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La letteratura evidenzia la necessita di interventi funzionali in cui le strategie di supporto psicologico, emotivo e comportamentale siano sfruttate per coinvolgere i pazienti di chirurgia bariatrica nella cura della loro salute. Questo studio esplora i risultati auto riferiti dei pazienti obesi gravi con un intervento guidato da un’infermiera che fornisce un supporto all’impegno del paziente ("PHEinAction") prima della chirurgia bariatrica. E stato condotto uno studio di valutazione qualitativa attraverso interviste semi-strutturate e questionari self-report in un ospedale pubblico italiano. La Patient Health Engagement Scale e stata somministrata prima, alla fine e tre mesi dopo l’intervento. Le interviste individuali sono state condotte nei tre mesi dopo l’intervento. I cambiamenti nei questionari sono stati analizzati usando i test a coppie, le interviste usando un approccio induttivo tematico. Tra i 17 parteci-panti, c’e stato un miglioramento significativo nei punteggi di engagement da 2,7 al baseline a 3,3 alla fine e a 3,5 tre mesi dopo l’intervento. PHEinAction ha avuto un impatto sui pazienti in attesa di chirurgia bariatrica, con cambiamenti nei punteggi di engagement e nel modo in cui hanno vissuto la loro obesita, le loro relazioni interpersonali e la loro cura di se. Questo studio offre un supporto preliminare all’ipotesi che PHEinAction aiuti i pazienti con obesita nel percorso di cambiamento comportamentale.

Effective communication is essential for understanding and recall of hospital discharge information. This study aimed to explore discharge information, patient recall and patient involvement in discharge encounters. We conducted an explorative observational study at a secondary care level, observational ward. Patients discharged to their home were asked to participate. 34 patients were assessed for eligibility, of which 13 were included in the analysis. Multiple sources of data were collected: videotapes of discharge encounters, questionnaires to patients and physicians, and semi-structured interviews with patients 2 weeks after discharge. All patients were satisfied with the information received. Five of the eight patients discharged with more than one change in medication had only partial or no recall of these changes. In seven of the 13 encounters the patients and physicians did not agree on the main message most important information item. The patients were to a small extent involved in decision-making. Our findings highlight the gaps in the information exchange at discharge encounters and the resulting poor information recall among patients. Patients do not seem aware of these gaps. Greater provider awareness of patient involvement in the encounter and inclusion of the patient’s perspective may improve communication, and consequently understanding and recall. Keywords: patient recall, patient perspective, shared decision-making, information exchange, discharge

Objective To define and operationalize three taught strategies for providing information in interactions with patients using videos collected in a randomized controlled trial (RCT). Methods This was a qualitative exploratory study embedded in a randomized controlled design, using microanalysis of face-to-face dialogue as an inductive video analysis method to operationalize physicians’ use of three information-provision strategies. Data were 34 video-recorded simulated (but unscripted) interactions between 17 physicians and 34 multiple sclerosis patients collected before and after a brief course on information provision. We operationalized (1) mapping the patient’s preferences and (2) checking the patient’s understanding, and pauses indicative of (3) portioning information. Results Results are detailed analytical definitions, criteria, and assessable, quantifiable outcomes for each of the three strategies. Patients responded to portioning pauses as expected: whereas 91% of these pauses elicited an immediate patient response, only 23% of non-portioning pauses did so. Conclusion Our methods revealed how to define and evaluate information sharing strategies physicians used within the contingencies of clinical interaction. Practice implications Findings provide applicable methods to teach, analyze, and evaluate information sharing strategies and indications for further training.

Introduction: In this article we can find the report of the main phases of the collaboration between ASUGI and the Università Cattolica del Sacro Cuore of Milan from 2015 to today. Methods: During these years, a path of activation and implementation of engagement practices within ASUGI has been developed, from basic training on the tools for monitoring and supporting engagement to the selection of a group of operators involved in a participatory path as “trainers to trainers”, up to the grafting of engagement practices within the individual patient education paths in the different sectors of ASUGI. Results and Conclusions: This contribution is an exemplifying scenario that can be useful for other health structures that want to undertake a similar path.

