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Background: Educational programs incorporating physical activity (PA) sessions and nutritional workshops have demonstrated potential benefits for overweight and obese pregnant women. However, participation in such programs remains challenging. This prospective study aimed to investigate the factors influencing participation and regular attendance, while examining changes in health behaviors, along with obstetric and neonatal outcomes. Methods: Pregnant women with at 12–22 weeks' gestation a BMI ≥ 25 kg/m2 were invited to join an educational program combining three nutritional workshops conducted in groups and 12 weekly PA sessions. They self-selected their participation into the program. Regardless of program uptake and regularity of attendance, the women's PA levels, eating behaviors, and affectivity were assessed using validated questionnaires at 20–24 weeks, 32–34 weeks, and postpartum. A multivariable logistic regression model was used to determine the factors influencing participation. Results: Of the 187 women enrolled in the study, 61.5% agreed to participate in the program. Of these, only 45% attended six or more sessions (regardless of the nature of sessions, i.e. nutritional workshops and/or PA sessions), while only 8.7% attended six or more PA sessions. Participation was associated with higher rates of problematic eating behaviors and lower PA levels at baseline, while regular attendance was mainly associated with higher household incomes. No significant difference was observed between participants and non-participants in terms of changes in eating behaviors, PA levels, or affectivity. However, at the 32–34 week visit, regular participants displayed a higher change in positive affectivity, but unexpectedly also in cognitive restraint, than non-regular participants, a difference that did not persist at postpartum. Conclusion: The educational program combining nutrition and PA was shown to be safe. Women facing challenges related to health behavior displayed a willingness to sign up for the program, but tailored interventions addressing their individual challenges are needed to improve attendance. Accordingly, four recommendations are proposed for the design of future interventions. Trial registration: ClinicalTrials.gov; Identifier: NCT02701426; date of first registration: 08/03/2016. [ABSTRACT FROM AUTHOR]

Objective: In oncology, research remains unclear as to whether physician empathy is associated with patient outcomes. Our goal was to answer this question and explore potential moderators of the association. Methods: In this meta‐analysis on adult cancer care, we excluded randomised controlled trials, and studies of survivors without active disease or involving analogue patients. Eight databases were searched, in addition to reference lists of relevant articles and grey literature. Two reviewers independently screened citations, extracted data, assessed risk of bias and graded quality of evidence by using the AXIS tool. Effect size correlations (ESr) were chosen and pooled by using a random effect model. Subgroup analyses were performed, and statistically significant variables were introduced in a meta‐regression. Several methods were used to explore heterogeneity and publication biases. Results: We included 55 articles, yielding 55 ESr (n = 12,976 patients). Physician empathy was associated with favourable patient outcomes: ESr = 0.23, 95% confidence interval (CI) (0.18 to 0.27), z = 9.58, p < 0.001. However, heterogeneity was high, as reflected by a large prediction interval, 95% (−0.07 to 0.49) and I2 = 94.5%. The meta‐regression explained 53% of variance. Prospective designs and physician empathy assessed by researchers, compared with patient‐reported empathy, decreased ESr. Bad‐news consultations, compared with all other types of clinical encounters, tended to increase ESr. Conclusion: Patient‐reported physician empathy is significantly associated with cancer patient outcomes. However, the high heterogeneity warrants further longitudinal studies to disentangle the conditions under which physician empathy can help patients. Recommendations are proposed for future research. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of global physician empathy and its three subdimensions (establishing rapport, emotional and cognitive processes) on the severity of postoperative complications in a sample of cancer patients. Methods: We retrospectively analyzed data on 256 patients with esogastric cancer from the French national FREGAT database. Empathy and its subdimensions were assessed using the patient-reported CARE scale and the severity of medical and surgical complications was reported with the Clavien-Dindo classification system. The usual covariates were included in multinomial logistic regression analyses. Results: Physician empathy predicted the odds of reporting major complications. When patients perceived high empathy, they were less likely to report major complications compared to no complications (OR =.95, 95% CI = [.91–.99], p =.029). Among the three dimensions, only "establishing rapport" (OR =.84, 95% CI = [.73–.98], p =.019) and the "emotional process" (OR =.85, 95% CI = [.74–.98], p =.022) predicted major complications. Conclusions: Physician empathy is essential before surgery. Further research is needed to understand the mechanisms associating empathy with health outcomes in cancer. Physicians should be trained to establish good rapport with patients, especially in the preoperative period. [ABSTRACT FROM AUTHOR]

