The choice dilemma in chronic hematological conditions: Why choosing is not only a medical issue? A psycho-cognitive perspective

Toward a new personalized psycho-social approach for the support of prostate cancer and their caregivers dyads: a pilot study

Introduction

Prostate cancer patients (PCP) often struggle with a significant emotional, physical, and social burden during the care-flow pathway. Noteworthy, PCP should not be considered a standalone patient, but someone who is connected with a relevant social environment and that is usually supported by a beloved one, the caregiver. The involvement of the caregivers through the care pathway might bring significant benefits both on the psychological and the treatment and decision-making side. The present pilot study aimed at preliminarily assessing quantitatively the psychological impact of a prostate cancer diagnosis on the degree of agreement of PCPs and their caregivers on medical decisions, coping resources and psychological distress levels.

Methods

16 PCP and their caregivers were enrolled in the study and fulfilled a battery of standardized questionnaires.

Results

Results showed low concordance in decision making styles and preferences in patients and their caregivers and that the dyads showed similar depression symptoms levels. Relevant features of the psychological needs of the analyzed dyads, such as need for information and support, also emerged.

Conclusion

On the basis of these preliminary results, guidelines for the construction of tailored brief psychological support interventions for PCP dyads are provided.

Prognostic Awareness in Terminally Ill Cancer Patients: A Narrative Literature Review of the Processes Involved

High prognostic awareness (PA) is seen by many as a threat to terminal patients' psychological well-being. Whether this concern is supported by evidence or not is still a matter of discussion, given the heterogeneity of existing findings. This ambiguity points to the importance of considering contextual processes involved in the relationship between high PA and psychological outcomes, as a possible mediator and moderator mechanism. Aiming to capture a holistic image of the relationship between PA and the psychological experiences of patients, we adapted a narrative method to synthesize and discusses patient-related (physical symptoms, coping strategy, spirituality) and external (family support, received medical care) processes as potential explaining mechanisms.

The role of caregivers in the clinical pathway of patients newly diagnosed with breast and prostate cancer: A study protocol

Background

Caregivers may play a fundamental role in the clinical pathway of cancer patients. They provide emotional, informational, and functional support as well as practical assistance, and they might help mediate the interaction and communication with the oncologists when care options are discussed, or decisions are made. Little is known about the impact of dyadic dynamics on patient-doctor communication, patient's satisfaction, or adherence to the therapies. This study protocol aims to evaluate the efficacy of a psychological support intervention on patients-caregivers relationship and their alignment in the treatment decision-making (TDM) process and estimate related improvement in patient' compliance/adherence to treatments.

Methods

A total of 102 patients-caregivers' dyads will be involved, among breast and prostate cancer patients. The study entails a pre- post- evaluation through psychological questionnaires, with a randomization of participants in two conditions, the experimental one in which subjects participate in a psychological support consultation, and the control one, where dyads do not receive any intervention. A follow up after 6 months from the enrollment is planned.

Discussion

A positive impact of the psychological support intervention on patients' anxiety, depression, distress, and perceived social support is expected. Such improvements can directly affect patients' satisfaction and adherence to treatments. Data gathered from this study may inform health care providers, policy makers, and public health managers about the importance of caregiver's involvement in the cancer care pathway, and the best way to manage it. A further impact is to develop a specific intervention protocol to support caregivers' involvement in cancer care pathway, improve patient's wellbeing, the interaction with physicians and the compliance with the cancer treatment.

Predicting Effective Adaptation to Breast Cancer to Help Women BOUNCE Back: Protocol for a Multicenter Clinical Pilot Study

Background

Despite the continued progress of medicine, dealing with breast cancer is becoming a major socioeconomic challenge, particularly due to its increasing incidence. The ability to better manage and adapt to the entire care process depends not only on the type of cancer but also on the patient’s sociodemographic and psychological characteristics as well as on the social environment in which a person lives and interacts. Therefore, it is important to understand which factors may contribute to successful adaptation to breast cancer. To our knowledge, no studies have been performed on the combination effect of multiple psychological, biological, and functional variables in predicting the patient’s ability to bounce back from a stressful life event, such as a breast cancer diagnosis. Here we describe the study protocol of a multicenter clinical study entitled “Predicting Effective Adaptation to Breast Cancer to Help Women to BOUNCE Back” or, in short, BOUNCE.

Objective

The aim of the study is to build a quantitative mathematical model of factors associated with the capacity for optimal adjustment to cancer and to study resilience through the cancer continuum in a population of patients with breast cancer.

Methods

A total of 660 women with breast cancer will be recruited from five European cancer centers in Italy, Finland, Israel, and Portugal. Biomedical and psychosocial variables will be collected using the Noona Healthcare platform. Psychosocial, sociodemographic, lifestyle, and clinical variables will be measured every 3 months, starting from presurgery assessment (ie, baseline) to 18 months after surgery. Temporal data mining, time-series prediction, sequence classification methods, clustering time-series data, and temporal association rules will be used to develop the predictive model.