Background and aims The role of new psychological factors such as psychopathological patterns and defense mechanisms in the care of inflammatory bowel disease (IBD) has been poorly investigated. We aimed to assess the psychological characteristics and defense mechanisms of IBD patients. Methods This was a single-center, observational, cross-sectional study. Consecutive adult IBD patients were enrolled and stratified according to disease activity. Sociodemographic and clinical data were collected, and validated questionnaires (Symptom Checklist-90-R [SCL-90-R]) for psychological distress, Defense Mechanism Inventory (DMI) for psychological defense mechanisms, and Inflammatory Bowel Disease Questionnaire (IBDQ) for quality of life (QoL) were administered. Results Two hundred one patients were enrolled: 101 in remission and 100 with active disease. The mean score for IBDQ was below the cutoff level (156.8 ± 37.8), with a significantly greater impairment of QoL in subjects with flares (136.5 vs 177.5, P < 0.001). Lower scores were associated with female gender. No patients had psychological scores above the cutoff for normality. Statistically higher SCL-90-R scores were found in active patients for obsessive-compulsive disorder (P = 0.026), depression (P = 0.013), anxiety (P = 0.013), phobic anxiety (P = 0.002), psychoticism (P = 0.007), global severity index (GSI) (P = 0.005) and positive symptom total (PST) (P = 0.001). A significantly increased probability of higher global indexes was associated with Crohn’s disease and disease flares. None of the defensive Defense Mechanism Inventory (DMI) styles resulted above the cutoff in our cohort. Conclusions Further data are needed to demonstrate the potential key role of psychological intervention in the therapeutic strategies utilized for IBD patients, and the identification of specific psychological patterns based on the patients profile is necessary to optimize psychological intervention.

Objectives To systematize the scientific knowledge of empirically tested strategies for verbally providing medical information in patient-physician consultations. Methods A scoping review searching for terms related to physician, information, oral communication, and controlled study. Four pairs of reviewers screened articles. For each selected study, we assessed the quality and summarized aspects on participants, study, intervention, and outcomes. Information provision strategies were inductively classified by types and main categories. Results After screening 9422 articles, 39 were included. The methodological quality was moderate. We identified four differently used categories of strategies for providing information: cognitive aid (n = 13), persuasive (n = 8), relationship- (n = 3), and objectivity-oriented strategies (n = 4); plus, one “mixed” category (n = 11). Strategies were rarely theoretically derived. Conclusions Current research of tested strategies for verbally providing medical information is marked by great heterogeneity in methods and outcomes, and lack of theory-driven approaches. The list of strategies could be used to analyse real life communication. Practice implications Findings may aid the harmonization of future efforts to develop empirically-based information provision strategies to be used in clinical and teaching settings.

Obiettivo del presente contributo e sistematizzare le evidenze scientifiche inerenti le pratiche di gestione autonoma del diabete di tipo 2 in pazienti anziani, con una particolare at-tenzione ai fattori che possono ostacolare e facilitare un simile processo. A tal fine, e stata condotta un’analisi sistematica della letteratura su articoli estratti dai principali database scientifici, senza limiti di anno o di lingua di pubblicazione. Gli articoli estratti sono stata analizzati indipendentemente da due ricercatori seguendo una griglia costruita ad hoc e seguendo la SIGN checklist per la valutazione metodologica degli articoli. Le barriere e i facilitatori per la gestione autonoma della malattia sono stati sintetizzati tematicamente. 17 articoli sono stati inclusi nelle analisi. Cinque principali temi inerenti le barriere ed i facilitatori delle pratiche di gestione autonoma del diabete di tipo 2 nei pazienti anziani sono stati identificati: aspetti connessi alla malattia, aspetti socio-demografici, aspetti psicologici, aspetti legati alla relazione medico-paziente e aspetti legati al contesto sociale. In particolare, la sintomatologia, le comorbidita e la cronicita dei trattamenti appiano ostacolare principalmente le pratiche di gestione autonoma della malattia. Dall’altra parte, lavorare sulle risorse personali e coinvolgere la rete di pari e familiari rappresentano utili strategie per supportare le pratiche di gestione autonoma della malattia. Infine, la comunicazione con i professionisti sanitari risulta essere la principale fonte di informazione ed educazione per favorire comportamenti di self-care. Poiche coinvolgere i pazienti anziani affetti da diabete di tipo 2 nella gestione della loro malattia si configura come una sfida unica e multisfaccettata che coinvolge diversi livelli di azione potenzialmente modificabili (individuale, relazionale, sociale), si auspica l’individuazione di azioni capaci di considerare questi diversi livelli di azione. Inoltre, emerge il bisogno di un intervento specificamente dedicato ai pazienti anziani, che consideri sia le difficolta connesse all’invecchiamento sia quelle connesse al diabete di tipo 2.

