IJCS | Volume 32, Nº5, September/October 2019

442 Figure 1 - ROC curve showing the cut-off point and respective sensitivity and specificity values. Cut-off point Sensitivity Specificity ROC curve Sensitivity 1 - Specificity Gontijo et al. Distress evaluation (stop-d) brazilian version Int J Cardiovasc Sci. 2019;32(5):438-446 Original Article Discussion The development and the adaptation of international instruments have emerged as strategies for the understanding of psychosocial factors associated with health-disease process. As mentioned by Duarte et al., 29 in Brazil there are few standardized instruments that evaluate psychosocial aspects of patients with chronic diseases. In addition to limited access to these instruments, the inclusion of multidimensional signs (e.g. distress and pain) as important variables of the clinical course is still recent. However, increasing evidence has indicated a direct relationship of psychosocial aspects with disease development and prognosis. 7,18,30,31 Translation is a complex, accurate process, beyond the mere translation of the instrument items. In the present study, translation was successfully performed, in terms of developing an adapted version that was adequate and proportional to the original version, considering cultural variations and language adequacies. In addition, in this process, cultural, idiomatic, linguistic and contextual aspects were considered, as recommended in the literature. 21,22 At the end of this phase, a simple, brief instrument was developed, consistent with the Brazilian population reality. Finally, with the back-translation process, a final version of the instrument was developed, with conceptual consistency comparable with that of the original version. These findings indicate that both translation and adaption of the STOP-D to the Brazilian culture met important quality criteria. 22 It is worth mentioning that distress encompasses not only a psychological concept; in the international scenario, the screening for distress is performed by other professionals, including nurses and physicians. In Brazil, the role of psychologists in hospitals has expanded; these professionals have been increasingly involved in the translation, adaptation, and validation processes of international instruments. This promotes the understanding of the phenomena aspects and communication with the health staff by means of clear and objective data and evidence-based measures. 21,22,32 The access to a good instrument, with adequate psychometric characteristics is determinant for an effective screening, and one of the main steps of this process. With the Brazilian version of the STOP-D, we obtained not only a general score for distress, but also a time-effective instrument, in conformity with the concept of distress described in the literature. 3,17,18 The ROC curve was used to analyze this score and the cut- off point of 15 yielded an excellent sensitivity (> 92.9%). A good sensitivity was a priority, since it contributes