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OBJECTIVE: to establish which kind of physician communicative responses to patient cues and concerns are appreciated by lay people. METHODS: A balanced sample (259 people) was recruited in public places to participate in a full day observation of four videotaped standardized medical consultations. In a two-step procedure participants gave their individual quality ratings of the whole consultations and then of a set of four fragments from each consultation. They contained a patient negative emotional expression and the subsequent physician response, according to the VR-CoDES. RESULTS: Higher quality ratings were given to physician responses which provided space to the patient to talk and to the explicit expressions of empathy. The explicit responses were favored above non-explicit responses. Participants' global evaluation of the whole consultation affected their quality assessments of the fragments (halo-effect). In a multivariate model, lay people's background characteristics appeared to be relevant: to be female, of lower educational level and living in Belgium or Italy predicted higher ratings. CONCLUSIONS: Providing space to patients is appreciated by all participants, combined with the need for tailor made communication. PRACTICE IMPLICATIONS: To teach physicians listening skills and how to show empathy with distressed patients should be a core element in medical education. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To illustrate how patients introduce cues and concerns during clinical consultations and how psychiatrists respond to them. METHOD: Sixteen psychiatrists recorded 104 first diagnostic consultations, coded with the Verona Coding Definitions of Emotional Sequences (VR-CoDES). Cues, concerns and responses were analyzed in relation to patient gender and ICD-10 diagnosis, and psychiatrists' age, gender, clinical experience and consultation process. RESULTS: Cues were more frequent among female patients and were equally distributed among diagnostic categories. Concerns were more frequent among patients with 'Mood' or 'Neurotic' disorders. Psychiatrists' responses to cues tended to 'provide space' without being explicit. Referral to the affective part was restricted to concerns which had been solicited by the psychiatrist. Empathic responses were infrequent. Cues and concerns received more attention by female psychiatrists. CONCLUSION: The study confirms gender differences in expressing and dealing with emotions both by patients and psychiatrists. Females tend to give more space to this topic. Psychiatrists 'responses differed according to cues, concerns, gender, diagnosis and to who prompted the cue/concern, showing a preference for topics introduced by themselves. PRACTICE IMPLICATIONS: The VR-CoDES is a useful tool to define the strategies psychiatrists adopt when handling patients' emotions in terms of cues and concern. [ABSTRACT FROM AUTHOR]

BACKGROUND: In primary care the General Health Questionnaire (GHQ) is used to provide an independent assessment of probable caseness of psychological disorder against which to test the ability of the general practitioner (GP) to recognize patients with current emotional problems. METHOD: The aim of the present study was to identify those clinical and psychosocial data on patients that increase the likelihood of GPs' attribution of emotional distress (GP model) and those that predict patients' emotional distress as defined by the GHQ-12 (GHQ model). The associations were explored using a classification tree technique (CHAID) and compared using bivariate logistic regression. Six GPs and 444 primary care patients took part. RESULTS: The accuracy indices of the hierarchical GP and GHQ models were 72% and 69% respectively. The availability of information on patients' psychopharmacological and psychiatric/psychological treatment in the last year was the most important predictor of attribution. Occupational, financial and housing problems and life events of loss were the most important predictors of the GHQ-12 case definition. The overall accuracy of the bivariate model was 73%. Compared with the GHQ-12, GPs gave significantly more importance to psychiatric treatment, psychopharmacological drug use and chronic illness. CONCLUSIONS: The findings suggest that to improve the detection of current emotional distress in primary care patients GPs should pay foremost and systematic attention to social problems and recent life events of loss. These problems are important clues for the possible presence of emotional distress, whereas critical patient data, in particular psychiatric history and psychopharmacological treatment, increase the probability of attribution errors. [ABSTRACT FROM AUTHOR]

