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In the advanced cancer setting, low psychological functioning is a common symptom and its deleterious impact on health outcomes is well established. Yet, the beneficial role of positive psychological well-being (PPWB) on several clinical conditions has been demonstrated. Early palliative care (EPC) is a recent value-based model consisting of the early integration of palliative care into standard care for solid tumors and hematologic malignancies. While the late palliative care primary offers short-term interventions, predominantly pharmacological in nature and limited to physical symptom reduction, EPC has the potential to act over a longer term, enabling specific interventions aimed at promoting PPWB. This narrative review examines nine English studies retrieved from MEDLINE/PubMed, published up to October 2023, focusing on EPC and three dimensions of PPWB: hope, gratitude, and death acceptance. These dimensions consistently emerge in our clinical experience within the EPC setting for advanced cancer patients and appear to contribute to its clinical efficacy. The choice of a narrative review reflects the novelty of the topic, the limited existing research, and the need to incorporate a variety of methodological approaches for a comprehensive exploration. [ABSTRACT FROM AUTHOR]

Introduction: Early palliative care (EPC) improves the quality of life (QoL) of advanced cancer patients and their caregivers. The increasingly widespread use of this care model requires the development of measures supporting its interventions. Although the construct of patient's QoL has been extensively investigated and several QoL measures have been further validated, there is a paucity of data concerning the QoL of the caregiver. In 2018, McDonald and colleagues addressed this issue by interviewing 23 primary caregivers of advanced cancer patients who participated in an EPC randomized clinical trial to understand their perspective on the QoL construct. The Authors identified six major dimensions associated with the construct of caregiver's QoL. The present retrospective study aimed to validate these dimensions on a larger sample and in a real-life EPC setting. Methods: Previously collected reports from 137 primary caregivers of advanced cancer patients on EPC answering questions about their experience with this care model were qualitatively analyzed through a deductive, thematic approach to identify and confirm the six dimensions constituting the construct of interest based on McDonald's and colleagues' results. Results: The six dimensions ("living in the patient's world", "burden of illness and caregiving", "assuming the caregiver role", "renegotiating relationships", "confronting mortality", and "maintaining resilience") were consistently found in the reports from primary caregivers in a real-life EPC setting, confirming to be significant themes associated to their QoL. Conclusion: A definite and recurrent construct of primary caregiver's QoL as described by McDonald and colleagues was also found in a larger sample and in a real-life EPC setting. Thus it may lay the groundwork for the development of a dedicated questionnaire. [ABSTRACT FROM AUTHOR]

Simple Summary: Early palliative care represents a successful model of care for advanced cancer patients and their caregivers. Yet, early palliative care provision remains confined to the last weeks of life. Among the possible reasons, the stigma associated with the name "palliative care" seems to have a prominent role. The present study aimed to investigate the perception of palliative care that a sample of 78 patients and 110 caregivers had before their referral to the early palliative care service. The results suggest on which levels it is necessary to intervene to overcome the stigma. From a policy perspective, it is clear that broad education is needed to ensure a more widespread understanding of the essence of anticipated palliative care. The early referral to palliative care (PC) represents a successful value-based model with proven benefits regarding the quality of life and clinical outcomes for advanced cancer patients and their caregivers. Yet, its provision remains typically confined to the last weeks of life as per the historical, late PC model. The stigma according to which PC represents end-of-life care has been identified as the root of the problem. To explore the presence and effects of the stigma in a clinical context, we surveyed 78 patients and 110 caregivers (mean age: 71.7 and 60.7, respectively) on early PC to study what their perception of PC was before their direct experience. The responses were analyzed through a qualitative descriptive approach. The participants explicitly mentioned a lack of knowledge about PC (53% of the sample), which they identified also among physicians and the population (13%); an identification of PC with the late PC model (53%); and a detrimental reaction to the proposal of an early PC referral (83%). However, the participants explicitly mentioned that a direct experience of early PC allowed for an acquired awareness of early PC meaning and benefits (52%), as well as a comprehension of its differences with late PC (34%); the regret for the delayed referral (8%); the perception of the word "palliative" as a barrier (21%); and the belief that early PC should be part of the cancer routine practice (25%). A comprehensive multi-level intervention is necessary for a widespread understanding of the essence of anticipated PC. [ABSTRACT FROM AUTHOR]