Results

The recruitment process stared in January 2019 and ended in November 2021. Preliminary results have been published in a scientific journal and are available for consultation on the BOUNCE project website. Data analysis and dissemination of the study results will be performed in 2022.

Conclusions

This study will develop a predictive model that is able to describe individual resilience and identify different resilience trajectories along the care process. The results will allow the implementation of tailored interventions according to patients’ needs, supported by eHealth technologies.

Trial Registration

ClinicalTrials.gov NCT05095675; https://clinicaltrials.gov/ct2/show/NCT05095675

International Registered Report Identifier (IRRID)

DERR1-10.2196/34564

Shared decision-making and the lessons learned about decision regret in cancer patients

The commentary presents reflections on the literature on post-treatment cancer patient regret. Even though a lot of effort has been made to increase patient satisfaction by engaging them in medical decisions, patient regret remains present in clinical settings. In our commentary, we identify three main aspects of shared decision-making that previously have been shown to predict patient regret. Based on these findings, we provide recommendations for physicians involved in the shared decision-making process. In addition, we make methodological suggestions for future research in the field.

Patient Preferences in Shared Decision Making During Healthcare and Associated Factors Among Adult Admitted Patients at Public Hospitals of West Shoa Oromia, Ethiopia

BACKGROUND

Patient preferences mean the choices of individuals to make decisions about health and medical treatment by using their own experiences, beliefs, and values. The aim of this study was to assess patient preferences in shared decision making during healthcare and associated factors among adult admitted patients at public hospitals of West Shoa Oromia, Ethiopia.

METHODS

A cross-sectional study was carried out among adult admitted patients at public hospitals of West Shoa Oromia, Ethiopia. An interviewer-administered with the Control Preference Scale questionnaire instrument tool was used to assess patient preferences in shared decision making. All statistical analysis was performed using SPSS for windows program version 21.

RESULTS

A total of 403 respondents participated. Out of the total respondents, 168 (41.7%) were females. Overall, 64.8% (n=261) of the respondents prefer a collaborative role in shared decision making. Age (AOR 4.11, 95% CI 2.21-7.64), marital status (AOR 0.37, 95% CI 0.20-0.68), and education level (AOR 2.45, 95% CI 1.13-4.87) are significant in patient preference in shared decision making.

CONCLUSION AND RECOMMENDATION

More than half of respondents 261 (64.8%) prefer shared decision making in a collaborative role with healthcare providers. Age, marital status, and level of education are factors associated with the patient preferences in shared decision making. The Ethiopian ministry of health should work on policy of shared decision making. Healthcare providers have to consider patients in shared decision making.

Evaluating the effectiveness of clinical ethics committees: a systematic review

Clinical Ethics Committees (CECs), as distinct from Research Ethics Committees, were originally established with the aim of supporting healthcare professionals in managing controversial clinical ethical issues. However, it is still unclear whether they manage to accomplish this task and what is their impact on clinical practice. This systematic review aims to collect available assessments of CECs' performance as reported in literature, in order to evaluate CECs' effectiveness. We retrieved all literature published up to November 2019 in six databases (PubMed, Ovid MEDLINE, Scopus, Philosopher's Index, Embase and Web of Science), following PRISMA guidelines. We included only articles specifically addressing CECs and providing any form of CECs performance assessment. Twenty-nine articles were included. Ethics consultation was the most evaluated of CECs' functions. We did not find standardized tools for measuring CECs' efficacy, but 33% of studies considered "user satisfaction" as an indicator, with 94% of them reporting an average positive perception of CECs' impact. Changes in patient treatment and a decrease of moral distress in health personnel were reported as additional outcomes of ethics consultation. The highly diverse ways by which CECs carry out their activities make CECs' evaluation difficult. The adoption of shared criteria would be desirable to provide a reliable answer to the question about their effectiveness. Nonetheless, in general both users and providers consider CECs as helpful, relevant to their work, able to improve the quality of care. Their main function is ethics consultation, while less attention seems to be devoted to bioethics education and policy formation.

Taking into Account Patient Preferences: A Consensus Study on the Assessment of Psychological Dimensions Within Patient Preference Studies

Patient preferences are gaining recognition among key stakeholders involved in benefit-risk decision-making along the medical product lifecycle. However, one of the main challenges of integrating patient preferences in benefit-risk decision-making is understanding differences in patient preference, which may be attributable to clinical characteristics (eg age, medical history) or psychosocial factors. Measuring the latter may provide valuable information to decision-makers but there is limited guidance regarding which psychological dimensions may influence patient preferences and which psychological instruments should be considered for inclusion in patient preference studies. This paper aims to provide such guidance by advancing evidence and consensus-based recommendations and considerations. Findings of a recent systematic review on psychological constructs having an impact on patients' preferences and health-related decisions were expanded with input from an expert group (n = 11). These data were then used as the basis for final recommendations developed through two rounds of formal evaluation via an online Delphi consensus process involving international experts in the field of psychology, medical decision-making, and risk communication (n = 27). Three classes of recommendations emerged. Eleven psychological constructs reached consensus to be recommended for inclusion with the strongest consensus existing for health literacy, numeracy, illness perception and treatment-related beliefs. We also proposed a set of descriptive and checklist criteria to appraise available psychological measures to assist researchers and other stakeholders in including psychological assessment when planning patient preference studies. These recommendations can guide researchers and other stakeholders when designing and interpreting patient preference studies with a potential high impact in clinical practice and medical product benefit-risk decision-making processes.

