Abstract
Purpose
This study aims to adapt the Pictorial Representation of Illness and Self-Measure (PRISM), a practical, nonverbal method with strong psychometric properties, to Spanish and to explore its criterion validity in advanced cancer and palliative care (PC).
Methods
Of the consecutive advanced cancer patients attending a palliative care consultation, 209 were invited to participate. To examine criterion validity, correlations were calculated between the PRISM, the Detection of Emotional Distress scale (DED), the Edmonton Symptom Assessment System (ESAS), the Structured Interview of Symptoms and Concerns (SISC), and the suffering visual analogue scale (VAS).
Results
Ninety-eight patients fulfilled inclusion criteria (mean age, 60 years; SD, 14.25; 57 % female). The most frequent types of cancer were lung, breast, and colorectal. Average time since diagnosis was 30 months (2.5 years). PRISM significantly correlated with the Suffering VAS, the DED, and the SISC. It also showed significant correlations with psychosocial factors such as emotional distress, anxiety, loss of control, and perceived coping and spiritual distress items such as loss of dignity and hopelessness, but not with items examining physical symptoms.
Conclusions
The PRISM is a valid measure of suffering in advanced cancer patients. Its Spanish version fits adequately with current definitions and conceptualizations of suffering and may be used in PC settings. Further analysis of other psychometric properties in Spanish-speaking settings is recommended.
Similar content being viewed by others
References
Cassell EJ (1999) Diagnosing suffering: a perspective. Ann Intern Med 131(7):531–534
Krikorian A, Limonero JT (2012) An integrated view of suffering in palliative care. J Palliat Care 28(1):41–49
WHOQOL (1997) Measuring quality of life. Resource document World Health Organization. http://www.who.int/mental_health/media/68.pdf. Accessed 12 February 2013
Hui KK, Hui EK, Johnston MF (2006) The potential of a person-centered approach in caring for patients with cancer: a perspective from the UCLA center for East-West medicine. Integr Cancer Ther 5(1):56–62
World Health Organization (WHO) (2002) Cancer Control Program: policies and managerial guidelines, 2nd edn. WHO, Geneva
Morrison RS, Meier DE (2011) The National Palliative Care Research Center and the Center to Advance Palliative Care: a partnership to improve care for persons with serious illness and their families. J Pediatr Hematol Oncol 33(Suppl 2):S126–S131. doi:10.1097/MPH.0b013e318230dfa0
WHO (2013) WHO definition of palliative care. http://www.who.int/cancer/palliative/definition/en/. Accessed 13 March 2013
Büchi S, Sensky T, Sharpe L, Timberlake N (1998) Graphic representation of illness: a novel method of measuring patients’ perceptions of the impact of illness. Psychother Psychosom 67(4–5):222–225
Büchi S, Sensky T (1999) PRISM: Pictorial Representation of Illness and Self Measure. A brief nonverbal measure of illness impact and therapeutic aid in psychosomatic medicine. Psychosomatics 40(4):314–320
Büchi S, Villiger P, Kauer Y, Klaghofer R, Sensky T, Stoll T (2000) PRISM (Pictorial Representation of Illness and Self Measure): a novel visual method to assess the global burden of illness in patients with systemic lupus erythematosus. Lupus 9(5):368–373
Büchi S, Buddeberg C, Klaghofer R, Russi EW, Brändli O, Schlösser C et al (2002) Preliminary validation of PRISM (Pictorial Representation of Illness and Self Measure)—a brief method to assess suffering. Psychother Psychosom 71(6):333–341
Rumpf HJ, Löntz W, Uesseler S (2004) A self-administered version of a brief measure of suffering: first aspects of validity. Psychother Psychosom 73(1):53–56
