed a questionnaire for analysis according to the Connor-Davidson Resilience Scale (CD-RISC).
Results
The median resilience score was 77 (interquartile range 70–80). The group of patients who had survived for six or more years since the diagnosis had a higher score for total resilience (90: IR 76–92) than those diagnosed more recently (74: IR 65.7–83.7) (
p
= 0.012). Regarding the patients’ education background, the group with no formal qualifications or only primary studies had a score of 72 (IR 64–84), versus 79 (IR 74–89.7) for the group with higher levels of education (
p
= 0.016). Of the clinical variables, only the administration of chemotherapy was significantly associated with the score obtained on the CD-RISC scale (
p
= 0.012).
Conclusions
The results obtained in this study lead us to conclude that sociodemographic and clinical factors have a positive impact on the level of resilience among women resident in the Costa del Sol Health Area and who are long-term survivors of breast cancer.
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