To investigate whether prostate cancer (PCa) patients’ coping strategies (i.e., fighting spirit, anxious preoccupation, fatalism, helplessness/hopelessness, and avoidance) significantly change during the first 3-year follow-up period of active surveillance (AS). Altogether, 104 patients on AS completed the Mini-Mental Adjustment to Cancer (Mini-MAC) at baseline (T0), at 10 and 12 months after diagnostic biopsy (T1 and T2, respectively) and then at 24- (T3) and 36-month (T4) follow-up. Paired samples T test was used to detect statistically significant changes over time. Changes ≥ 1 point (or ≤ − 1) were hypothesized to be clinically relevant. During the first 3 years on AS, men experienced decreased anxiety, avoidance thoughts/behaviors, and fight-against-cancer attitudes, and these changes were found to be statistically significant. When considering clinically significant changes between inclusion in AS (T0) and 3-year follow-up (T4), avoidance decreased in 19% of patients. Most patients were observed to have adopted functional coping strategies at baseline, which were maintained through the first 3 years on AS. Overall, men on AS may perceive increasing control over their cancer and comfort with the AS protocol over time and experience slight decreases in anxious preoccupation, cancer-related avoidance thoughts and behaviors, and fight-against-cancer reactions. For those men who find it difficult to cope with AS, psychological monitoring and interventions could be helpful throughout the monitoring journey.

BACKGROUND Inflammatory bowel diseases [IBD] are characterised by significant quality of life [QoL] impairment, as well as illness perception. Assessing illness perception may help in optimising the management of IBD patients. METHODS In this single-centre, observational, transversal study, consecutive adult IBD patients were enrolled and stratified according to disease activity [active/remission]. The Revised Illness Perception Questionnaire [IPQ-R], based on identity, opinions, and causes of their disease was administered to all patients. Comparison within IPQ-R parameters was done between clinically active patients and those in remission. RESULTS A total of 201 patients were enrolled (Crohn's disease [CD] = 47%). The most frequently reported IBD-related symptoms were fatigue [86.9%], loss of strength [83.3%], pain [80%], and weight loss [68.2%]. Active patients reported significantly more frequently fatigue [p = 0.005], sore eyes [p = 0.046], and sleep difficulties [p = 0.001], and reported more symptoms than controls [p = 0.023]. Overall, the patients considered stress [84.1%], altered immunity [69.32%], family problems [49.4%], and emotional status [40.9%] as the main causes of IBD. Work overload was more frequently considered as a disease cause in active patients than in those in remission [p = 0.002]. Smoking, family history, and previous inadequate therapies were considered as a relevant risk factor for illness by only 20% of patients. Active IBD patients had more negative thoughts on prognosis [p = 0.001] and more negative emotions [p < 0.0001]. Patients in remission were significantly more convinced about treatment control [p = 0.007] and had clearer understanding of illness [p = 0.009]. CONCLUSIONS Illness perception is impaired in IBD patients. Adequate educational and psychological support may be helpful in the optimal management of IBD patients.

Background Information exchange between physician and patient is crucial to achieve patient involvement, shared decision making and treatment adherence. No reliable method exists for measuring how much information physicians provide in a complex, unscripted medical conversation, nor how much of this information patients recall. This study aims to fill this gap by developing a measurement system designed to compare complex orally provided information to patient recall. Methods The development of the complex information transfer measurement system required nine methodological steps. Core activities were data collection, definition of information units and the first draft of a codebook, refinement through independent coding and consensus, and reliability testing. Videotapes of physician-patient consultations based on a standardized scenario and post-consultation interviews with patients constituted the data. The codebook was developed from verbatim transcriptions of the videotapes. Inter-rater reliability was calculated using a random selection of 10% of the statements in the transcriptions. Results Thirtyfour transcriptions of visits and interviews were collected. We developed a set of rules for defining a single unit of information, defined detailed criteria for exclusion and inclusion of relevant units of information, and outlined systematic counting procedures. In the refinement phase, we established a system for comparing the information provided by the physician with what the patient recalled. While linguistic and conceptual issues arose during the process, coders still achieved good inter-rater reliability, with intra-class correlation for patient recall: 0.723, and for doctors: 0.761. A full codebook is available as an appendix. Conclusions A measurement system specifically aimed at quantifying complex unscripted information exchange may be a useful addition to the tools for evaluating the results of health communication training and randomized controlled trials.