“Optimism Is a Strategy for Making a Better Future”

Abstract. Cancer is a deadly disease that can lead to psychological suffering and decreased quality of life (QoL). Personality has been proven to have an effect on QoL and, in particular, Dispositional Optimism (DO) has been studied in relation to overcoming health crisis. The aim of this systematic review is to deepen the state of art of the relationship between QoL and DO in cancer patients. PubMed and Embase databases were systematically searched. Fifteen studies were included with a total of 5,249 cancer patients. All of the studies consider the relationship between DO and QoL, some studies analyze the correlation between the two variables and found a positive association. The majority of the studies investigate the predictive power of DO over QoL and most of them found DO to be predictive of a higher QoL. Results confirmed the association between DO and QoL in a sample of cancer patients. These results could influence the clinical practice as DO has been proven to have a beneficial effect on mental and physical health.

Web-Based Relaxation Intervention for Stress During Social Isolation: Randomized Controlled Trial

BACKGROUND

Relaxation practices might be helpful exercises for coping with anxiety and stressful sensations. They may be of particular utility when used in web-based interventions during periods of social isolation.

OBJECTIVE

This randomized study aimed to test whether web-based relaxation practices like natural sounds, deep respiration, and body scans can promote relaxation and a positive emotional state, and reduce psychomotor activation and preoccupation related to the COVID-19 pandemic.

METHODS

Participants were randomly assigned to one of three experimental conditions. Each condition was characterized by a single online session of a guided square breathing exercise, a guided body scan exercise, or natural sounds. The participants listened to one of the fully automated audio clips for 7 minutes and pre-post completed self-assessed scales on perceived relaxation, psychomotor activation, level of preoccupation associated with COVID-19, and emotional state. At the end of the session, qualitative reports on subjective experience were also collected.

RESULTS

Overall, 294 participants completed 75% of the survey and 240 completed the entire survey as well as one of three randomly assigned interventions. Perceived relaxation, psychomotor activation/stress, and preoccupation related to COVID-19 showed a positive improvement after participants listened to the audio clips. The same pattern was observed for the valence and perceived dominance of the emotional state. The square breathing and body scan exercises yielded superior results compared to natural sounds in lowering perceived stress.

CONCLUSIONS

This study provides a novel insight that can guide the development of future low-cost web-based interventions to reduce preoccupation and stress in the general population.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/19236.

Exploring public attitude toward biofeedback technologies: Knowledge, preferences and personality tendencies

Background: Biofeedback is increasingly used in the clinical area and in daily health monitoring through wearable devices (e.g. smart watches). Nevertheless, it remains rather unknown. This study aimed to assess, in a sample of Italian citizens, the level of knowledge, attitudes, perceived efficacy and personality tendencies which could affect the uptake of biofeedback technologies.

Design and Methods: Participants were recruited by advertising the survey on the social networks, from March to May 2019. 160 subjects filled in an ad hoc online questionnaire assessing socio-demographic variables, clinical status, physical activity, knowledge and attitude towards biofeedback, psychological tendencies toward health.

Results: Data showed a good level of interest in biofeedback training in spite of poor knowledge about such technologies. Sport and chronic diseases were not correlated to a greater use of biofeedback. People informed about biofeedback technologies were more interested in undergoing biofeedback training and had higher scores in the Health Locus of Control. Finally, people who showed a positive perception of their own health (Health Esteem) did not rely on these technologies.

Discussion: Despite the huge spread of biofeedback technologies, our results disconfirmed the expectation that people having an active lifestyle or a disease were more familiar with biofeedback systems. The attitude toward such technologies seems to depend on individual tendencies.

Conclusions: This study suggests the importance to improve general public literacy on biofeedback technologies, tailor tools on their needs and characteristics, empower people’s sense of internal health control for promoting a valid use and a proper knowledge of biofeedback.

Genetic Testing Consumers in Italy: A Preliminary Investigation of the Socio-Demographic Profile, Health-Related Habits, and Decision Purposes

Aim of the study: Genetic testing is becoming increasingly common in clinical practice and health management; nonetheless, little is known about how the population approaches genetic services through private companies. Our study aims to describe socio-demographic aspects, health-related habits, and overall beliefs and knowledge about genetic risk and testing in a population of Italian citizens who decided to undergo a genetic examination through a private genetic company.

Study design: A sample of 152 clients from an Italian private genetic company completed an ad-hoc survey from September 2016 to February 2018, addressing socio-demographic data, health habits, psycho-physic condition, perceived utility of genetic results, decision purposes about data sharing, and behavioral changes after results.

