Análise dos fatores causais do diagnóstico de enfermagem sofrimento espiritual em adultos com câncer metastático

Abstract

Spiritual distress (00066) is a nursing diagnosis that may be present in people who have metastatic cancer. Studies on the etiological factors of Spiritual distress are still scarce. Investigating these factors is important to refine the concept within the language of the Nursing discipline. Thus, the objective was to analyze the causal factors of the nursing diagnosis of Spiritual distress in adults with metastatic cancer. This is a descriptive and analytical study of a cross-sectional nature with a quantitative approach. It was carried out between May 2023 and February 2024 in two institutions in the state of Ceará that qualified as High Complexity Oncology Care Units by the Ministry of Health. The sample consisted of 219 adults diagnosed with metastatic cancer and who were aware of their diagnosis and their oncological treatment. Data collection was performed by volunteer students trained for this purpose. Data were collected from primary sources and the participant's medical records. Statistical analysis was performed using R statistical software version 4.2.0. A Rasch analysis was initially performed, followed by a Latent Class Analysis (LCA). Posterior probabilities were calculated from each LCA model. Finally, a univariate logistic regression analysis was performed, followed by a multiple logistic regression analysis to identify a causal multivariate model. The research project was submitted to the Federal University of Ceará Research Ethics Committee via the Brazil platform and was accepted under substantiated opinion no. 6,003,643. Of the adults investigated, 60.27% were female, with a median age of 60 (p=0.017). A set of clinical indicators at the occurrence of the diagnosis was identified, which converged more towards specificity (Sp=0.89) than towards sensitivity (Se=0.47), consisting of the indicators: “Expresses concerns about the future” (di= -0.10; Se=0.78); “Questions one’s dignity” (di=1.84; Sp=0.90); “Excessive guilt” (di=2.24; Sp=0.94); “Expresses loss of control” (di=1.73; Sp=0.86); “Expresses loss of serenity” (di=1.66; Sp=0.92); “Expresses suffering” (di=0.81; Sp=0.83); “Expresses concerns about value system” (di=1.66; Sp=0.93); and “Crying” (di=0.93; Sp=0.82). Furthermore, it was possible to verify that the presence of the indicators “Expresses concerns about the future,” “Expresses suffering,” and “Crying” increases the probability of the individual presenting Spiritual Suffering (probability = 1.0). Regarding the causal factors, individually, the following stood out in the occurrence of Spiritual Suffering: “Anxiety” (OR=3.38), “Barrier to experiencing love” (OR=5.84), “Cultural conflict” (OR=3.38), “Fear” (OR=8.53), “Perception of having unfinished business” (OR=4.72), “Altered spiritual practice” (OR=1.92), “Inadequate interpersonal relationships” (OR=11.64), “Expresses feeling useless” (OR=4.37), “Separation from the support system” (OR=6.73) and “Loneliness” (OR=14.73). In an associated manner, the set that increases the occurrence of Spiritual Suffering is made up of: “number of family members,”; “Barrier to experiencing love,”; “Fear,”; “Perception of having unfinished business,”; “Inadequate interpersonal relationships,”; and “Loneliness.” It is important to note that the causal factors that stood out for the development of the nursing diagnosis have an important relationship with social aspects of the human dimension. This research contributes to the review of the nursing diagnosis of Spiritual distress and, consequently, to the standardization of nursing language.