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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.

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.

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.

Background Providing diagnostic and treatment information to patients is a core clinical skill, but evidence for the effectiveness of different information-giving strategies is inconsistent. This systematic review aimed to investigate the reported effects of empirically tested communication strategies for providing information on patient-related outcomes: information recall and (health-related) behaviors. Methods The databases MEDLINE, Embase, PsycINFO (Ovid), Cochrane Central Register of Controlled Trials, and relevant bibliographies were systematically searched from the inception to April 24, 2020, without restrictions, for articles testing information-giving strategies for physicians (PROSPERO ID: CRD42019115791). Pairs of independent reviewers identified randomized controlled studies with a low risk of selection bias as from the Cochrane risk of bias 2 tool. Main outcomes were grouped into patient information recall and behavioral outcomes (e.g., alcohol consumption, weight loss, participation in screening). Due to high heterogeneity in the data on effects of interventions, these outcomes were descriptively reported, together with studies’, interventions’, and information-giving strategies’ characteristics. PRISMA guidelines were followed. Results Seventeen of 9423 articles were included. Eight studies, reporting 10 interventions, assessed patient information recall: mostly conducted in experimental settings and testing a single information-giving strategy. Four of the ten interventions reported significant increase in recall. Nine studies assessed behavioral outcomes, mostly in real-life clinical settings and testing multiple information-giving strategies simultaneously. The heterogeneity in this group of studies was high. Eight of the nine interventions reported a significant positive effect on objectively and subjectively measured patients’ behavioral outcomes. Discussion Using specific framing strategies for achieving specific communication goals when providing information to patients appears to have positive effects on information recall and patient health–related behaviors. The heterogeneity observed in this group of studies testifies the need for a more consistent methodological and conceptual agenda when testing medical information-giving strategies. Trial Registration PROSPERO registration number: CRD42019115791

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.

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 Personalized medicine is becoming a widespread effort to provide the right treatment to the right patient at the right time. However, it lacks of consideration for nonmedical factors, such as patient preferences and psychosocial factors, which should not be avoided. Objective and methods The present study summarizes the psychosocial difficulties experienced by patients with inflammatory bowel disease (IBD) during different phases of the disease in order to identify methods to assess psychosocial risk factors and personalize treatment strategies. To reach this goal, the quantitative literature is matched with the patients' perspective, offering a broad overview of psychosocial risk factors that IBD patients experience. Results Quantitative results offer strong evidences for specific psychosocial risk factors in IBD and for weak results of psychosocial interventions, but show a lack of individually tailored researches, instruments and interventions, increasing the distance between the research findings and clinical practice. At the same time, qualitative findings show important, though veiled information uncovered by the quantitative research (e.g., identity recovery, fight for control, sexual concerns), which may be used as a starting point for further explorations. Conclusion The present study suggests a need to adopt individualized therapeutic approach and deliver psychological therapies while taking into account patients' experiences and preferences.

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.

L’aumento dell’aspettativa di vita, ed il conseguente incremento di malattie croniche, pone importanti sfide alle societa contemporanee. Parlare di invecchiamento attivo significa occuparsi in maniera sostenibile ed efficace di una serie di problematiche – cliniche, psicologiche, sociali - che sempre piu possono accompagnare la terza eta. La missione e valorizzare l'utile contributo degli anziani alla societa, favorendo opportune condizioni di lavoro, di partecipazione alla vita sociale e di vita sana ed indipendente. Eppure simili iniziative possono risultare inefficaci se considerano il cittadino anziano passivo recettore e non ne sostengono la capacita di diventare attivo promotore del suo benessere e della sua salute. La ricerca qui presentata, parte del piu ampio progetto "Crescere da Anziani", si e articolata in tre fasi: un primo momento e stato dedicato a sistematizzare e mappare gli interventi attualmente presenti in letteratura finalizzati alla promozione dell’invecchiamento attivo; un secondo momento e stato dedicato ad approfondire l’esperienza di gestione della salute da parte del cittadino anziano al fine di comprendere quali condizioni (soggettive, relazionali e contestuali) possano favorirne il coinvolgimento attivo (engagement) in quest’area; un ultimo momento, infine, ha previsto la verifica quantitativa delle relazioni associative tra coinvolgimento attivo nella gestione della salute e una selezione di caratteristiche socio-anagrafiche e psicologiche dell’individuo. Il presente documento riporta in modo sintetico e critico i principali risultati emersi dalla ricerca al fine di trarre implicazioni operative per la ricerca e l’intervento in quest’area.