Results: Participants (mean age 42.4) were predominantly female (82.2%) and were overall well-educated. Their main source of information were physicians (77%), and 41.1% entrusted the management of results to the same. Thirty-eight percentage underwent genetic analysis for cancer predisposition, 31.3% for fertility problems, 24% for dietary or intolerance issues in the period of enrolment. More than half of them (62.7%) reported a family history of the disease, and overall 69% had a current or past experience with a disease. Clients perceived the genetic screening as useful to adopt behaviors that may prevent disease onset (37.7%), to know their “real health status” (27.4%), and to adopt health-related behaviors (23.3%). 62.8% claimed they were motivated to change behaviors after results (healthier diet, practice exercise, medical checks), and they wanted to share results with their physician and family members.

Discussion/Conclusion: The overview of consumers' profiles in Italy and other European countries can contribute to tailoring and regulating genetic services in a way that could be efficient in terms of healthy choices, behaviors, and health resource expenditures for the general public.

Spontaneous Participation in Secondary Prevention Programs: The Role of Psychosocial Predictors

Disease prevention is a multifaceted construct that has been widely studied. Nevertheless, in spite of its importance, it is still not sufficiently considered by the general population. Since the reasons for this lack of consideration are not yet fully understood, we created an Online Prevention Survey (OPS) to investigate the role of both sociodemographic and psychological factors in predicting individuals’ spontaneous participation in secondary prevention programs. The results revealed that younger people, men, manual workers, unemployed people, and those who do not regularly practise physical activity were less likely to spontaneously participate in such programs. Furthermore, an analysis of the psychological determinants of the willingness to participate in secondary prevention programs showed that depressive symptoms negatively predict it, while an individual’s perception of receiving high social support acts as a positive predictor. Based on these results, we suggest the need for implementing new tailored approaches to promote prevention initiatives to those segments of the population which are more reluctant to spontaneously undertake prevention paths.

An Internet-Based Intervention to Alleviate Stress During Social Isolation With Guided Relaxation and Meditation: Protocol for a Randomized Controlled Trial

Background

Psychophysiological stress and decreased well-being are relevant issues during prolonged social isolation periods. Relaxation practices may represent helpful exercises to cope with anxiety and stressful sensations.

Objective

The aim of this research protocol is to test whether remote relaxation practices such as natural sounds, deep respiration, and body scan meditation promote relaxation and improved emotional state and reduce psychomotor activation and the preoccupation related to the coronavirus disease (COVID-19) pandemic.

Methods

The study population will consist of 3 experimental groups that will randomly receive one of 3 internet-based audio clips containing a single session of guided breathing exercise, guided body scan exercise, or natural sounds. The participants will listen to the fully automated audio clip for 7 minutes and complete pre-post self-assessment scales on their perceived relaxation, psychomotor activation, level of worry associated with COVID-19, and emotional state. At the end of the session, the participants will also be asked to provide qualitative reports on their subjective experiences.

Results

Analyses will be performed to test the differences in the efficacy of the different audio clips in an internet-based intervention on 252 participants (84 per group), investigating whether natural sounds or remote guided practices such as deep respiration and body scan meditation positively enhance the participants’ perceived psychological state.

Conclusions

The study will provide information on if and to what extent guided practices can help in reducing psychological side effects related to social isolation during the COVID-19 pandemic.

International Registered Report Identifier (IRRID)

PRR1-10.2196/19236

Hereditary Gastric and Breast Cancer Syndromes Related to CDH1 Germline Mutation: A Multidisciplinary Clinical Review

E-cadherin (CDH1 gene) germline mutations are associated with the development of diffuse gastric cancer in the context of the so-called hereditary diffuse gastric syndrome, and with an inherited predisposition of lobular breast carcinoma. In 2019, the international gastric cancer linkage consortium revised the clinical criteria and established guidelines for the genetic screening of CDH1 germline syndromes. Nevertheless, the introduction of multigene panel testing in clinical practice has led to an increased identification of E-cadherin mutations in individuals without a positive family history of gastric or breast cancers. This observation motivated us to review and present a novel multidisciplinary clinical approach (nutritional, surgical, and image screening) for single subjects who present germline CDH1 mutations but do not fulfil the classic clinical criteria, namely those identified as-(1) incidental finding and (2) individuals with lobular breast cancer without family history of gastric cancer (GC).

Do You Transfer Your Skills? From Sports to Health Management in Cancer Patients

Skill transfer is a process where personal cognitive and behavioral abilities are applied to contexts that are different from the one in which they were originally learned. Literature demonstrates that skill transferability is possible: for example, people can apply skills learned in sports to other life-domains (such as school, work, or health management) with the aim to improve individual characteristics and reach personal goals. To do this, several factors, such as positive communication, adequate context, a person-centered perspective, and specific strategies, are necessary. On the basis of this, the aim of this contribution is explore the relationship between sports and health management skills to enhance the coach/athlete as well as the patient/physician relationships. Useful strategies for skill transfer from sports to cancer management are shown.