Kassardjian CD, Gardner-Nix J, Dupak K, Barbati J, Lam-McCullock J (2008) Validating PRISM (Pictorial Representation of Illness and Self Measure) as a measure of suffering in chronic non-cancer pain patients. J Pain 9(12):1135–1143
Klis S, Vingerhoets AJ, de Wit M, Zandbelt N, Snoek FJ (2008) Pictorial Representation of Illness and Self Measure Revised II (PRISM-RII): a novel method to assess perceived burden of illness in diabetes patients. Health Qual Life Outcome 6:104
Streffer ML, Büchi S, Mörgeli H, Galli U, Ettlin D (2009) PRISM (Pictorial Representation of Illness and Self-Measure): a novel visual instrument to assess pain and suffering in orofacial pain patients. J Orofac Pain 23(2):140–146
Lehmann V, Oerlemans S, van de Poll-Franse LV, Vingerhoets AJ, Mols F (2011) Suffering in long-term cancer survivors: an evaluation of the PRISM-R2 in a population-based cohort. Qual Life Res 20(10):1645–1654
Wouters EJ, Reimus JL, van Nunen AM, Blokhorst MG, Vingerhoets AJ (2008) Suffering quantified? Feasibility and psychometric characteristics of 2 revised versions of the Pictorial Representation of Illness and Self Measure (PRISM). Behav Med 34(2):65–78
Sensky T (2010) Suffering. Int J Integr Care 10:66–68
Krikorian A, Limonero JT, Corey M (2012) Suffering assessment: a review of available instruments for use in palliative care. J Palliat Med 16(2):130–142. doi:10.1089/jpm.2012.0370
Woodruff R (2004) Palliative care: basic principles. In: Bruera E, DeLima L, Wenk R, Farr W (eds) Palliative care in developing countries: principles and practice. IAHPC Press, Texas, pp 1–9
El-Jawahri A, Greer JA, Temel JS (2011) Does palliative care improve outcomes for patients with incurable illness? A review of the evidence. J Support Oncol 9(3):87–94
Brislin RW (1980) Translation and content analysis of oral and written materials. In: Triandis HC, Berry JW (eds) Handbook of cross-cultural psychology, vol 2. Allyn & Bacon, Boston, pp 389–444
Maté J, Mateo D, Bayés R, Bernaus M, Casas C, Gonzalez-Barboteo J et al (2009) Elaboración y propuesta de un instrumento para la detección de malestar emocional en enfermos al final de la vida. Psicooncología 6:507–518
Limonero JT, Mateo D, Maté-Méndez J, González-Barboteo J, Bayés R, Bernaus M et al (2012) Assessment of the psychometric properties of the Detection of Emotional Distress Scale in cancer patients. Gac Sanit 26(2):145–152
Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7(2):6–9
Carvajal A, Centeno C, Watson R, Bruera E (2011) A comprehensive study of psychometric properties of the Edmonton Symptom Assessment System (ESAS) in Spanish advanced cancer patients. Eur J Cancer 47(12):1863–1872
Nekolaichuk C, Watanabe S, Beaumont C (2008) The Edmonton Symptom Assessment System: a 15-year retrospective review of validation studies (1991–2006). Palliat Med 22(2):111–122
Richardson LA, Jones GW (2009) A review of the reliability and validity of the Edmonton Symptom Assessment System. Curr Oncol 16(1):53–64
Krikorian A, Limonero JT, Maté J (2011) Suffering and distress at the end-of-life. Psychooncology 21(8):799–808
Wilson KG, Graham ID, Viola RA, Chater S, de Faye BJ, Weaver LA et al (2004) Structured interview assessment of symptoms and concerns in palliative care. Can J Psychiatry 49(6):350–358
Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Psychology Press, New Jersey
Abraham A, Kutner JS, Beaty B (2006) Suffering at the end of life in the setting of low physical symptom distress. J Palliat Med 9(3):658–665
SPSS Inc (2009) PASW statistics for windows, version 18.0. SPSS Inc, Chicago
Sherman DW, McSherry CB, Parkas V, Ye XY, Calabrese M, Gatto M (2005) Recruitment and retention in a longitudinal palliative care study. Appl Nurs Res 18(3):167–177