Background Oncologists are often concerned that talking about death with patients may hinder their relationship. However, the views of death held by patients have not been thoroughly investigated. This study aimed to describe the perception of death among patients with advanced cancer receiving early palliative care (EPC) and their caregivers. Material and Methods Qualitative and quantitative analyses were performed on 2 databases: (a) transcripts of open-ended questionnaires administered to 130 cancer patients receiving EPC with a mean age of 68.4 years and to 115 primary caregivers of patients on EPC with a mean age of 56.8; (b) texts collected from an Italian forum, containing instances of web-mediated interactions between patients and their caregivers. Results Quantitative analysis shows that: (a) patients and caregivers are not afraid of speaking about death; (b) patients and caregivers on EPC use the word "death" significantly more than patients on standard oncology care (SOC) and their caregivers (P  < .0001). For both participants on EPC and SOC, the adjectives and verbs associated with the word "death" have positive connotations; however, these associations are significantly more frequent for participants on EPC (verbs, P s < .0001; adjectives, P s < .003). Qualitative analysis reveals that these positive connotations refer to an actual, positive experience of the end of life in the EPC group and a wish or a negated event in the SOC group. Conclusions EPC interventions, along with proper physician-patient communication, may be associated with an increased acceptance of death in patients with advanced cancer and their caregivers. [ABSTRACT FROM AUTHOR]

Doctor -couple interactions in the context of assisted reproductive medicine frequently include occurrences of laughter, especially patient-initiated. These have been examined in previous studies from a quantitative perspective and in relation to specific topics, but not as regards the functions that laughter realises throughout the interactions. Our study aims to address this underinvestigated issue by providing an analysis of a small sample of consultations (n = 10) about assisted reproductive technology (ART) treatments. The analysis is set within a discourse-interactional perspective on clinical interactions, which focuses on consultations as advice-seeking activities in which advice-giving is the main discourse type. The consultations have been analysed through structural mapping, which has revealed five main phases: opening, information sharing, problem identification, discussion of the options and closing. Laughter tokens have been identified and their functions are described from the point of view of an incongruity-based framework. The interactional functions of laughter described in this framework, e.g., 'marking incongruity', 'softening trouble-telling', 'showing sympathy', 'marking irony' etc., have then been mapped onto the different phases of the consultations, yielding a fine-grained description of when laughter occurs and what participants are using it for. Our study expands on previous analyses of laughter in ART consultations, offering a novel methodological approach that could be applied to larger corpora. [ABSTRACT FROM AUTHOR]

Background Oncologists' fear of taking away hope from patients when proposing early palliative care (EPC) is a barrier to the implementation of this model. This study explores hope perceptions among bereaved caregivers of onco-hematologic patients who received EPC. Materials and Methods Open-ended questionnaires were administered to 36 primary caregivers of patients who received EPC (26 solid and 10 hematologic cancer patients; mean age: 51.4 years, range age: 20-74), at 2 cancer centers, 2 months to 3 years after a patient death. Definitions of hope in the caregivers' narratives were analyzed through a directed approach to content analysis. Results were complemented with automated lexicographic analysis. Results Caregivers perceived hope mainly as resilience and as expectations based on what they were told about the patients' clinical conditions. Their hope was bolstered by trusting relationships with the healthcare teams. EPC interventions were recalled as the major support for hope, both during the illness and after the death of the patient. The automated quantitative lexical analysis provided deeper insights into the links between hope, truth, and trust. Conclusions Our findings suggest that telling the truth about an incurable onco-hematologic disease and beginning EPC might be the combination of factors triggering hope in the setting of incurable cancer. [ABSTRACT FROM AUTHOR]