Patients' health locus of control and preferences about the role that they want to play in the medical decision-making process

Health locus of control (HLOC) may influence people's behavior regarding their health as well as their desires to be involved in the medical decision-making. Our study aimed to examine HLOC's relations with people's control preferences about the medical decision-making. A total of 153 people filled out the self-administered version of the Control Preference Scale and the Multidimensional Health Locus of Control Scale - form C. The most preferred role is the collaborative one. However, HLOC explained heterogeneity in people's control preferences: lower scores in external HLOC were related to a greater preference for the active and the collaborative role. From the personalized medicine perspective, an accurate evaluation of the patient's HLOC could help tailoring the decision-making process within the clinical context.

Changes in IDH2, TET2 and KDM2B Gene Expression After Treatment With Classic Chemotherapeutic Agents and Decitabine in Myelogenous Leukemia Cell Lines

Background

Hematological malignancies are a heterogeneous group of tumors with increased proliferative and auto-replicative capacity. Despite treatment advances, post-treatment quality of life remains highly affected. Studies addressing the molecular mechanisms of these diseases are critical for the development of effective, rapid and selective therapies, since few therapeutic strategies succeed in being effective without triggering high-grade toxicities or debilitating late effects. Our aim of this study was to verify changes in the expression of genes involved in the malignant phenotype of hematological malignancies, by treating human cell lines in vitro with classic chemotherapeutic agents and the demethylating agent, decitabine.

Methods

KASUMI-1 and K-562 human myeloid leukemia cell lines were plated at a density of 3 × 10⁴ cells/well and treated with increasing concentrations of different chemotherapeutic agents commonly used in the clinical setting. After 24 and 48 h of treatment, cell viability was tested, and RNA was extracted. Complementary DNA (cDNA) was synthesized and quantitative real-time polymerase chain reaction (qPCR) was performed to evaluate the gene expression of IDH2, TET2 and KDM2B.

Results

A modulation in gene expression was observed before and after treatment with classic chemotherapeutic agents. It was possible to demonstrate a difference in gene expression when cells were treated with chemotherapeutic agents or decitabine alone when compared to chemotherapeutic agents in association with decitabine.

Conclusions

The genes tested, and the modulation of their expression during in vitro treatments suggest that IDH2, TET2, and KDM2B should be further investigated as potential biomarkers for ongoing treatment response and follow-up for patients diagnosed with hematological malignancies of the myeloid lineage.

Breast implant-associated anaplastic large cell lymphoma: emotional impact and guidelines for psychological support

PURPOSE

During the last two decades, the number of breast implants used in aesthetic, oncologic, and risk-reducing surgery has increased substantially mainly due to the improvement and confirmed safety of these devices. Since the identification of the first case of anaplastic large cell lymphoma associated with a breast implant (BIA-ALCL) 20 years ago, there has been an increase in the number of reports of this very rare disease, demonstrating a clear association with breast implants. While the majority of cases are localized and cured by implant removal and full capsulectomy, a small percentage require chemotherapy and the mortality rate is very low. Nevertheless, the evidence linking BIA-ALCL to implant surface texturing has raised concerns about the long-term safety of these devices resulting in patient and regulatory authority concerns globally.

METHODS AND RESULTS

In this commentary, we report the current debate on BIA-ALCL and the main European government's actions, with a special focus on the emotional impact that media coverage has on cancer patients. We comment the emotional impact of such risk for patients with breast implant, the hard process of patient's acceptance for mastectomy and reconstructive surgery, and how this is an essential part of recovery and return to the normal living for many women.

CONCLUSION

We conclude by providing guidelines for patient-physician communication and patients' psychological support on this topic of delicate actuality. Our contribution aims at guiding the medical community in managing risk communication about BIA-ALCL with a multidisciplinary approach, according to the most recently available published evidence.

Sexism Interacts with Patient-Physician Gender Concordance in Influencing Patient Control Preferences: Findings from a Vignette Experimental Design

BACKGROUND

Patient preferences regarding their involvement in shared treatments decisions is fundamental in clinical practice. Previous evidences demonstrated a large heterogeneity in these preferences. However, only few studies have analysed the influence of patients' individual differences, contextual and situational qualities, and their complex interaction in explaining this variability.

METHODS

We assessed the role of the interaction of patient's sociodemographic and psychological factors with a physician's gender. Specifically, we focused on patient gender and attitudes toward male or female physicians. One hundred fifty-three people participated in this randomised controlled study and were randomly assigned to one of two experimental conditions in which they were asked to imagine discussing their treatment with a male and a female doctor.

RESULTS

Analyses showed an interplay between attitude towards women and the gender of patients and doctors, explaining interindividual variability in patient preferences.

CONCLUSIONS

In conclusion, patients' attitudes toward the physicians' gender constitutes a relevant characteristic that may influence the degree of control patients want to have and the overall patient-physician relationship.

