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Accuracy of assessment of distress, anxiety, and depression by physicians and nurses in adolescents recently diagnosed with cancer
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Caring Sciences)ORCID iD: 0000-0001-6296-0160
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnonkologisk forskning/Lönnerholm)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Barnonkologisk forskning/Lönnerholm)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology.
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2006 (English)In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 46, no 7, p. 773-9Article in journal (Refereed) Published
Abstract [en]

Background. As staff members prioritize medical resources forpatients, it is imperative to find out whether their assessments ofpatients’ health status agree with patients’ assessments. The degree towhich physicians and nurses can identify the distress, anxiety, anddepression experienced by adolescents recently diagnosed withcancer was examined here. Procedure. Adolescents undergoingchemotherapy (13–19 years, n¼53), physicians (n¼48), and nurses(n¼53) completed a structured telephone interview, 4–8 weeksafter diagnosis or relapse, investigating disease and treatment-relateddistress, anxiety, and depression. Results. The accuracy of staffratings of physical distress could be considered acceptable.However, problems of a psychosocial nature, which were frequentlyoverestimated, were difficult for staff to identify. Staff underestimatedthe distress caused by mucositis and worry about missing schoolmore than they overestimated distress. These aspects were some ofthe most prevalent and overall worst according to the adolescents.Both physicians and nurses overestimated levels of anxiety anddepression. Nurses tended to show higher sensitivity than physiciansfor distress related to psychosocial aspects of distress, whilephysicians tended to show higher accuracy than nurses for physicaldistress. Conclusions. Staff was reasonably accurate at identifyingphysical distress in adolescents recently diagnosed with cancerwhereas psychosocial problems were generally poorly identified.Thus, the use of staff ratings as a ‘‘test’’ to guide specific supportseems problematic. Considering that the accuracy of staff ratingsoutside a research study is probably lower, identification of andaction taken on adolescent problems in relation to cancer diagnosisand treatment need to rely on direct communication.

Place, publisher, year, edition, pages
2006. Vol. 46, no 7, p. 773-9
Keywords [en]
Adolescent, Adult, Anxiety/*diagnosis/epidemiology/etiology, Comparative Study, Depression/*diagnosis/epidemiology/etiology, Female, Health Status, Humans, Male, Middle Aged, Neoplasms/complications/*psychology, Nurses, Observer Variation, Physicians, Prevalence, Research Support; Non-U.S. Gov't, Self Assessment (Psychology), Sensitivity and Specificity, Stress; Psychological/*diagnosis/epidemiology/etiology, Sweden/epidemiology
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-19352DOI: 10.1002/pbc.20693PubMedID: 16333833OAI: oai:DiVA.org:uu-19352DiVA, id: diva2:47124
Available from: 2008-06-24 Created: 2008-06-24 Last updated: 2017-12-08
In thesis
1. Distress among Adolescents with Cancer
Open this publication in new window or tab >>Distress among Adolescents with Cancer
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The primary aim was to investigate the distress perceived by adolescents with cancer treated in paediatric oncology. In Study I, especially distressing events for children/adolescents with cancer were identified by interviews with children/adolescents/parents and nurses. Data were analysed with content analysis. A range of physical and emotional concerns was identified. Physical concerns are of a rather similar nature across age groups. Emotional concerns vary more between age groups. For children 8-12 years, emotional concerns are rather frequent. In Study II distressing and positive aspects related to some care situations for adolescents with cancer were identified by interviews with adolescents and nurses. Data were analysed with content analysis. A range of negative aspects, e.g. fear of alienation, fear of dying, altered appearance and physical concerns, as well as positive aspects, e.g. positive relations to staff and being well cared for were identified.

The aspects of distress identified in Studies I and II formed the basis for a structured interview-guide, used in Studies III and IV. Adolescents, recently diagnosed with cancer, physicians and nurses were interviewed by telephone about distress, anxiety, depression and well-being experienced by the adolescents. Adolescent ratings of prevalence, levels and worst aspects of distress do not necessarily agree, however, worry missing school and mucositis are among those rated with the highest prevalence, levels and those perceived as the overall worst. The findings from Study IV demonstrate that physicians and nurses underestimate the distress caused by worry missing school and mucositis. The accuracy of physician and nurse ratings of physical distress is acceptable, however, this is not the case for psychosocial distress. It can be concluded that it is crucial to consider how questions are asked when interpreting the significance of the answers, and that action on adolescent problems in relation to cancer diagnosis and treatment need to rely on direct communication.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. p. 61
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 18
Keywords
Caring sciences, adolescents, anxiety, cancer, children, depression, distress, staff ratings, positive experiences, well-being, Vårdvetenskap
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-4832 (URN)91-554-6176-X (ISBN)
Public defence
2005-04-21, Aulan, Döbelnsgatan 2, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2005-03-30 Created: 2005-03-30 Last updated: 2009-06-02Bibliographically approved

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Hedström, MariannKreuger, AndersLjungman, GustafNygren, Petervon Essen, Louise

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Hedström, MariannKreuger, AndersLjungman, GustafNygren, Petervon Essen, Louise
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Department of Public Health and Caring SciencesDepartment of Women's and Children's HealthDepartment of Oncology, Radiology and Clinical Immunology
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