O’Mara AM, St Germain D, Ferrell B, Bornemann T (2009) Challenges to and lessons learned from conducting palliative care research. J Pain Symptom Manage 37(3):387–394. doi:10.1016/j.jpainsymman.2008.03.014
Dirección Seccional de Salud de Antioquia (DSSA) (2012) Registro Poblacional de Cáncer de Antioquia. SSSA: Datos preliminares 2007–2009. www.dssa.gov.co. Accessed 21 February 2013
Rivero J (2000) Reforma y desigualdad educativa en América Latina. Rev Iberoamericana Educa, 23:103–133. http://www.rieoei.org/rie23a03.htm. Accessed 19 February 2013
Echeverría R (2000) Opciones para reducir la pobreza rural en América Latina y el Caribe. Cepal 70:147–160. http://ruta.org:8180/xmlui/bitstream/handle/123456789/539/RN74.pdf?sequence=1. Accessed 22 January 2013
Herrera MC (1993) Historia de la educación en Colombia la republica liberal y la modernización de la educación: 1930–1946. Rev Colombiana Educa 26:97–124
Bayés R, Limonero JT (1999) Prioridad en el tratamiento de los síntomas que padecen los enfermos oncológicos en situación terminal. Med Paliat 6:19–21
Thompson GN, Chochinov HM, Wilson KG, McPherson CJ, Chary S, O’Shea FM et al (2009) Prognostic acceptance and the well-being of patients receiving palliative care for cancer. J Clin Oncol 27(34):5757–5762
Lieberman MD, Eisenberger NI, Crockett MJ, Tom SM, Pfeifer JH, Way BM (2007) Putting feelings into words: affect labeling disrupts amygdala activity in response to affective stimuli. Psychol Sci 18(5):421–428
Wilson KG, Chochinov HM, McPherson CJ, LeMay K, Allard P, Chary S et al (2007) Suffering with advanced cancer. J Clin Oncol 25(13):1691–1697
Schroepfer TA, Noh H, Kavanaugh M (2009) The myriad strategies for seeking control in the dying process. Gerontologist 49(6):755–766
Wittmann L, Sensky T, Meder L, Michel B, Stoll T, Büchi S (2009) Suffering and posttraumatic growth in women with systemic lupus erythematosus (SLE): a qualitative/quantitative case study. Psychosomatics 50(4):362–374
Chochinov HM (2006) Dying, dignity, and new horizons in palliative end-of-life care. CA Cancer J Clin 56(2):84–103
McGrath P (2002) Creating a language for ‘spiritual pain’ through research: a beginning. Support Care Cancer 10(8):637–646
Taylor SE, Burklund LJ, Eisenberger NI, Lehman BJ, Hilmert CJ, Lieberman MD (2008) Neural bases of moderation of cortisol stress responses by psychosocial resources. J Pers Soc Psychol 95(1):197–211
Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinava 67:361–370
Al-Shahri MZ, Eldali AM, Al-Zahrani O (2012) Prevalence and severity of suffering among patients with advanced cancer. Support Care Cancer 20(12):3137–3140
Baines BK, Norlander L (2000) The relationship of pain and suffering in a hospice population. Am J Hosp Palliat Care 17(5):319–326
Bruera E, Neumann CM (1999) Respective limits of palliative care and oncology in the supportive care of cancer patients. Support Care Cancer 7(5):321–327
Moreno F, Otero J (2006) Demografía de la lengua española. Instituto Complutense de Estudios Internacionales, Madrid, pp 38. eprints.ucm.es/8936/1/DT03-06.pdf. Accessed 5 February 2013
Acknowledgments
A. Krikorian thanks Universidad Pontificia Bolivariana for their financial support. All authors thank T. Alvarez, N. Acosta, and the Instituto de Cancerología of Clínica Las Américas for their invaluable help while conducting the study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Krikorian, A., Limonero, J.T., Vargas, J.J. et al. Assessing suffering in advanced cancer patients using Pictorial Representation of Illness and Self-Measure (PRISM), preliminary validation of the Spanish version in a Latin American population. Support Care Cancer 21, 3327–3336 (2013). https://doi.org/10.1007/s00520-013-1913-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-013-1913-5