How to Train Your Health: Sports as a Resource to Improve Cognitive Abilities in Cancer Patients

From a cognitive-psychological perspective, physical exercise (PE) and sports are an interesting tool for improving people's cognitive abilities. One field of application for such a tool is decision making (DM) support in chronic patients, cancer patients, and survivors in particular. On the one hand, cancer patients and survivors have to continually take important decisions about their own care (e.g., treatment choice; changes in lifestyle), in collaboration with caregivers and health providers; on the other hand, side effects of treatment may be detrimental to cognitive abilities, such as attention, which make the health DM tasks even more demanding, complex, and emotionally disruptive for patients. Since cancer patients have to engage in healthy activities both for improving their own quality of life and for sustaining the effects of medications, clinical advice to engage in sport and PE is becoming more and more widespread within interventions. However, while sports are usually seen as healthy physical activities, their impact on cognitive abilities is mostly overlooked in the literature. The hypothesis of the present work is that sports could be fully exploited in their potential as focused exercises for cognitive ability training, in the field of cognitive training for chronic patients specifically. Indeed, literature shows that different sports (e.g., individual or team-based) influence and possibly augment cognitive abilities such as focused and divided attention, working memory, and DM under time constraints. Moreover, besides providing training for cognitive abilities, the experience of sports may represent an opportunity to explore, train and sharpen DM abilities directly: we identify five ways in which sport experiences may influence DM processes, and provide indications for future research on the topic.

The patient perspective: investigating patient empowerment enablers and barriers within the oncological care process

Patient empowerment is a multi-factorial concept and its relevance has led to a growing body of literature; despite this attention, there is still no agreement regarding the elements that define its expression. While several studies have already investigated the positive effect of empowerment interventions on the care process outcome, the aim of this study is to investigate which factors can foster an empowered management of the cancer condition from the patient's perspective. To examine patients' perception of empowerment enablers, we asked for participants' input on the role of three factors frequently cited as positively affected by empowerment: care quality, perception of direct control and relationships within the care context, during the care process. Three focus groups were conducted with 34 cancer patients. The results highlight the perception of direct control on their treatment as the least valued element (2.87, SD 0.566) when compared with care quality (3.75, SD 0.649) and relational support in the care context (3.91, SD 0.274). Unlike traditional approaches to empowerment, patient's expression of empowerment does not mainly reside in the direct control of their condition as much as in an active role within the relationship with caretakers, such as the ability to choose the doctor, the care team or the health organisation in charge of their healthcare. Emerging aspects from this analysis of patient's perspective are central in order to adequately consider empowerment in the care process and to provide more effective care strategies.

User-Centered Virtual Reality for Promoting Relaxation: An Innovative Approach

Virtual reality has been used effectively to promote relaxation and reduce stress. It is possible to find two main approaches to achieve such aims across the literature. The first one is focused on generic environments filled with relaxing "narratives" to induce control over one's own body and physiological response, while the second one engages the user in virtual reality-mediated activities to empower his/her own abilities to regulate emotion. The scope of the present contribution is to extend the discourse on VR use to promote relaxation, by proposing a third approach. This would be based on VR with personalized content, based on user research to identify important life events. As a second step, distinctive features of such events may be rendered with symbols, activities or other virtual environments contents. According to literature, it is possible that such an approach would obtain more sophisticated and long-lasting relaxation in users. The present contribution explores this innovative theoretical proposal and its potential applications within future research and interventions.

Biased Perceptions and Personality Traits Attribution: Cognitive Aspects in Future Interventions for Organizations

In most European countries, the proportion of females and males pursuing a career in Technology and Engineering is quite different. The under-representation of women in these jobs may be attributable to a variety of factors, one of which could be the negative and stereotyped perception of these work sectors as unsuitable for women. The purpose of this study was to determine whether stereotyped perceptions impact the job representation of males and females in the Construction Industry, which is a particularly male-dominated work sector. Three construction organizations in the West Midlands (United Kingdom) were studied by means of ethnographic interviews and observations. Three (6.7%) of the 45 research participants (mean age 44.3) were women (focusing only in people working in Construction sites). There was a high differentiation of activities between the males and females. Biased perceptions and personality traits attribution played a fundamental role in such a differentiation. Despite some main limitations (low generalisability, lack of longitudinal findings), this study focused on some important practical implications for current work policies: changing the mindsets of people (starting from school age), using new flexible strategies and creating the role of internal advocates. The findings provide definitive evidence of the need to increase the promotion of social communication and public campaigns on gender equalities in male-dominated work sectors, taking into account the cognitive processes behind gender differences. The findings also give new hints on re-thinking the contribution of Psychology, particularly Cognitive Psychology, in fields with allegedly wide gender gaps.

eHealth for improving quality of life in breast cancer patients: A systematic review

