6533b7d9fe1ef96bd126c9e8

RESEARCH PRODUCT

Impacto de intervención de psicoterapia aplicada por enfermería para el control de la ansiedad en pacientes oncológicos

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INTRODUCCIÓN: La enfermería de la Unidad de Hospital de Día desarrolla un papel fundamental en el control de la ansiedad del paciente onco-hematológico sometido a tratamiento quimioterápico. OBJETIVOS: Tratamos de demostrar la eficacia de una intervención de psicoterapia de apoyo (IPA) aplicada por enfermería en Hospital de Día en la reducción del nivel de ansiedad en pacientes sometidos a quimioterapia. Además se valoró el grado de respuesta del nivel de ansiedad de los pacientes a la IPA en función de diferentes variables clínico-sociodemográficas por medio de diferentes análisis secundarios. METODOLOGÍA: Se seleccionaron 150 pacientes consecutivos sometidos a ciclos de quimioterapia en nuestra institución entre junio de 2010 y febrero de 2011, aleatorizados en 2 grupos homogéneos: 75 con IPA durante la administración de tratamiento y 75 controles. Fueron excluidos aquellos con antecedentes/tratamiento de síndrome ansioso y/o puntuaciones de escala STAI (State-Trait Anxiety Inventory) >30 puntos. La IPA se aplicó durante 4 ciclos de tratamiento consecutivos, siempre previamente a la administración del tratamiento con quimioterapia. Se obtuvo la puntuación de la escala de ansiedad de Hamilton (HAS) antes de la administración del tratamiento y tras cada uno de los sucesivos ciclos de quimioterapia en ambos grupos. Otras variables clínico-sociodemográficas estudiadas fueron: edad, diagnóstico oncológico, sexo, nivel sociocultural, estado civil y número de hijos. Finalmente, se identificaron factores predictores de la respuesta a la IPA que permitiesen seleccionar el subgrupo de mejores candidatos a dicha intervención. RESULTADOS: La puntuación HAS inicial se correlacionó significativamente con la edad (r=-0.683; p30 points were excluded. SPI was performed during 4 consecutive cycles, always before starting chemotherapy treatment. Hamilton anxiety scale (HAS) score was obtained before the administration of the treatment and after each cycle of treatment in both groups. Other clinical and sociodemographic variables studied were: age, oncologic diagnose, gender, sociocultural level, marital status and number of children. Finally, different predicting factors of the response to SPI were identified in order to be able to select a subgroup of the best candidates to undergo this intervention. RESULTS: Initial HAS score was significantly correlated to age (r=-0.683; p<0.0001). A lower number of children and a higher sociocultural level were also related significantly to higher degrees of anxiety. No statistical differences were found among gender, type of oncologic diagnosis or marital status for the initial HAS score. SPI reduced sustained and significantly the HAS score along the different cycles of treatment (global reduction from cycle 1st to 4th: 8.70 ± 5.72 vs. 6.42 ± 5.54; p<0.014). The evolution of the anxiety level along the four cycles showed significative differences in sociodemogaphic variables age, sociocultural level, number of children and marital status, with analogue tendencies to the formerly expressed. Differences between genders were slight but not statistically significative with a sustained higher level of anxiety for female population. No statistically significative differences were found among the different oncologic diagnosis included. A model to identify those patients with better response to SPI was developed regarding the preintervention sociodemographic variables. However, initial HAS score showed to be the best independent predictor of the response to SPI (global predictive value 94%). CONCLUSIONS: In our experience, SPI performed by nursery has shown to be an effective and efficient measure in the control of anxiety in oncologic patients undergoing chemotherapy treatment in Day Hospital Unit. Predictors of better response to SPI were identified: younger age, limited marital support, higher initial anxiety levels and higher sociocultural level. The application of protocol study, or similar ones, to daily practice in Day Hospital Unit may improve attention offered to our oncologic patients allowing a better control of disease-related anxiety.