title: 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.
abstract: OBJECTIVE
  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.
authors.affiliation: Pain and Palliative Care Group, School of Health Sciences, Universidad Pontificia Bolivariana, Calle 78B No. 72A-109, Medellín, Colombia, aliciakriko@gmail.com.
authors.forename: Alicia
authors.initials: A
authors.lastname: Krikorian
authors.forename: Joaquín T
authors.initials: JT
authors.lastname: Limonero
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargas
authors.forename: Carolina
authors.initials: C
authors.lastname: Palacio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003105:Colombia; D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D010147:Pain Measurement / Q000379:methods; D010166:Palliative Care; D011594:Psychometrics / Q000379:methods*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014481:United States; D055815:Young Adult
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