Objective: The mechanisms associating physician empathy (PE) with patient outcomes remain unclear. PE can be considered as a whole (one process) or three subcomponents can be identified (an establishing rapport process; an emotional process; a cognitive process). The objective was to test two competitive models of PE in cancer care: a three‐process model adapted from Neumann's model versus a one‐process model, with the use of the Consultation and Relational Empathy measure (CARE). Methods: The CARE was completed by 488 oesogastric cancer patients from the national French database FREGAT. A confirmatory factor analysis (CFA) and a bifactor model were performed to test the two competitive models. Results: The CFA revealed that the one‐factor structure showed a moderate fit to the data whereas the three‐factor structure showed a good fit. However, the bifactor model favoured unidimensionality. Conclusion: We cannot provide a clear‐cut conclusion about whether PE should be considered as on unique process or not. Further work is still needed. Meanwhile, one should not preclude the use of three subscores in cancer care if specific elements of the encounter need to be assessed. [ABSTRACT FROM AUTHOR]

Aims: To explore professionals' (i.e. nurses and nursing assistants) motivation for Patient Education according to their emotional skills. Design: A cross‐sectional study using a convenience sample of professionals completing self‐reported questionnaires assessing their general emotional skills and their Patient‐Education‐related sense of competence, autonomy and relatedness, according to the theory of basic psychological needs. Methods: Professionals from 27 French hospitals working in various departments completed paper and web‐based questionnaires between January 2015 ‐ May 2017. Mediation analyses were performed controlling for the already known variables associated with motivation for patient education. Results: Usable questionnaires (N = 185) were analysed. Professionals' emotional skills were associated with their motivation for Therapeutic Patient Education both directly and indirectly (i.e. partial mediation) via a higher sense of competence in Patient Education. Among the covariates, professionals who had received a high‐level training in Patient Education, those with a high recognition of their work in patient education and nurses (compared with nursing assistants) were the most motivated. Conclusion: Professionals' emotional skills are the mainstay of their motivation for Patient Education. Training should aim to develop these skills so that professionals can manage their own emotions better (e.g. frustration when faced with non‐motivated patients) and those of patients (e.g. discouragement) and thus effectively support patient self‐management. Impact: The study addressed nurses' and nursing assistants' motivation for patient education. Their emotional skills were directly and indirectly – via a higher sense of patient‐education‐related competence – associated with higher motivation. Training for professionals should therefore develop their emotional skills. [ABSTRACT FROM AUTHOR]

Objective: In cancer settings, physician empathy is not always linked to a better patient emotional quality of life quality of life (eQoL). We tested two possible moderators of the inconsistent link: type of consultation (bad news versus follow-up) and patient emotional skills (emoSkills, i.e., the way patients process emotional information).Methods: In a cross-sectional design, 296 thoracic and digestive tract cancer patients completed validated questionnaires to assess their physician empathy, their emoSkills and eQoL. Moderated multiple regressions were performed.Results: In follow-up consultations, physician empathy was associated with a better eQoL in patients with low or average emotional skills. Those with high emotional skills did not benefit from physician empathy. Their eQoL was nonetheless very good. In bad news consultations, the pattern was reversed: only patients with average or high emotional skills benefited from physician empathy. Those with low emotional skills were not sensitive to it and presented a poor eQoL.Conclusion: Medical empathy is important in all consultations. However, in bad news consultations, patients with low emoSkills are at risk of psychological distress even with an empathetic doctor.Practice Implications: Accordingly, physicians should be trained to detect patients with low emoSkills in order to refer them to supportive care. [ABSTRACT FROM AUTHOR]