To present a method to classify health provider responses to patient cues and concerns according to the VR-CoDES-CC (Del Piccolo et al. (2009) [2] and Zimmermann et al. (submitted for publication) [3]). The system permits sequence analysis and a detailed description of how providers handle patient's expressions of emotion. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the inter-rater and intra-rater reliability of the English translation of the original Italian version of the VR-MICS and to evaluate its sensitivity by comparing the coding of English and Italian general practice consultations with emotionally distressed and non-distressed patients, as defined by the 12-item General Health Questionnaire (GHQ-12). Method: Six male GPs from Manchester (UK) and six from Verona (Italy) each contributed five consultations, which were coded using the VR-MICS. Intra-rater and inter-rater reliability were assessed both for the division of interviews into speech units and the speech unit coding. Interaction and main effects of GHQ-12 status and nationality on patient and GP expressions were assessed by two-way ANOVA. Results: Agreement indices for the division of speech units varied between 88-96 and 87-93% for GP and patient speech, respectively; those for coding categories between 88-91 and 82-86%, with Cohen's Kappa values between 0.86-0.91 and 0.80-0.85 for GP and patient speech, respectively. Cross-cultural comparisons of patient and GP speech showed no interaction effects between GHQ-12 status and nationality. The Italian GPs were more 'doctor-centred', while the UK GPs tended to use a more 'sharing' consulting style. Independent of nationality, distressed patients talked more, gave more psychosocial cues and increased amounts of positive talk compared to non-distressed patients. GPs in both settings, when interviewing distressed patients, reduced social conversation and increased psychosocial information-giving, checking questions and reassurance. Conclusion: The English translation of the VR-MICS showed satisfactory reliability indices and similar sensitivity to patients' verbal behaviours in relation to their emotional state in the two settings. Practice Implications: The VR-MICS may be an useful coding instrument to support collaborative research on doctor-patient communication between the two countries. [ABSTRACT FROM AUTHOR]

Background: The present paper focuses on socio-demographics, clinical variables, and the distance from the infection in predicting the long-term psycho-social consequences of COVID-19., Methods: Patients were screened with a cross-sectional design at the Psychological Service of the University Hospital of Verona (Italy) at 3, 6, 12, and 18 months after their SARS-CoV-2 infection. The assessment was part of the Horizon 2020-funded ORCHESTRA Project and included the Hospital Anxiety and Depression Scale (HADS), the Short Form Health Survey 36 (SF-36), the Impact of Event Scale-Revised (IES-R), and ad-hoc questions measuring pre-post COVID-19 changes on psycho-social dimensions (sleep quality, nutrition, level of autonomy, work, social relationships, emotional wellbeing)., Results: Between June 2021 and June 2023, we evaluated 1317 patients (mean age 56.6 ± 14.8 years; 48% male): 35% at three months, 40% at 6, 20% at 12, and 5% at 18 months after the infection. Thirty-five percent were hospitalized due to COVID-19. Overall, 16% reported some form of clinically significant mental distress following the infection (HADS-TOT), with 13% and 6%, respectively, experiencing anxiety (HADS-Anxiety) and depressive symptoms (HADS-Depression). Four percent testified post-traumatic symptoms. The SF-36 scale revealed that 16% and 17% of subjects had physical or psychological deterioration in quality of life, respectively. The regression analyses showed that females experienced higher levels of anxiety and depression compared to males, along with worse mental and physical quality of life and pre-post infection changes in nearly all the investigated psycho-social dimensions. Younger people felt more anxiety and had a reduced mental quality of life than their older counterparts, who, in turn, had poorer scores in terms of autonomy and physical functioning. Hospitalized patients had lower levels of self-sufficiency, social relationships, and work than non-hospitalized people. The latter were more anxious and reported a lower physical quality of life. Finally, patients evaluated for the first time at 12- and 18 months showed a more significant impairment in mental and physical quality of life than those assessed at three months., Conclusions: Our data show that COVID-19 psychological sequelae tend to persist over time, still needing clinical attention and intervention planning, especially for females., (© 2024. The Author(s).)

Nursing homes (NHs) are crucial for de-hospitalization and addressing the needs of non-self-sufficient individuals with complex health issues. This study investigates the patient safety culture (PSC) in NHs within a northern Italian region, focusing on factor influencing overall safety perceptions and their contributions to subjective judgements of safety. A cross-sectional study was conducted on 25 NHs in the Autonomous Province of Trento. The Nursing Home Survey on Patient Safety Culture (NHSPSC) was utilized to assess PSC among NH staff. Multilevel linear regression and post hoc dominance analyses were conducted to investigate variabilities in PSC among staff and NHs and to assess the extent to which PSC dimensions explain overall perceptions of PS. Analysis of 1080 questionnaires (44% response rate) revealed heterogeneity in PSC across dimensions and NHs, with management support, organizational learning, and supervisor expectations significantly influencing overall safety perceptions. Despite some areas of concern, overall safety perceptions were satisfactory. However, the correlation between individual dimensions and overall ratings of safety was moderate, suggesting the need to enhance the maturity level of PSCs. Promoting a shift in PSC could enhance transparency, prioritize resident safety, empower nursing staff, and increase family satisfaction with care provided in NHs. The support provided by management to PSC appears essential to influence NH staff perceptions of PS.

