IJCS | Volume 32, Nº5, September/October 2019

443 Gontijo et al. Distress evaluation (stop-d) brazilian version Int J Cardiovasc Sci. 2019;32(5):438-446 Original Article to an effective identification of individuals at a low risk of psychosocial distress. This points out the need for referral psychosocial support services, since once individuals at risk for distress are identified by the instrument, they should be referred for complementary interprofessional care. Regarding the statistic validation of the Brazilian version of the STOP-D, its exploratory and confirmatory validations also corroborated the quality of the instrument. In these processes, psychometric properties of the instrument were assessed by factor analysis, which identified the stability of the tool. Also, the factorability indicators obtained in the factor analysis supported the proposal of using the instrument as a general distress score. Finally, we found a high area under the ROC curve, indicating an 85% accuracy of the Brazilian version of the STOP-D in identifying distress. According toMargotto, 33 an area above 0.70 indicates a satisfactory performance. These findings demonstrate that the instrument evaluated in the present study has good sensitivity and accuracy in detecting distress in cardiac disease patients. The Brazilian public health faces a deficit in human resources and increased patient demand, in addition to a limited number of multidisciplinary professionals. For this reason, the structuration of services by psychosocial screening models seems a beneficial strategy, able to promote equity. Here we present a low-cost and fast instrument with high sensitivity and high accuracy for screening of distress in patients with heart diseases that can be of help in the treatment of this population. Limitations of the study include the use of a convenience rather than a probabilistic sample. Clinical information was not collected from patients’ medical record but reported by the patients. This may represent a bias in the quality of the information, as it depends on patients’ ability to recall and educational level. In the original study, other screening instruments were used and compared with the STOP-D, while in the present study, only the HADS was used in this regard. Although it is true that these limitations may have influenced the results, they did not invalidate our study, which succeeded in achieving the objectives proposed. Conclusions In heart disease patients, distress is associated with worsening of the clinical course, and in this scenario, the Brazilian version of the STOP-D would be of great help in promoting adequate full support to these patients. The first topic to be explored is the concept of distress, which should receive an interprofessional approach to early detect and efficiently treat this condition. Second, the screening for psychosocial demands should be implemented in routine clinical practice, using simple, free instruments, that are accessible to all healthcare providers involved. Finally, patients with a high level of distress should be referred to a psychosocial support team. In this context, more interdisciplinary professionals – psychologists, dietitians, social assistants, physiotherapists, among others – should be added to the healthcare team and establish an efficient communication with cardiologists. The Brazilian version of the STOP-D can also act as a facilitator in this process, as it can be an indicator of the quality of the interprofessional support, guiding and measuring team interventions. Therefore, this strategy is believed to improve the quality of life of the patients. The psychometric analysis of the Brazilian version of the STOP-D confirmed that this is an appropriate instrument to measure distress. The translated, adapted, and validated version of the tool also maintained the properties of the original version (no item of the original version was excluded). Another positive characteristic of the Brazilian version of the STOP-D was its single-factor nature (cut-off point of 15 for distress). This finding contrasts with what is reported in the literature about the concept of distress – a psychosocial phenomenon, influenced by emotional, physical and social aspects. Therefore, the Brazilian version of the STOP-D can be used in routine practice for psychosocial screening in cardiology; the time of application is from three to five minutes, and the correction of the instrument is simple (summation of the patients’ items/answers). The identification of distress using the STOP-D could also serve as a strategy by which patients can better deal with their disease. Author contributions Conception and design of the research: Gontijo IBR, Rassi S. Acquisition of data: Gontijo IBR, Rassi S. Analysis and interpretation of the data: Gontijo IBR, Souza JR, Rassi S. Statistical analysis: Gontijo IBR, Souza JR, Barbosa DF, Rassi S. Obtaining financing: Gontijo IBR. Writing of the manuscript: Gontijo IBR. Critical revision