Therapeutic patient education is effective for various patient outcomes; however, healthcare professionals sometimes lack the motivation to carry out patient education. Surprisingly, this issue has rarely been addressed in research. Therefore, this study explores healthcare professionals' perceived barriers to and motivation for therapeutic patient education. Healthcare professionals, mainly nurses, working in different French hospitals were interviewed. Thematic content analysis was performed. Findings included a lack of skills, knowledge, and disillusionment of the effectiveness of therapeutic patient education were features of a demotivated attitude. In contrast, a positive attitude was observed when therapeutic patient education met a need to work differently and more effectively. A key factor motivating professionals was the integration of therapeutic patient education in routine care within a multidisciplinary team. To keep healthcare professionals motivated, managers should ensure that therapeutic patient education is implemented in accordance with its core principles: a patient-centered approach within a trained multidisciplinary team. In the latter case, therapeutic patient education is viewed as an efficient and rewarding way to work with patients, which significantly motivates healthcare professionals. [ABSTRACT FROM AUTHOR]

Objective: Unmet supportive care needs of patients decrease patient perception of physician empathy (PE). We explored whether the accurate physician understanding of a given patient's unmet needs (AU), could buffer the adverse effect of these unmet needs on PE.Methods: In a cross-sectional design, 28 physicians and 201 metastatic cancer patients independently assessed the unmet supportive care needs of patients. AU was calculated as the sum of items for which physicians correctly rated the level of patient needs. PE and covariates were assessed using self-reported questionnaires. Multilevel analyses were carried out.Results: AU did not directly affect PE but acted as a moderator. When patients were highly expressive and when physicians perceived poor rapport with the patient, a high AU moderated the adverse effect of patient unmet needs on PE.Conclusion: Physician AU has the power to protect the doctor-patient relationship in spite of high patient unmet needs, but only in certain conditions.Practice Implications: Physicians should be encouraged toward AU but warned that high rapport and patient low emotional expression may impede an accurate reading of patients. In this latter case, they should request a formal assessment of their patients' needs. [ABSTRACT FROM AUTHOR]

Objective Unmet supportive care needs of patients decrease patient perception of physician empathy (PE). We explored whether the accurate physician understanding of a given patient's unmet needs (AU), could buffer the adverse effect of these unmet needs on PE. Methods In a cross-sectional design, 28 physicians and 201 metastatic cancer patients independently assessed the unmet supportive care needs of patients. AU was calculated as the sum of items for which physicians correctly rated the level of patient needs. PE and covariates were assessed using self-reported questionnaires. Multilevel analyses were carried out. Results AU did not directly affect PE but acted as a moderator. When patients were highly expressive and when physicians perceived poor rapport with the patient, a high AU moderated the adverse effect of patient unmet needs on PE. Conclusion Physician AU has the power to protect the doctor–patient relationship in spite of high patient unmet needs, but only in certain conditions. Practice implications Physicians should be encouraged toward AU but warned that high rapport and patient low emotional expression may impede an accurate reading of patients. In this latter case, they should request a formal assessment of their patients’ needs. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine the determinants of the accuracy with which physicians assess metastatic cancer patient distress, also referred to as their empathic accuracy (EA). Hypothesized determinants were physician empathic attitude, self-efficacy in empathic skills, physician-perceived rapport with the patient, patient distress and patient expressive suppression. Methods: Twenty-eight physicians assessed their patients’ distress level on the distress thermometer, while patients (N =201) independently rated their distress level on the same tool. EA was the difference between both scores in absolute value. Hypothesized determinants were assessed using self-reported questionnaires. Multilevel analyses were carried out. Results: Little of the variance in EA was explained by physician variables. EA was higher with higher levels of patient distress. Physician-perceived quality of rapport was positively associated with EA. However, for highly distressed patients, good rapport was associated with lower EA. Patient expressive suppression was also related to lower EA. Conclusion: This study adds to the understanding of EA in oncological settings, particularly in challenging the common assumption that EA depends largely on physician characteristics or that better rapport would always favor higher EA. Practice implications: Physicians should ask patients for feedback regarding their emotions. In parallel, patients should be prompted to express their concerns. [Copyright &y& Elsevier]