This paper proposes a method for analyzing the dialogical functions of metaphors in communicative interactions, and more specifically in the context of medical interviews. The dialogical goals proposed and pursued by the interlocutors are coded using a coding scheme that captures seven mutually exclusive categories of dialogical moves. The functions of the moves, including metaphors, can be identified and correlated with other variables relevant to the type of communication under analysis. The coding scheme is used to analyze a corpus of 39 interactions between healthcare providers and patients affected by Type 2 diabetes. The exploratory quantitative analysis, for the purpose of determining the different distributions of metaphor uses between patients and providers, is combined with qualitative analysis in which the thematic areas of the metaphors are considered. The findings show how patients and providers use metaphors for pursuing different dialogical goals and meeting distinct communicative needs. [ABSTRACT FROM AUTHOR]

Early palliative/supportive care (ePSC) is a medical intervention focused on patient's needs, that integrates standard oncological treatment, shortly after a diagnosis of advanced/metastatic cancer. ePSC improves the appropriate management of cancer pain. Understanding the semantic and emotional impact of the words used by patients to describe their pain may further improve its assessment in the ePSC setting. Psycholinguistics assumes that the semantic and affective properties of words affect the ease by which they are processed and comprehended. Therefore, in this cross-sectional survey study we collected normative data about the semantic and affective properties of words associated to physical and social pain, in order to investigate how patients with cancer pain on ePSC process them compared to healthy, pain-free individuals. One hundred ninety patients and 124 matched controls rated the Familiarity, Valence, Arousal, Pain-relatedness, Intensity, and Unpleasantness of 94 words expressing physical and social pain. Descriptive and inferential statistics were performed on ratings in order to unveil patients' semantic and affective representation of pain and compare it with those from controls. Possible effects of variables associated to the illness experience were also tested. Both groups perceived the words conveying social pain as more negative and pain-related than those expressing physical pain, confirming previous evidence of social pain described as worse than physical pain. Patients rated pain words as less negative, less pain-related, and conveying a lower intense and unpleasant pain than controls, suggesting either an adaptation to the pain experience or the role played by ePSC in improving patients' ability to cope with it. This exploratory study suggests that a chronic pain experience as the one experienced by cancer patients on ePSC affects the semantic and affective representation of pain words. [ABSTRACT FROM AUTHOR]

Dialogue moves are a pragmatic instrument that captures the most important categories of "dialogical intentions." This paper adapts this tool to the conversational setting of chronic care communication, characterized by the general goal of making reasoned decisions concerning patients' conditions, shared by the latter. Seven mutually exclusive and comprehensive categories were identified, whose reliability was tested on an Italian corpus of provider-patient encounters in diabetes care. The application of this method was illustrated through explorative analyses identifying possible correlations between the dialogical structure of medical interviews and one of the indicators of personalized decision-making, namely the specificity of the recommendations given by the provider ("customization"). The statistical analyses show a significant correlation between the exchange of personal information and very specific and customized recommendations for change. It suggests how the creation of common ground, exceeding the boundaries of the paternalistic or patient-centered models, can lead to highly effective communication. [ABSTRACT FROM AUTHOR]

In this paper, argumentation practices will be discussed in view of their potential for favoring effective information sharing and the creation of 'emergent common ground', i.e. the common ground that is sought, created and co-constructed in the process of communication. Argumentation is usually tightly knit with information sharing: if the parties have not previously shared a sufficient amount of relevant knowledge, it is difficult for them to produce effective argumentation. Based on these premises, in this paper the argumentation stages of medical encounters will be viewed as opportunities to reveal and integrate insufficient common ground between clinicians and patients. By relying on the analysis of a corpus of real life encounters in a chronic care setting, the interaction between information sharing and argumentation will be shown, along with problematic cases of misunderstandings or ineffective argumentation due to lack of common ground. Implications for the clinical practice will be discussed. [ABSTRACT FROM AUTHOR]