Introduction: Multiple sclerosis (MS) is generally diagnosed at an early age, making the acceptance of this chronic disease challenging. Research dedicated to young adults with MS (YawMS) is still limited. A biopsychosocial co-created intervention for YawMS integrating social, physical and psychological activities was developed (ESPRIMO intervention) in order to improve the quality of life (QoL) and well-being. This pre-post intervention assessment study examines the feasibility of the ESPRIMO intervention and its signal of efficacy., Methods: Inclusion criteria were: age 18-45 years, MS diagnosis, Expanded Disability Status Scale score < 3.5. After giving informed consent, YawMS completed a battery of questionnaires, which was repeated after the intervention. The battery included a bespoke feasibility scale, the COOP/WONCA charts, and the Short Form-12 Health Survey (SF-12)., Results: Fifty-three YAwMS were enrolled and 43 (81.1%) completed the intervention. The majority of the sample positively rated the pleasantness, usefulness and feasibility of the intervention. A significant change in the COOP/WONCA "general QoL" chart ( t  = 3.65; p  < 0.01) and SF-12 mental wellbeing component ( t  = -3.17; p  < 0.01) was found., Discussion: ESPRIMO is an innovative intervention that is feasible; preliminary results show an improvement in QoL and mental wellbeing. Further studies are needed to test its efficacy and evaluate future implementation in health services. Clinical trial registration : ClinicalTrials.gov, NCT04431323., Competing Interests: RN has received funding (speakers’ bureau) from Novartis, Biogen, and Merck for delivering lectures on the psychological aspects of MS. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Poli, Donisi, Mazzi, Gobbin, Giusto, Orlandi, Schena, Del Piccolo, das Nair, Gajofatto and Rimondini.)

Pancreatic cancer is one of the most lethal malignancies. Currently, the only treatment is surgical resection, which contributes to significant preoperative anxiety, reducing quality of life and worsening surgical outcomes. To date, no standard preventive or therapeutic methods have been established for preoperative anxiety in pancreatic patients. This observational study aims to identify which patients' socio-demographic, clinical and psychological characteristics contribute more to preoperative anxiety and to identify which are their preoperative concerns. Preoperative anxiety was assessed the day before surgery in 104 selected cancer patients undergoing similar pancreatic major surgery, by administering the STAI-S (State-Trait Anxiety Inventory Form) and the APAIS (Amsterdam Preoperative Anxiety and Information Scale). Our data suggest that patients with high STAI-S showed higher levels of APAIS and that major concerns were related to surgical aspects. Among psychological characteristics, depressive symptoms and trait anxiety appeared as risk factors for the development of preoperative anxiety. Findings support the utility of planning a specific psychological screening to identify patients who need more help, with the aim of offering support and preventing the development of state anxiety and surgery worries in the preoperative phase. This highlights also the importance of good communication by the surgeon on specific aspects related to the operation.

