Caracterización de la soledad no deseada y su relación con mortalidad en pacientes con cáncer

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dc.contributor.advisorDe La Hoz Restrepo, Fernandospa
dc.contributor.authorValdelamar Jiménez, Adrianaspa
dc.contributor.orcidValdelamar Jiménez, Adriana [0000000303770222]spa
dc.contributor.researchgroupInvestigaciones Clínicas en Cáncerspa
dc.coverage.cityBogotáspa
dc.coverage.countryColombiaspa
dc.coverage.temporal2019-2023spa
dc.date.accessioned2024-12-06T14:38:07Z
dc.date.available2024-12-06T14:38:07Z
dc.date.issued2024
dc.descriptionilustraciones, diagramas, tablasspa
dc.description.abstractObjetivo: Describir el fenómeno de la soledad no deseada (SND) en pacientes con cáncer y establecer su relación con la mortalidad. Diseño: Se llevó a cabo un estudio mixto compuesto por: la validación de escalas mediante la Teoría Clásica de la Medición (TCM) y el método de Respuesta al Ítem-Rasch; un estudio observacional y analítico de cohorte prospectivo; y un estudio cualitativo basado en la teoría fundamentada de Strauss y Corbin. La población de estudio incluyó pacientes con diversos tipos de cáncer (mama, próstata, cérvix, gastrointestinal y hematológico), con 100 participantes en cada grupo, atendidos en el Instituto Nacional de Cancerología (INC) entre 2019 y 2023. La escala UCLA-LS3 fue validada en 500 pacientes (TCM y Rasch). En la cohorte prospectiva (n=400), se realizaron mediciones repetidas de la escala mensualmente y cada seis meses durante dos años. Además, se llevaron a cabo 13 entrevistas en profundidad utilizando un muestreo no probabilístico, secuencial, por conveniencia y teórico. Plan de análisis:Se realizaron análisis descriptivos para variables continuas y discretas utilizando medias, desviaciones estándar, medianas, rangos intercuartílicos y porcentajes según correspondiera. La escala UCLA-LS3 fue traducida, adaptada y evaluada en términos de validez de contenido (mediante análisis factorial exploratorio y confirmatorio con matrices de correlación policórica), validez de constructo (divergente y discriminante) y validez concurrente. La confiabilidad test-retest se evaluó con el coeficiente de concordancia de Lin y la consistencia interna con los coeficientes alfa de Cronbach, Omega de McDonald y GLB. El análisis cualitativo incluyó codificación abierta, axial y selectiva para generar una teoría emergente sobre la SND en pacientes con cáncer, realizado con ATLAS.ti. Los análisis cuantitativos se efectuaron con Winstep®, Stata 12® y R. Resultados: Se abordaron dos problemas de salud pública: la soledad no deseada y el cáncer. Aunque la escala UCLA-LS3 mostró propiedades adecuadas según la TCM, el método Rasch reveló limitaciones al aplicarla en pacientes con cáncer, indicando que no mide integralmente la SND en esta población. Los pacientes con niveles moderados o altos de soledad presentaron mayor riesgo de mortalidad, mientras que el tratamiento quirúrgico y una funcionalidad elevada se asociaron con mayor supervivencia. Factores como el nivel educativo, estado civil, tipo de cáncer y funcionalidad también influyeron en la experiencia de soledad. El estudio cualitativo identificó componentes adicionales de la SND no contemplados en la escala UCLA-LS3, como la "soledad administrativa" generada por la burocracia del sistema de salud, que afecta negativamente la calidad de vida de los pacientes y contribuye a la pauperización de la salud. Asimismo, se observó que la soledad está vinculada no solo a la muerte prematura, sino también a conductas suicidas, mientras que los pacientes suelen preferir enfrentar el cáncer y la muerte en entornos hospitalarios debido al impacto emocional y psicológico de la soledad. Conclusiones: Este estudio, pionero en Colombia, permite comprender de manera integral la SND en pacientes con cáncer y su impacto en la mortalidad. Los resultados subrayan la necesidad de ajustar las escalas actuales para medir la SND, incorporando las experiencias específicas de esta población y las barreras del sistema de salud. También se recomienda desarrollar instrumentos diseñados específicamente para los pacientes con cáncer, así como simplificar los procesos administrativos. Estas acciones podrían mejorar la calidad de vida de los pacientes y orientar políticas de salud más solidarias y efectivas (Texto tomado de la fuente).spa
dc.description.abstractObjective: To describe the phenomenon of unwanted loneliness (UL) in cancer patients and establish its relationship with mortality. Design: A mixed-methods study was conducted, comprising: the validation of scales using Classical Test Theory (CTT) and the Item Response Theory (IRT-Rasch); an observational and analytical prospective cohort study; and a qualitative study based on Strauss and Corbin's grounded theory. The study population included patients with various types of cancer (breast, prostate, cervical, gastrointestinal, and hematological), with 100 participants in each group, treated at the National Cancer Institute (INC) between 2019 and 2023. The UCLA-LS3 loneliness scale was validated in 500 patients (CTT and Rasch). In the prospective cohort (n=400), repeated measurements of the scale were performed monthly and every six months over two years. Additionally, 13 in-depth