Psychological distress in cancer patients : A matter of perspective

Abstract: The general alms are to investigate perceptions of psychological distress in cancer patients, and to contribute to the understanding of the discrepant perceptions of patients and their medical staff in this respect. Assessments of patient distress were made on standardized (Hospital Anxiety and Depression Scale) and study-specific self-administered questionnaires. Among patients attending a medical follow-up control visit, a majority reported low levels of anxiety before, during and after the visit (Studies I-III). Patient and staff perceptions of patients' psychological distress were investigated in two settings: physicians seeing patients at a follow-up visit (Study III), and nursing staff caring for hospitalized patients (Study IV). Staff systematically overestimated anxiety in comparison to patient self-report and showed limited ability to adequately assess patient anxiety and depression in terms of rank. Patient-staff agreement was better for patients with higher levels of self-reported anxiety. Findings in Study IV lend support to the hypothesis of "empathic requirement of mourning", indicating that staffmay overestimate patient anxiety on the basis of how they believe they would feel in the patient's situation. Results from Study V indicate that changes in the perceived importance of some life values may constitute one part of women's adaptation to a breast cancer diagnosis. Patients' low distress ratings may be the result of successful adaptation to cancer. To the extent that such adaptational processes occur and are unknown to staff, this may contribute to patient-staff discrepancies in the assessment of patient distress. The different perspectives held by patients and staff motivates an increased reliance on the patient's evaluation of his or her distress in the care of cancer patients.