Breast cancer patients (and survivors) use to deal with important challenges daily, such as coping with stress and depression, and adopting healthy lifestyles in order to improve treatment effectiveness; moreover, some experiential issues are quite specific of this disease, such as sexuality and fertility disfunctions after hormonal therapy, and distortions in body image after breast surgery. Recent literature highlighted the utility of eHealth or the use of new technologies to promote health management and quality of life in chronic diseases generally. The present contribution aims at (1) exploring usage and effectiveness of eHealth resources to improve breast cancer patients/survivors' quality of life, and (2) describing whether existing eHealth interventions addressed specific characteristics of breast cancer, or employed a generic approach only. A systematic literature search according to PRISMA guidelines was performed. Twenty-four studies met inclusion criteria and were included. Discussion highlights a majority of encouraging results about eHealth in breast cancer patients' health management, especially in those interventions featuring eHealth tools for improving patients' abilities (e.g., coping) and complex eHealth systems with multiple resources. However, generic use of eHealth is still predominant over disease-focused solutions. Guidelines for future eHealth research and development are listed in order to promote technology design centered on the lived experience of specific illness.

Patient Preferences as Guidance for Information Framing in a Medical Shared Decision-Making Approach: The Bridge Between Nudging and Patient Preferences

Guidelines and policies support the decision process to make sure that patients can benefit from the best treatment for their condition. The implementation of guidelines and policies is evolving, allowing decision makers to be able to choose between alternatives while considering the effect of biases and fallacies that may hinder their choice. Patient preferences play a precious role in those decisions in which is not possible to recognize an objective "best" alternative and it's not possible to nudge them toward one alternative based on scientific evidence and clinical experience. Having patient input as part of the decision process itself would allow the recognition of the attributes related to what is relevant for patients, which can be considered as important as clinical data. The authors advocate that the integration of preference-sensitive attributes with decision policies could provide a benefit against fallacies in the decision process when there is not a "best" alternative, and a shared decision-making paradigm allows both patient and clinician to recognize and pursue the option that best fits the individual case.

Psychiatric, behavioral, and cognitive disorders in patients with extracranial cancers

Patients with cancer may report neuropsychiatric abnormalities including cognitive impairment, behavioral disturbances, and psychiatric disorders that potentially worsen their quality of life, reduce their treatment response, and aggravate their overall prognosis. Neuropsychiatric disturbances have a different pathophysiology, including immuno-inflammatory and neuroendocrine mechanisms, as a consequence of oncologic treatments (chemo- and radio-therapy). Among clinicians involved in the management of such patients, psychiatrists need to pay particular attention in recognizing behavioral disturbances that arise in oncologic patients, and determining those that may be effectively treated with psychotropic medications, psychotherapeutic interventions, and an integration of them. Through the contribution of different clinicians actively involved in the management of oncological patients, the present review is ultimately aimed at updating psychiatrists in relation to the pathophysiological mechanisms responsible for the onset of cognitive, affective, and behavioral syndromes in these patients, along with epidemiologic and clinical considerations and therapeutic perspectives.

Attitudes of Individuals with Gaucher Disease toward Substrate Reduction Therapies

Type 1 Gaucher disease (GD) is the most common lysosomal storage disorder. Previously, treatment for GD was limited to intravenous enzyme replacement therapies (ERTs). More recently, oral substrate reduction therapies (SRTs) were approved for treatment of GD. Although both therapies alleviate disease symptoms, attitudes toward SRTs and patient perceptions of health while using SRT have not been well established. Electronic surveys were administered to adults with GD and asked about treatment history, attitudes toward SRTs, and perception of health while using SRTs as compared to ERTs, if applicable to the participant. ERT users that were offered treatment with SRTs cited potential side effects, wanting more research on SRTs, and satisfaction with their current treatment regimen as reasons for declining SRTs. SRT users expressed convenience and less invasiveness as reasons for choosing SRTs. Additionally, those using SRTs most often perceived their health to be similar to when they previously used ERT. Participant responses illustrate that attitudes toward SRTs can be variable and that one particular treatment may not be ideal for all patients with GD depending on individual perceptions of factors such as convenience, invasiveness, or side effects. Thus, individuals with GD should be counseled adequately by healthcare providers about both ERTs and SRTs for treatment of GD now that SRTs are clinically available.

Shared decision making in Italy: An updated revision of the current situation

The aim of this paper is to update the previous review on the state of patient and public participation in healthcare in Italy. Policymakers consider patient involvement an important aspect in health care decisions and encourage patients to actively participate in the clinical interaction. Nevertheless, the term shared decision making (SDM) is still not clearly defined. Patient associations promote patient participation in health care decisions. Several experts attended the latest consensus conference about patient engagement to reach a consensus on the definition of SDM. Research regarding SDM in Italy continues to increase with 17 articles published between 2012 and 2017. Researchers have assessed the variables associated with patient involvement and explored the use of the SDM approach in different medical settings. Despite the dedicated SDM initiative, researchers in Italy recognize room for improvement. Work is needed to reach a common language regarding SDM and its mechanisms to implement this approach at the clinical level.