interviews were conducted using non-probabilistic, sequential, convenience, and theoretical sampling methods. Analysis Plan: Descriptive analyses were performed for continuous and categorical variables using means, standard deviations, medians, interquartile ranges, and percentages, as appropriate. The UCLA-LS3 scale was translated, adapted, and evaluated for content validity (through exploratory and confirmatory factor analysis using polychoric correlation matrices), construct validity (divergent and discriminant), and concurrent validity. Test-retest reliability was assessed using Lin's concordance coefficient, and internal consistency was measured with Cronbach's alpha, McDonald's omega, and GLB coefficients. The qualitative analysis included open, axial, and selective coding to generate an emergent theory on UL in cancer patients, conducted using ATLAS.ti. Quantitative analyses were performed using Winstep®, Stata 12®, and R. Results: Two public health issues were addressed: unwanted loneliness and cancer. While the UCLA-LS3 scale showed adequate properties under CTT, Rasch analysis revealed limitations when applied to cancer patients, indicating that it does not comprehensively measure UL in this population. Patients with moderate to high levels of loneliness exhibited an increased risk of mortality, whereas surgical treatment and higher functionality were associated with better survival. Factors such as educational level, marital status, cancer type, and functionality also influenced the experience of loneliness. The qualitative study identified additional components of UL not included in the UCLA-LS3 scale, such as "administrative loneliness," generated by the bureaucracy of the healthcare system, which negatively impacts patients' quality of life and contributes to the deterioration of health. Furthermore, loneliness was linked not only to premature death but also to suicidal behaviors, with patients often preferring to face cancer and death in hospital settings due to the emotional and psychological burden of loneliness. Conclusions: This pioneering study in Colombia provides a comprehensive understanding of UL in cancer patients and its impact on mortality. The findings highlight the need to adjust current scales for measuring UL, incorporating the specific experiences of this population and the barriers within the healthcare system. Developing instruments specifically designed for cancer patients and simplifying administrative processes are also recommended. These measures could improve patients' quality of life and guide more empathetic and effective health policies.eng
dc.description.degreelevelDoctoradospa
dc.description.degreenameDoctora en Salud Públicaspa
dc.description.methodsDiseño metodológico mixto a través de un diseño explicativo secuencia: Estudio de validación de escalas, estudio observacional, analítico de tipo cohorte prospectiva y estudio cualitativo desde la teoría fundamentada de Strauss y Corbin ,spa
dc.description.researchareaEpidemiología y Evaluación en Salud Públicaspa
dc.format.extent314 páginasspa
dc.format.mimetypeapplication/pdfspa
dc.identifier.instnameUniversidad Nacional de Colombiaspa
dc.identifier.reponameRepositorio Institucional Universidad Nacional de Colombiaspa
dc.identifier.repourlhttps://repositorio.unal.edu.co/spa
dc.identifier.urihttps://repositorio.unal.edu.co/handle/unal/87279
dc.language.isospaspa
dc.publisherUniversidad Nacional de Colombiaspa
dc.publisher.branchUniversidad Nacional de Colombia - Sede Bogotáspa
dc.publisher.departmentDoctorado Interfacultades en Salud Públicaspa
dc.publisher.facultyFacultad de Medicinaspa
dc.publisher.placeBogotá, Colombiaspa
dc.publisher.programBogotá - Medicina - Doctorado en Salud Públicaspa
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dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.licenseAtribución-NoComercial-SinDerivadas 4.0 Internacionalspa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/spa
dc.subject.ddc610 - Medicina y salud::613 - Salud y seguridad personalspa
dc.subject.ddc610 - Medicina y salud::616 - Enfermedadesspa
dc.subject.decsEstudios Poblacionales en Salud Públicaspa
dc.subject.decsPopulation Studies in Public Healtheng
dc.subject.lembSOLEDAD-ASPECTOS PSICOLOGICOSspa
dc.subject.lembLoneliness - psychological aspectseng
dc.subject.lembCANCER-ASPECTOS PSICOLOGICOSspa
dc.subject.lembCancer - Psychological aspectseng
dc.subject.proposalSoledadspa
dc.subject.proposalNeoplasiasspa
dc.subject.proposalEstudios de validaciónspa
dc.subject.proposalEstudio de cohortesspa
dc.subject.proposalTeoría fundamentadaspa
dc.subject.proposalPacientes oncológicosspa
dc.subject.proposalLonelinesseng
dc.subject.proposalNeoplasmseng
dc.subject.proposalValidation studieseng
dc.subject.proposalCohort Studyeng
dc.subject.proposalGrounded Theoryeng
dc.subject.proposalOncology patientseng
dc.titleCaracterización de la soledad no deseada y su relación con mortalidad en pacientes con cáncerspa
dc.title.translatedCharacterization of unwanted loneliness and its relationship with mortality in cancer patientseng
dc.typeTrabajo de grado - Doctoradospa
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dcterms.audience.professionaldevelopmentInvestigadoresspa
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