Objective Despite a call for empathy in medical settings, little is known about the effects of the empathy of health care professionals on patient outcomes. This review investigates the links between physicians' or nurses' empathy and patient outcomes in oncology. Method With the use of multiple databases, a systematic search was performed using a combination of terms and subject headings of empathy or perspective taking or clinician-patient communication, oncology or end-of-life setting and physicians or nurses. Among the 394 hits returned, 39 studies met the inclusion criteria of a quantitative measure of empathy or empathy-related constructs linked to patient outcomes. Results Empathy was mainly evaluated using patient self-reports and verbal interaction coding. Investigated outcomes were mainly proximal patient satisfaction and psychological adjustment. Clinicians' empathy was related to higher patient satisfaction and lower distress in retrospective studies and when the measure was patient-reported. Coding systems yielded divergent conclusions. Empathy was not related to patient empowerment (e.g. medical knowledge, coping). Conclusion Overall, clinicians' empathy has beneficial effects according to patient perceptions. However, in order to disentangle components of the benefits of empathy and provide professionals with concrete advice, future research should apply different empathy assessment approaches simultaneously, including a perspective-taking task on patients' expectations and needs at precise moments. Indeed, clinicians' understanding of patients' perspectives is the core component of medical empathy, but it is often assessed only from the patient's point of view. Clinicians' evaluations of patients' perspectives should be studied and compared with patients' reports so that problematic gaps between the two perspectives can be addressed. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The objective of this research is to propose a comprehensive model for the prediction of long-term mental health in breast cancer survivors diagnosed 5 to 15 years earlier, compared to female participants referring to the most stressful event that occurred within the last 20 years. Nearly 300 survivors and 132 comparison participants were consulted using a questionnaire, which evaluated personality variables, transactional variables, and current mental quality of life. Structural equation modeling was used. The transactional proposed model was able to account for long-term mental health variance in both groups but was more relevant to women with breast cancer. [ABSTRACT FROM AUTHOR]

Background: Pre-pregnancy obesity and excessive gestational weight gain (GWG) are established risk factors for adverse pregnancy, delivery and birth outcomes. Pregnancy is an ideal moment for nutritional interventions in order to establish healthier lifestyle behaviors in women at high risk of obstetric and neonatal complications.Methods: Electronic-Personalized Program for Obesity during Pregnancy to Improve Delivery (ePPOP-ID) is an open multicenter randomized controlled trial which will assess the efficacy of an e-health web-based platform offering a personalized lifestyle program to obese pregnant women in order to reduce the rate of labor procedures and delivery interventions in comparison to standard care. A total of 860 eligible pregnant women will be recruited in 18 centers in France between 12 and 22 weeks of gestation, randomized into the intervention or the control arm and followed until 10 weeks of postpartum. The intervention is based on nutrition, eating behavior, physical activity, motivation and well-being advices in which personalization is central, as well as the use of a mobile/tablet application. Inputs includes data from the medical record of participants (medical history, anthropometric data), from the web platform (questionnaires on dietary habits, eating behavior, physical activity and motivation in both groups), and adherence to the program (time of connection for the intervention group only). Data are collected at inclusion, 32 weeks, delivery and 10 weeks postpartum. As primary outcome, we will use a composite endpoint score of obstetrical interventions during labor and delivery, defined as caesarean section and instrumental delivery (forceps and vacuum extractor). Secondary outcomes will consist of data routinely collected as part of usual antenatal and perinatal care, such as GWG, hypertension, preeclampsia, as well as fetal and neonatal outcomes including premature birth, gestational age at birth, birth weight, macrosomia, Apgar score, arterial umbilical cord pH, neonatal traumatism, hyperbilirubinemia, respiratory distress syndrome, transfer in neonatal intensive care unit, and neonatal adiposity. Post-natal outcomes will be duration of breastfeeding, maternal weight retention and child weight at postnatal visit.Discussion: The findings of the ePPOP-ID trial will help design e-health intervention program for obese women in pregnancy.Trial Registration: ClinicalTrials.gov Identifier: NCT02924636 / October 5th 2016. [ABSTRACT FROM AUTHOR]