Pragmatic presupposition is analyzed as grounded on an implicit reasoning process based on a set of presumptions, which can define cultural differences. The basic condition for presupposing a proposition is represented as a reasoning criterion, namely reasonableness. Presuppositions, on this view, need to be reasonable, namely they need to be the reasonable conclusions of an underlying presumptive reasoning, which does not or may not contain contradictions with other presumptions. Presumptions are in turn analyzed considering their nature and their hierarchy, namely their subject matter and their possible contextual backing, which eliminates some of their possible defaults. This analysis of presupposition brings to light the relationship between misunderstandings deriving from presuppositional failures and the underlying system of presumptions. This approach is applied to the investigation of communicative issues within the medical context, and more precisely doctor-patient communication in diabetes cases. [ABSTRACT FROM AUTHOR]

The paper discusses the role of argumentative competencies for the achievement of patient engagement through communication in doctor-patient consultations. The achievement of patient engagement is being proposed by recent studies as a condition that can facilitate in particular patient adherence, which involves behavior change. One obstacle to behavior change that has been observed is reactance, i.e., resistance to persuasive messages when a threat to freedom is perceived. In the medical field, reactance theory has been mostly applied in the field of mental health, less frequently to understand non-adherence in general. However, a few studies have revealed that reactance can actually explain in part the motives behind non-adherence. These studies propose that the arousal of reactance could be limited or prevented by adopting relational measures aimed at giving patients the feeling that they still hold some control over the process of care and that the "impositions" on their freedoms are acceptable because they have had the opportunity to decide about them. However, they do not discuss how these strategies should be operationalized at the dialogical level. A debated issue in the study of reactance is the role played by knowledge. It seems that pure information regarding an issue is likely to represent a threat in itself. Complementary to this is the finding that quality of argument does not impact on the degree of reactance. These findings pose a problem in view of the goal of patient education, itself considered as a necessary premise for any process of patient engagement and adherence. It seems necessary to move away from a conception of education as mere transmission of information and look for more effective ways of transferring knowledge to patients. With regard to this issue, the paper argues that useful insights can be found in studies on science education, in which it is shown experimentally that argumentative processes favor learning and understanding. Drawing on previous studies and taking an interdisciplinary perspective on the issue, the paper brings into the discussion on engagement concepts developed in the field of argumentation theory, showing how the suggestions for avoiding reactance could be realized dialogically. [ABSTRACT FROM AUTHOR]

Collaborative goal setting in patient-provider communication with chronic patients is the phase in which - after collecting the data regarding the patient's health - it is necessary to make a decision regarding the best therapy and behaviors the patient should adopt until the next encounter. Although it is considered a pivotal phase of shared decision making, there remain a few open questions regarding its components and its efficacy: What are the factors that improve or impede agreement on treatment goals and strategies?; What are the 'success conditions' of collaborative goal setting?; How can physicians effectively help patients make their preferences explicit and then co-construct with them informed preferences to help them reach their therapeutic goals? Using the theoretical framework of dialogue types, an approach developed in the field of Argumentation Theory, it will be possible to formulate hypotheses on the 'success conditions' and effects on patient commitment of collaborative goal setting. [ABSTRACT FROM AUTHOR]

The relevance of context has been acknowledged also recently as a fundamental element for the correct evaluation of argumentative moves within institutional fields of interaction. Indeed, not considering the larger culture-specific and social features of the context within which the interactions take place poses problems of interpretation of the data and comparability of results. Starting from these considerations, the paper aims at discussing a model for the description of the social context of interaction that may allow for a better interpretation and evaluation of argumentative moves within medical consultations. The efficacy of the model is shown by applying it to the description and analysis of examples of real-life consultations recorded in the Italian region of Lombardy. In the first section, the model for the description of the social context of interaction is presented and discussed. In the second section, examples of argumentative passages from a selection of consultations are presented and commented on by relying on the model. Some concluding remarks and further developments of the research are proposed in the final section [ABSTRACT FROM AUTHOR]