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Objective: Different social norms influence the type and amount of information transmitted to palliative care patients. In Italy disclosure rate is low and medical decisions are often mediated by the family since communication of diagnosis and prognosis is viewed as harmful and brutal. Aims of our study were to assess palliative care patients' knowledge about their diagnosis and prognosis and expectations; and to evaluate possible differences between palliative care patients with and without cancer., Method: 232 palliative care in-patients participated to the study and were interviewed about their knowledge about his/her diagnosis and prognosis, and about cure and disease expectations, perceived family/social support., Results: Overall, 45.4% of the patients knew their diagnosis and 35.3% had partial knowledge of it; 39.2% knew their prognosis. When the prognosis was fatal, only few patients explicitly referred to it (22.0%). Expectations during admission to the palliative care unit were: return back home after symptom management (61.6%), increase personal autonomy (51.3%), and pain relief (45.2%). Family/social support was frequently perceived as good (84.0%). Patients with cancer less frequently knew their diagnosis (44.7% vs. 52.9%) and prognosis (37.7% vs. 64.7%) compared to patients with a non-cancer diagnosis., Conclusions: About half of our patients were unaware of their diagnosis, although, in reality, about one-third of the patients had some knowledge, albeit partial, of their diagnostic and therapeutic course. What to tell or not to tell in palliative care is still controversial and stems from a tailored intervention involving the patient, his/her family and professionals and silence may be more effective than intrusive communication in helping a patient to approach death with tolerable knowledge and dignity.

Introduction: Quality of life is a dynamic concept that can undergo change with time and/or disease progression. The aim of this study was to test the reliability and validity of the Italian version of the McGill Quality of Life Questionnaire (MQOL-It), that we consider useful for assessing quality of life in Palliative Care., Methods: The MQOL-It was administered by interview to 175 patients (M 108; F 67) admitted to a Unit of Palliative Care. All patients were suffering from advanced disease: cancer, amyotrophic lateral sclerosis, chronic heart failure. Statistical analysis was performed to assess the psychometric properties of the questionnaire., Results: Factor analysis (VARIMAX) revealed four domains of quality of life, though the item composition differed, at composition analysis, from the original MQOL version. "Achieved goals" and "control over life", items classified in the English version as part of the existential domain, in the Italian version fitted the psychological domain; the item "well-being" was grouped into the physical domain and did not load clearly with other factors. Cronbach's alpha for the whole questionnaire was 0.85, with a good internal consistency for the four subscales (Cronbach's alpha > or = 0.65). All MQOL-It subscales were significantly correlated (Spearman correlation) with the Single Item rating Scale (SIS); comparison between the MQOL-It and the Nottingham Health Profile (NHP)-part I showed the instrument's concurrent validity., Conclusions: MQOL shows robust psychometric properties and appears suitable for evaluating quality of life in palliative care in Italy.

Unlabelled: Many studies have focused on the importance of the informal care provided by caregivers and on its impact in terms of worsening quality of life and increased burden. The aim of the present study is to analyze the psychometric validity and reliability of the Caregiver Needs Assessment (CNA) questionnaire, which has been built to investigate the needs (related to assistance) perceived by caregivers of severely impaired patients, particularly in the first stages of their illness., Methods: The CNA was administered to 226 family caregivers (24.3% males) of 197 patients (50.8% males) hospitalized for neuromotor rehabilitation after a stroke, head injury, Lateral Amyotrophic Sclerosis, Parkinson or other severely impairing diseases., Results: The instrument was tested on a large sample (KMO = 0.83) of heterogeneous caregivers. Explorative and confirmatory factor analysis, performed on a two subgroup random subdivision of the sample, showed the presence of two factors with good internal consistency: the factor "needs of emotional and social support" (alpha = 0.765) and the factor "needs of information and communication" (alpha = 0.742). The structural equation modeling confirms the goodness of fit of the 2-factor structure (RMSEA = 0.073; SRMR = 0.1; CFI = 0.96). We observed a positive correlation (p < 0.01) between the factor "needs of emotional and social support" of the CNA and other questionnaires aimed at assessing psychological wellbeing, and between the factor "needs of information and communication" and the factor "needs for knowledge about the disease" of the Family Strain Questionnaire, showing good convergent validity. We also observed high Pearson correlation coefficients (0.942 and 0.965) between test-retest measurements of both factors in the CNA., Conclusion: The statistical analysis confirms the good psychometric properties of the CNA questionnaire. For its brevity and ease in compilation the CNA is promising practical tool aimed at assessing caregivers' needs in order to personalize a programme of psychological support, to measure it's outcome and to provide comparison of the different needs in different diseases.

The sense or meaning (constructed meaning) that a person attributes to their own illness is one of the factors involved in the process of adaptation. The Constructed Meaning Scale (CMS), originally developed in the United States by Fife in 1995, is a brief 8-item survey investigating the subjective meaning that patients associate with their disease. The purpose of this study was to validate an Italian version of the CMS in a sample of patients with chronic disabling disease. The validation process consisted of 4 steps: (1) creation of an Italian version (translation and back translation); (2) administration of the translated version to a small sample of patients affected by different types of disease to verify its comprehensibility; (3) administration of the final version to a sample of 122 patients affected by chronic disabling conditions; (4) statistical analysis. The Italian version of the CMS was found to have the following psychometric properties: range of total-item correlation = .30 to .64; Cronbach's Alpha = .79; correlation with CBA 2.0 Depression Scale = -.44. We isolated two factors through VARIMAX factor analysis, which we defined as "disease as permanent damage" and "process of adaptation". The Italian version of the CMS is easy to understand and minimizes possible cultural biases. The psychometric properties of the scale are satisfactory.

This paper presents a questionnaire designed to assess the aspecific treatment efficacy and subjective perceived efficacy of group therapy. A preliminary version of the instrument was administered to a sample of 151 subjects undergoing group therapy. The psychometric properties of the instrument were evaluated by means of the Rasch model, and showed a good score range, good reproducibility and adequate coherence. The hierarchy of difficulty of the items remained stable among the respective categories of sex, age and professional level.