A influência da educação e depressão sobre a autonomia de mulheres com dor pélvica crônica: um estudo transversal

Barbosa, Hermes de Freitas; Nogueira, Antonio Alberto; Silva, Júlio César Rosa e; Poli Neto, Omero Benedicto; Reis, Francisco José Candido dos

doi:10.1055/s-0035-1570107

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Sumário

Original Articles • Rev. Bras. Ginecol. Obstet. 38 (1) • Jan 2016 • https://doi.org/10.1055/s-0035-1570107 copiar

A influência da educação e depressão sobre a autonomia de mulheres com dor pélvica crônica: um estudo transversal

Autoria SCIMAGO INSTITUTIONS RANKINGS

Objetivo

A autonomia da paciente é de grande importância para que o consentimento informado seja válido na prática clínica. Nossos objetivos foram quantificar os domínios da autonomia e avaliar variáveis que modificam a autonomia em mulheres com dor pélvica crônica.

Métodos

Este é um estudo transversal realizado em um Hospital Universitário terciário. Foram incluídas consecutivamente 52 mulheres com dor pélvica crônica agendadas para videolaparoscopia. Foi utilizada uma escala Likert com 24 afirmativas validadas para quantificar os três principais componentes da autonomia (competência, informação e liberdade).

Resultados

Os escores de competência (0,85 vs 0,92; p = 0,006) e informação (0,90 vs 0,93; p = 0,02) foram menores para mulheres com ensino fundamental incompleto. Os escores de informação foram menores em mulheres com sintomas de ansiedade (0,91 vs 0,93; p = 0,05) ou depressão (0,90 vs 0,93; p = 0,01).

Conclusões

Nossos dados mostram que a quantificação da autonomia pode produzir informações relevantes para a prática clínica em ginecologia. O nível educacional e a presença de ansiedade e depressão podem afetar a autonomia de mulheres com dor pélvica crônica.

autonomia; laparoscopia diagnóstica; dor pélvica crônica; educação

Category	Statement	Proposition
Information	I have been informed about the proposed surgery.	Positive
	I have been explained about the available non-surgical management for my pain.	Positive
	I have been informed the advantages of the proposed surgery.	Positive
	I have been informed the disadvantages of the proposed surgery.	Positive
	I have been explained the reason for the surgery.	Positive
	The explanations provided by the health team gave me confidence to make a decision.	Positive
	I would like having received further information about the proposed surgery.	Negative
	All my questions have been answered.	Positive
	I have been informed about the risks of the proposed surgery.	Positive
	I got the information to make the decision about undergoing surgery from internet, magazines, newspapers, TV shows or other sources.	Negative
	I got the information to make the decision about undergoing surgery from people who underwent to the same surgery.	Negative
Competence	I was able to understand the available alternatives to the proposed surgery.	Positive
	I found difficult to understand the provided information about the surgery.	Negative
	I found difficult to understand the medical terms used by the doctor.	Negative
	I was able to understand the procedure to be performed.	Positive
	I was able to understand the answers to my questions.	Positive
	The risks of the surgery are not clear to me.	Negative
Freedom	I feel free to talk to the health team about my doubts.	Positive
	The health team listened to my concerns.	Positive
	I felt difficulty to ask questions to the attending doctor.	Negative
	I feel free to decide about my treatment.	Positive
	I have not been asked about my preference for the type of treatment.	Negative
	I did not like the way I was treated when asked about the treatment.	Negative
	I made my decision based on the information provided by the health team.	Positive

Variable	Median	Range
Age	33	19–58
VAS* (pain intensity)	85	45–100
Pain duration (months)	27	6–240
	N	%
Laparoscopic diagnosis
Endometriosis	24	46.1
Benign ovarian cyst	6	11.5
Pelvic adhesion	8	15.3
Normal	14	26.9
HADS**
Anxiety	33	63.4
Depression	18	34.6
Educational level
Incomplete fundamental level	26	50,0
Complete fundamental level	22	42.3
College degree	4	7.6
Family income (monthly)
≥ US$ 1,000.00	9	17.3
< US$ 1,000.00	43	82.6
Marital status
Single	13	25,0
Married	39	75,0

	Competence	Information	Freedom
Competence	1.0
Information	r = 0.34 ( p = 0.01)	1.0
Freedom	r = 0.08 ( p = 0.56)	r = 0.01 ( p = 0.93)	1.0

Variable	Competence	P	Information	P	Freedom	P
Age		0.32		0.15		0.76
< 33 years	0.90 (0.11)		0.92 (0.03)		0.88 (0.09)
≥33 years	0.87 (0.11)		0.91 (0.05)		0.87 (0.08)
Educational attainment		0.006		0.02		0.10
Incomplete elementary school	0.85 (0.13)		0.90 (0.05)		0.86 (0.08)
Elementary school or more	0.92 (0.07)		0.93 (0.04)		0.89 (0.09)
Marital status		0.43		0.95		0.84
Single	0.90 (0.03)		0.92 (0.05)		0.87 (0.1)
Married	0.88 (0.02)		0.92 (0.04)		0.88 (0.08)
Familial monthly income		0.36		0.16		0.96
< US$1,000.00	0.88 (0.11)		0.91 (0.04)		0.87 (0.09)
≥US$1,000.00	0.91 (0.08)		0.93 (0.05)		0.88 (0.10)
Pain intensity		0.81		0.81		0.12
Moderate	0.88 (0.10)		0.91 (0.05)		0.85 (0.09)
Severe	0.89 (0.12)		0.92 (0.04)		0.89 (0.08)
Pain duration		0.59		0.65		0.65
< 2 years	0.89 (0.12)		0.91 (0.05)		0.87 (0.08)
≥2 years	0.88 (0.10)		0.92 (0.04)		0.88 (0.09)
Anxiety		0.66		0.05		0.29
Yes	0.88 (0.12)		0.91 (0.04)		0.86 (0.08)
No	0.89 (0.12)		0.93 (0.05)		0.89 (0.09)
Depression		0.34		0.01		0.63
Yes	0.86 (0.12)		0.90 (0.04)		0.87 (0.08)
No	0.89 (0.11)		0.93 (0.04)		0.88 (0.09)

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[1] Address for correspondence Francisco José Candido dos Reis, PhD, Departamento de Ginecologia e Obstetrícia, Ribeirao Preto School of Medicine, University of Sao Paulo, Av. Bandeirantes 3900, 8o andar, 14049-900 - Ribeirão Preto, Brazil (e-mail: fjcreis@fmrp.usp.br).