Objectives In this qualitative study, we provide an in-depth exploration of older people9s experiences and subjective meanings concerning their engagement in health promotion as well as the emotional and pragmatic difficulties they face during their engagement. Methods The study was designed according to the ethnoscience method, which implies a participatory process that values patients9 linguistic expressions to deeply understand the phenomena under the investigation and to give it a meaning. Using this method, thanks to repeated rounds of interviews and the Q-sorting task, participants created a dictionary, with the assistance of the researcher, to describe the phenomenon of interest. They agreed on a shared taxonomy of meanings and experiences related to the phenomenon. 25 North Italian older citizens participated in this study. Results Participants described a shared taxonomy of health engagement experiences by depicting 3 main positions (ie, locked position; awakening position; climbing position), which represented different experiential domains grouped by participants into 4 main semantic areas (eg, physical care, soul care, daily lifestyle, contact with ageing). Each position is characterised by specific emotions, personal representations of meaning and healthy behaviours that may sustain or hinder older citizens9 engagement in health promotion. Conclusions The results of the present study suggest the importance of deeply understanding older peoples9 experiences and their subjective meanings of health promotion. In particular, the results showed how their engagement in health promotion is framed in a complex system of psychological meanings, which may sustain or hinder their ability to adopt healthy behaviours. A deeper understanding of older citizens9 lived experiences, their doubts and their difficulties in engaging in health promotion may offer some important cues for orienting interventions in this area.

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 main purpose of the present study was to understand the subjective experience of patients adjusting to cancer by focusing on how that experience might be affected by participating in a psychodramatic group intervention. In-depth interviews using an interpretative-phenomenological approach were conducted with eight cancer patients involved in a psychodrama group. Four key themes were identified: (1) outside and inside relationships; (2) identities: nurturing other selves; (3) a feelings' gym: performing the internal world; and (4) many ends: mourning death and dying. Participation in cancer group using a psychodramatic approach provided positive results. In detail, the group setting: (1) favoured relationships in which it was possible to freely express oneself and (2) empowered patients in their feelings of being able to give and receive help; the psychodramatic approach: (1) supported the physical mobilisation of sense of agency and (2) permitted to deal with the grieving process. Cancer healthcare pathways would benefit from psychotherapeutic programmes using a similar approach, since psychodrama by actively involving body seems to works on areas that are often underwhelmed by other approaches, such as (i.e., physical mobilisation, body engagement, grieving adjustment). Psychodrama supports patients to achieve insights into their own possibilities to actively participate in their own life situations despite having cancer and undergoing treatment for it.

Introduzione. Recentemente la letteratura ha iniziato ad occuparsi del tema del coinvolgimento dei pazienti nelle cure attraverso il concetto di patient engagement. Il costrutto di engagement e stato fin’ora studiato in relazione al paziente ma mancano contributi volti a studiare il processo di engagement dei caregivers. Il fine vita pediatrico e un ambito in cui il coinvolgimento dei genitori e stato invocato sotto diversi aspetti, eppure poco si sa dell’esperienza di engagement dei genitori nel processo di cura. All’interno di un piu ampio studio sulla qualita delle cure di fine vita in Terapia Intensiva Pediatrica (TIP), il presente lavoro ha avuto l’obiettivo di esplorare l’esperienza di engagement dei genitori. Metodi. Lo studio si e svolto presso la TIP dell’Ospedale Policlinico di Milano. Con i genitori dei bambini deceduti tra il 2007-2010 sono state effettuate delle interviste semi-strutturate riguardanti l’esperienza delle cure di fine vita. I passaggi delle interviste riguardanti l’esperienza di engagement sono state analizzate tramite analisi del contenuto. Risultati. Sono state condotte 8 interviste con 12 genitori. L’engagement dei genitori si articola su tre dimensioni: 1) informativa (sapere); 2) decisionale (decidere); 3) relazionale (esserci). Queste dimensioni possono variare come essere compresenti in gradazioni diverse durante il ricovero del figlio. Conclusioni. Dai risultati emerge un concetto multidimensionale di engagement. In questo ambito clinico sembra che l’engagement dei genitori nelle cure mediche si fondi sul ruolo genitoriale e ne costituisca una declinazione. L’engagement verso i clinici e la TIP sembra continuare anche dopo la morte del figlio durante il processo del lutto.

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.