Objectives: Traditionally, the literature investigating patient‐reported outcomes in relation to cancer survival focused on negative factors such as distress. Meta‐analyses in this field have provided a clear identification of negative affect that reduce cancer survival (e.g., depression). Nevertheless, positive psychological factors and especially positive affect might be equally crucial for cancer survival but have been neglected so far. While studies in this domain have been conducted, they remain less numerous and have produced mixed results. Methods: A pre‐registered systematic review and meta‐analysis (https://osf.io/jtw7x) aimed at identifying the positive affect linked to mortality in cancers were conducted. Four databases (Pubmed, PsycINFO, Embase, and Cochrane Library) were searched to find longitudinal studies linking positive affect to survival in cancers. Two reviewers completed each stage of the study selection process, the data extraction, and the Quality in Prognosis Studies risk of bias assessments. Results: Twenty‐four studies involving 822,789 patients were included based on the 2462 references identified. The meta‐analysis reveals that positive affect is associated with longer survival (Hazard Ratio [HR] = 0.91; 95% CI [0.86, 0.96], z = −3.58, p < 0.001) and lower mortality (Odd Ratio [OR] = 0.59; 95% CI [0.45, 0.78], z = −3.70, p < 0.001). Sub‐group analyses indicated that the main predictors of survival are emotional and physical well‐being, optimism, and vitality. Conclusion: This work emphasizes the need to consider the role of affective mechanisms in patients with cancer, including their levels of well‐being or optimism to provide the most favorable conditions for survival. Therefore, stronger and continuous effort to improve patients' positive affect could be particularly beneficial for their life expectancy. [ABSTRACT FROM AUTHOR]

Objective: The aims were to: (1) apply the guidelines to develop and test the validity of video-vignettes manipulating empathy and context in oncology; (2) compare lay people's and patients' assessments of validity; (3) reflecting on our experiment METHODS: Guidelines were followed: (1) deciding whether video-vignettes were appropriate; (2) developing a valid script; (3) designing valid manipulations; (4) converting the scripted consultations into videos. One hundred sixteen lay people and 46 cancer patients filled in the Video Engagement Scale, the CARE, and ad hoc questionnaires on realism and emotions.Results: The video-vignettes are valid for experimental use. Differences appeared in the emotions participants reported. The empathic processes were successfully manipulated and perceived. Lay people's and patients' assessments were equivalent, except for video-vignettes in neutral consultations. Participants' comments on nonverbal behavior, camera perspective, scripts and empathy assessment were reported.Conclusion: Patients' assessments are impacted by their personal experiences. Researchers should control for this in analogue patient studies.Practice Implications: Based on this experience, we reflect on: (1) adopting congruent nonverbal behavior throughout the video-vignettes; (2) alternating camera perspectives; (3) avoiding the sole use of written scripts; (4) using quantitative and qualitative analysis to validate scripts and video-vignettes. [ABSTRACT FROM AUTHOR]

Despite a growing number of studies on the role of the multidimensional construct of trait emotional intelligence (EI) in health, most have focused on global EI, without examining the role of the sub‐dimensions. The present systematic review aimed to highlight the current knowledge about self‐reported health associated with trait‐EI sub‐dimensions in general and clinical populations. We searched for the articles including valid self‐report scales of trait‐EI and health (mental or physical or general) in general and clinical samples. Based on 42 studies, the majority of studies was based on mental health with cross‐sectional designs and the TMMS scale, in the general population. Few studies have been focused on physical health and clinical population. The description of studies results revealed that trait‐EI sub‐dimensions are associated to a greater extent with better mental health, rather than with physical and general health. Furthermore, intrapersonal dimensions, and especially emotion regulation, have stronger effects on health than interpersonal dimensions. Finally, patients with a clinical disorder present lower trait‐EI sub‐dimensions than the general population. This review supports the importance of focusing on the sub‐dimensions of trait‐EI to understand better the role of EI in health. The use of scales exclusively based on emotional competences in health contexts is recommended. Developing interventions targeting emotional competences according to the emotional profiles and contexts of individuals could be beneficial to improve health and disease adjustment. [ABSTRACT FROM AUTHOR]