Objective Health promotion is a key aspect for health outcomes of prostate cancer (PCa) patients. However, it has been poorly explored among patients following monitoring programmes, for example Active Surveillance (AS). This study aimed to explore PCa patients' perceptions of health promotion during AS. Methods An explorative qualitative research design was adopted. Four focus groups were used to collected data from 24 men enrolled in the Prostate Cancer Research International: AS (PRIAS) protocol. A thematic analysis with an inductive approach was performed. Results Participants described promoting health during AS as challenged by mental, age-related, informational and organisational issues. It was reported as an effort to stay in the present with a positive outlook, despite the worries for the future ("the mental theme"). It was perceived as impacted by being older and having to manage physical and mental struggles related to age ("the life-course theme"). It depended, in their accounts, on obtaining reliable information and personalised education ("the educational theme"). Finally, it was related on taking responsibility on the care process ("the organisational theme"). Conclusion This study suggested ways of promoting health during AS that can help healthcare professionals and organisations building a "health-promoting AS," able to improve overall health outcomes.

In 2002, the World Health Organization emphasised the concept of active ageing to manage and increase the last third of life. Although many efforts have been made to optimise treatment management, less attention has been paid to health promotion initiatives. To date, few shared guidelines exist that promote an active life in healthy older targets. To fill this gap, we conducted a systematic review to map health promotion interventions that targeted an active and healthy ageing among older citizens. Articles containing the key term active ageing and seven synonyms were searched for in the electronic databases. Because we were interested in actions aimed to promote healthier lifestyles, we connected the string with the term health. A total of 3,918 titles were retrieved and 20 articles were extracted. Twelve of the 20 studies used group interventions, five interventions targeted the individual level and three interventions targeted the community level. Interventions differed for the health focus of the programmes, which ranged from physical activity interventions to social participation or cognitive functioning. Most of the studies aimed to act on psychological components. The review suggests that different interventions promoted for active ageing are effective in improving specific healthy and active lifestyles; however, no studies were concerned directly with a holistic process of citizen health engagement to improve long-term outcomes.

The participatory health revolution is shaping consumers' health behaviors that are increasingly influence by people's desire to play an active role in promoting a positive life functioning. Technologies are addressing the emerging needs of the participatory health, as they favor a proactive users' attitude. This chapter describes the results of a software-assisted quali-quantitative study aimed at exploring the scientific debate about technological interventions for wellbeing in the era of participatory health. Based on the study's results, technologies for wellbeing in the participatory health era may be clustered depending on the “context of delivery,” on their degree of personalization,” and on their inner “conceptualization of positive interventions”. According to a consumer health engagement perspective, those technologies are not mutually exclusive but can coexist based on the specific wellness needs and health engagement expectations of their users.

Background The issue of breaking bad news in assisted reproductive technology (ART) has been only partially explored by literature, and although some recommendations are available, specific guidelines are lacking. The present study aimed to explore the applicability of the oncologic SPIKES Protocol to the ART context. Methods Thirteen ART clinicians (7 gynecologists; 4 psychologists; 1 biologist; 1 obstetrician) completed the Critical Incidents Report (CIR) to describe the experience of delivering bad news in ART. The CIRs were first discussed with clinicians, then a focus group was created composed of 13 clinicians, one health communication expert and a patient to discuss the applicability of the six-step (SPIKES) Buckman Protocol to ART. The discussion was audiotaped, transcribed and analyzed with content analysis. Results The SPIKES Protocol seems to fit ART consultations and participants found it practical and easy to understand. Some specificities were found for the ART context: the reiteration of bad news, the “patient” as a couple and the fact that ability to conceive is closely related to self-esteem, as well as to social and family identity. During the discussion of the SPIKES Protocol, participants highlighted the importance of: 1) providing a caring setting, by adding a reflection on the value of communication by phone; 2) exploring patients’ perceptions but also misinformation; 3) exploring patients’ desires and expectations, while balancing the need to be honest and clear; 4) applying Buckman’s suggestions for delivering information, and integrating clinical aspects with psychosocial ones; 5) managing and legitimizing patients’ emotions, in particular anger; 6) having a strategy for follow-up and supporting couples to make meaning of the ART experience. Conclusion The proposal of a shared protocol for giving bad news in ART could be the starting point for training and experimental studies.

Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal. This contributes to a wide “system” inertia—really difficult to be overcome—and put at risk any form of innovation in this filed. As a result, patient engagement risk today to be a buzz words, rather than a real guidance for practice. To make the field clearer, we promoted an Italian Consensus Conference on Patient Engagement (ICCPE) in order to set the ground for drafting recommendations for the provision of effective patient engagement interventions. The ICCPE will conclude in June 2017. This document reports on the preliminary phases of this process. In the paper, we advise the importance of “fertilizing a patient engagement ecosystem”: an oversimplifying approach to patient engagement promotion appears the result of a common illusion. Patient “disengagement” is a symptom that needs a more holistic and complex approach to solve its underlined causes. Preliminary principles to promote a patient engagement ecosystem are provided in the paper.

eHealth and mHealth interventions for type 2 diabetes are emerging as useful strategies to accomplish the goal of a high functioning integrated care system. However, mHealth and eHealth interventions in order to be successful need the clear endorsement from the healthcare professionals. This cross-sectional study included a sample of 93 Italian-speaking type 2 diabetes patients and demonstrated the role of the perceived ability of healthcare professionals to motivate patients' initiative in improving the level of their engagement and activation in type 2 diabetes self-management. The level of type 2 diabetes patients' activation resulted also in being a direct precursor of their attitude to the use of mHealth and eHealth. Furthermore, patient engagement has been demonstrated to be a mediator of the relationship between the perceived ability of healthcare professionals in motivating type 2 diabetes patients and patients' activation. Finally, type 2 diabetes patients adherence did not result in being a direct consequence of the frequency of mHealth and eHealth use. Patient adherence appeared to be directly influenced by the level of perceived healthcare professionals ability of motivating patients' autonomy. These results offer important insights into the psychosocial and organizational elements that impact on type 2 diabetes patients' activation in self-management and on their willingness to use mHealth and eHealth devices.

eHealth and mHealth interventions for type 2 diabetes are emerging as useful strategies to accomplish the goal of a high functioning integrated care system. However, mHealth and eHealth interventions in order to be successful need the clear endorsement from the healthcare professionals. This cross-sectional study included a sample of 93 Italian-speaking type 2 diabetes patients and demonstrated the role of the perceived ability of healthcare professionals to motivate patients’ initiative in improving the level of their engagement and activation in type 2 diabetes self-management. The level of type 2 diabetes patients’ activation resulted also in being a direct precursor of their attitude to the use of mHealth and eHealth. Furthermore, patient engagement has been demonstrated to be a mediator of the relationship between the perceived ability of healthcare professionals in motivating type 2 diabetes patients and patients’ activation. Finally, type 2 diabetes patients adherence did not result in being a direct consequence of the frequency of mHealth and eHealth use. Patient adherence appeared to be directly influenced by the level of perceived healthcare professionals ability of motivating patients’ autonomy. These results offer important insights into the psychosocial and organizational elements that impact on type 2 diabetes patients’ activation in self-management and on their willingness to use mHealth and eHealth devices.

The present article aims to review the literature on the relationship between psychology and inflammatory bowel disease (IBD). In particular, the first section is dedicated to explore the role of psychological factors in the etiopathology of the disease, its development and the efficacy of treatments, while the second analyzes existing literature on the role of psychological interventions in the care of IBD patients. Although the role of psychological factors in IBD appears controversial, literature seems to distinguish between antecedents of the disease (stress and lifestyle behavior), potential mediators of disease course (family functioning, attachment style, coping strategies, and illness perception), outcomes of IBD and concurrent factors (anxiety, depression and quality of life). Four types of psychological interventions are described: Stress management, Psychodynamic, Cognitive behavioral and Hypnosis based. Data on the role and efficacy of psychological interventions in IBD patients show little evidence both on reduction of the disease activity and benefits on psychological variables. Psychological interventions seem to be beneficial in the short term especially for adolescents. The importance of considering the connections between psychology and IBD from a broader perspective reflecting the complexity of the phenomenon at multiple levels is discussed.