Bringing a humanistic approach to cancer clinical trials

In this article, we describe some practical aspects that promote the humanisation of clinical research. Actions are not limited to improving the communication skills of medical staff but also include maintenance of care continuity, accessible written information, and application of theoretic models such as shared decision-making and management of stress in decision-making under uncertainty. We believe that a comprehensive strategy will increase patients' motivation to participate in and adhere to clinical research.

Value as the key concept in the health care system: how it has influenced medical practice and clinical decision-making processes

In the last 10 years, value has played a key role in the health care system. In this concept, innovations in medical practice and the increasing importance of patient centeredness have contributed to draw the attention of the medical community. Nonetheless, a large consensus on the meaning of "value" is still lacking: patients, physicians, policy makers, and other health care professionals have different ideas on which component of value may play a prominent role. Yet, shared clinical decision-making and patient empowerment have been recognized as fundamental features of the concept of value. Different paradigms of health care system embrace different meanings of value, and the absence of common and widely accepted definition does not help to identify a unique model of care in health care system. Our aim is to provide an overview of those paradigms that have considered value as a key theoretical concept and to investigate how the presence of value can influence the medical practice. This article may contribute to draw attention toward patients and propose a possible link between health care system based on "value" and new paradigms such as patient-centered system (PCS), patient empowerment, and P5 medicine, in order to create a predictive, personalized, preventive, participatory, and psycho-cognitive model to treat patients. Indeed, patient empowerment, value-based system, and P5 medicine seem to shed light on different aspects of a PCS, and this allows a better understanding of people under care.

Decisions and the involvement of cancer patient survivors: a moral imperative

Purpose

The aim of this study was to review the experiences of direct involvement in patient survivorship for treatment and research.

Methods

This is a narrative-focused review of the following two recent experiences of patient involvement: the Chordoma Foundation and the Triple Negative Breast Cancer Foundation.

Results

These two examples represent concrete experiences that patients have built to favor a real involvement in the care and treatment of tumors. These experiences are profoundly modifying how cancer research is conducted and draw attention to the psychosocial dimensions of health care.

Conclusion

These examples represent the new scenario in which modern medicine faces completely new challenges, copes with new needs, and cooperates with new health care professionals.

Implications

Involving patients in a new perspective raises practical and ethical challenges for organizations to work together, for health providers to be professionally skilled and for the government to promote safeguarding policies.

Optimistic bias in young adults for cancer, cardiovascular and respiratory diseases: A pilot study on smokers and drinkers

Optimistic bias defines the tendency for human beings to underrate risk when it pertains to themselves compared with their view of risk pertaining to other people in the same conditions. The aim of this work is to investigate the optimistic bias in risk perception and health-related behaviours for three specific conditions in a young adult sample: cancer, respiratory disorders and cardiovascular diseases. Young adults showed an optimistic bias related to cancer, and to cardiovascular diseases. Our findings suggest that optimistic bias is linked to specific behavioural patterns, largely widespread in young adults, such as tobacco cigarette smoking and alcohol consumption.

Narrating positive versus negative memories of illness: does narrating influence the emotional tone of memories?

Psychoncological studies have recognised a reduced autobiographical memory in cancer patients, furthermore cognitive studies have found that narrative is an effective instrument to re-elaborate memories. However, it is still unclear whether narrating positive versus negative events can have a different impact on autobiographical memory. The present study aims to explore the emotional experience of autobiographical memory before and after having narrated negative or positive events related to the illness. Of 63 oncological patients, 35 were selected for the present study. Participants completed a Memory Fluency Task twice, before and after having selected and narrated a positive (PN group) or a negative (NN group) memory of illness. They also had to attribute one or more emotions to each memory and to the narrative. The number of emotions and the percentage of emotional tones in both narrated and non-narrated memories were assessed. Narrated memories were more emotionally re-elaborated than non-narrated ones. Negative group participants, more than positive group ones, decreased negative emotions and increased complex ones. Authors discuss these results claiming that narrating works as a rehearsal of autobiographical memories in oncological patients and narrating negative memories eases the emotional re-elaboration of illness.

Pediatric Blood Cancer Survivors and Tobacco Use across Adolescence and Emerging Adulthood: A Narrative Review

Scholars underline the pivotal role of tobacco cigarette smoking in carcinogenesis process for blood tumors. A controversial debate is represented by the diffusion of tobacco use in young cancer survivors that had a previous diagnosis of blood tumor during the childhood. Compared with their peers, scientific evidence highlights that pediatric survivors have more difficult to give-up cigarette smoking. Furthermore, tobacco-smoking is frequently linked with others risk behaviors as drinking or substance abuse. In reviewing the main knowledge on this topic, authors affirm the need for increasing research on blood cancer survivors in order to depict psychological characteristics of pediatric blood cancer survivors. Improving health decision-making skills in young survivors could reduce the risk to adopt un-healthy behaviors and increase psychological wellbeing. Furthermore, authors propose tailored antismoking interventions based on the knowledge of the psychological and cognitive factors that support smoking during the transition toward emerging-adulthood.