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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.

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.

The extraordinary circumstances of deaths during COVID-19 pandemic have been challenging for the deceased's families. This contribution aims to describe some spontaneous strategies that family members may adopt to cope with the loss of a relative for COVID-19. The present reflection derives from the experience of a clinical psychology unit of one of the biggest public hospital in Milan, Italy, which supported 246 families of COVID-19 victims in the 1st days after the loss. Spontaneous strategies used by family members to deal with such a unique mourning process involved: creating alternative good-bye rituals, normalizing the loss, addressing faith and hope, highlighting the perks of isolation, supporting others in need, and delivering the bad news to others. These observed strategies may suggest how to assess and support a “normal” bereavement process during the extraordinary COVID-19 circumstances, in order to prevent further psychological distress.

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.

Several studies have been conducted on the quality of life (QoL) in men with low risk prostate cancer (PCa) who choose active surveillance (AS). While recent reviews have shown a lack of consistency among the available QoL-studies, a few key points have been identified, including decision-making (DM)-related issues and their potential effect on QoL. The importance of this theme has also been recently highlighted by the international task force of the European School of Oncology. However, to our knowledge, there are no studies that have specifically marshalled scientific knowledge on the association between DM and QoL among men with low-risk PCa undergoing AS. We performed a literature review to fill this gap, taking a systematic approach to retrieving and selecting articles that included both DM and QoL measures. Among the 272 articles retrieved, we selected nine observational, quantitative articles with both DM and QoL measures. The most considered DM aspects within these studies were decisional conflict and preference for the patient's role in the DM process, as well as health-related QoL aspects. The studies included 42 assessments of the relationship between an empirical measure of DM and an empirical measure of QoL. Among these assessments, 23 (55%) were both positive and significant. They mostly concerned the relationship between patient-related (decisional self-efficacy, decisional control and knowledge) and external (presence of social support, collaborative role within the DM process, and influence of different physicians) DM aspects, as well as the QoL after choice. The findings of these studies revealed key challenges to research and clinical practice related to DM and QoL in AS. These include adopting a person-centred perspective where clinicians, caregivers and their interactions are also included in evaluations and where the psychosocial existential experience of individuals within the DM and AS journey is considered. Much more attention needs to be paid to the DM process after diagnosis, as well as to all the other moments where patients may have to or want to review their decision. Healthcare professionals play a key role in enabling men to make informed decisions and to take care of their health and well-being during AS. There is still work that needs to be done in training healthcare professionals from different disciplines to work together in a model of shared DM and AS tailored to the needs of low-risk PCa patients and their family members.

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.

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.

The increasing prevalence of chronic conditions among older adults constitutes a major public health problem. Thus, changes in lifestyles are required to prevent secondary conditions and sustain good care practices. While patient engagement received great attention in the last years as key strategy to solve this issue, to date no interventions exist to sustain the engagement of older chronic patients towards their health management. This study describes the design, development, and optimization of PHEinAction, a theoretically-driven intervention program to increase patient engagement in older chronic populations, and, consequently, to foster healthy changes that can help reduce risks of health problems. The development process followed the UK Medical Research Council’s (MRC) guidelines and involved selecting the theoretical base for the intervention, identifying the relevant evidence-based literature, and conducting exploratory research to qualitatively evaluate program’s feasibility, acceptability and comprehension. The result was a user-endorsed intervention designed to improve older patients’ engagement in health management based on the theoretical framework of the Patient Health Engagement (PHE) model. The intervention program, which emerged from this process, consisted of two monthly face-to-face 1-hour sessions delivered by a trained facilitator and one brief telephonic consultation, and aimed to facilitate a range of changes for patient engagement (e.g., motivation to change, health information seeking and use, emotional adjustment, health behaviors planning). PHEinAction is the first example of a theoretically-based patient engagement intervention designed for older chronic targets. The intervention program is based on psychological theory and evidence; it facilitates emotional, psychological, and behavioral processes to support patient engagement and lifestyle change and maintenance. It provides estimates of the extent to which it could help high-risk groups engage in effective health management and informs future trials.

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.