Introduction: Adverse events (AEs) are a leading cause of patient morbidity and mortality, greatly impacting healthcare providers' well-being (second victim (SV) phenomenon). Since it is not accurately captured by existing psychometric instruments, we developed a clinimetric instrument for assessing SVs' emotional distress before and after an AE., Methods: Content validity and clinical utility of the WITHSTAND-PSY Questionnaire (WS-PSY-Q) were examined using cognitive interviews. Rasch analysis (n = 284) was applied for clinimetric assessment (i.e., construct, concurrent, and clinical validity, internal consistency), considering two crucial psychological facets of the SV phenomenon (1st: emotional impact of the AE, 2nd: current emotional state)., Results: The Rasch partial credit model was used. The 1st facet demonstrated overall acceptable clinimetric properties with the subscale anxiety meeting clinimetric threshold values (e.g., all items with ordered thresholds, Loevinger's coefficient h ≥ 0.40; Person Separation Reliability Index (PSI) = 0.7). The 2nd facet showed overall better clinimetric properties for both subscales (e.g., h ≥ 0.40, PSI = 0.82 and 0.79, respectively; receiver operating characteristic area of 0.80 and 0.86, respectively). For both datasets, item fit statistics, except those for item 19, were within the critical range (z-score &lt; ±2.5), and meaningful differential functioning analysis was observed for only 4 (out of 24) items. Local dependency was not observed, except for two item couples in the depression subscales., Conclusions: The WS-PSY-Q is the first clinimetric tool assessing SVs' emotional distress. It should be regarded as part of the armamentarium used by clinicians to assess in-depth healthcare providers' psychological reactions in the aftermath of an AE to mitigate burnout and allostatic overload., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Background: Co-creation allows to develop tailored interventions in chronicity and to increase patients' engagement. Considering the interacting nature of physical, psychological, and social domains in multiple sclerosis (MS), a biopsychosocial approach to care is crucial., Aims: This paper aims to present (i) an example of a co-creation process in the context of chronic diseases (ii) preferences and perspectives of young adults with multiple sclerosis (YawMS; aged 18-45) and healthcare professionals (HCPs) on the relevance, objectives, and modalities of a biopsychosocial intervention (named ESPRIMO) and on strategies/barriers to participation., Methods: A participatory mixed-method approach in three consecutive steps was implemented: online surveys with YawMS ( n  = 121) and HCPs ( n  = 43), online focus groups (FGs) with YawMS, consultation with an advisory board (AB) composed by YawMS, HCPs and researchers. For the survey, descriptive statistics and inductive content analysis have been used for quantitative and qualitative analysis, respectively. FGs and AB were used to deepen the understanding of the survey's results., Results: An integrated intervention is extremely relevant according to the perspectives of the main stakeholders. Helping disease acceptance, providing stress management strategies, and supporting emotional expression emerged as the most relevant psychological objectives according to participants. Having tangible benefits, being tailored, and fostering interpersonal relationships emerged as the main preferred characteristics of physical activity. Preferences emerged on the modalities and timing of the intervention, with a venue unrelated to the disease strongly supported. Both HCPs and YawMS highlighted as the most valuable advantages of conducting the intervention online the increased accessibility, while the main limit was the restriction to social interaction (recognized as already limited during the COVID-19 pandemic). Accessibility and lack of time resulted as the main barriers to participation., Conclusion: The co-creation process gave valuable information on preferences and perspectives of main stakeholders on objectives, modalities, and strategies to improve participation which has been used in the design of the ESPRIMO biopsychosocial intervention. Those results might inform future intervention development in the field of chronicity. The current paper outlined a co-creation methodology which might be replicated in future research on other conditions of vulnerability., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Donisi, Poli, Mazzi, Gobbin, Schena, Del Piccolo, Bigardi, Gajofatto and Rimondini.)

Objective: To describe the Emoty-Com training, its impact on medical students' attitudes towards doctors' emotions and to explore the association between students' empathy, emotional intelligence (EI), and attachment style (AS) with post-training performance scores., Methods: The 16-hour Emoty-Com training was delivered to all second-year medical students of Verona and Milan (Italy) Universities. At pre-training, students filled out three questionnaires assessing empathy, AS and EI and responded to three questions on attitudes towards doctors' emotions in the doctor-patient encounter. The same three questions and a final evaluation test were proposed at post-training., Results: 264 students participated in the study. The training reduced students' worry about managing emotions during doctor-patient relationships. Gender was associated with specific subscales of empathy, EI, and AS. Final performance scores were associated with students' attitudes towards emotions but not with empathy, EI, and AS., Conclusion: The Emoty-Com training increased students' self-efficacy in handling their own emotions during consultations. Students' performance scores were related to their attitude towards doctors' emotions in clinical encounters., Practice Implications: The Emoty-Com training suggests ways to teach and evaluate emotion-handling skills for medical students. Possible links between empathy, EI, AS, and the attitudes towards doctors' emotions during the years of education are highlighted., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The COVID-19 outbreak has impacted the wellbeing of people worldwide, potentially increasing maladaptive psychological responses of vulnerable populations. Although young adults with multiple sclerosis (yawMS) might be at greater risk of developing psychological distress linked to the pandemic, they might also be able to adapt to stress and find meaning in adverse life events. The aim of the present study was to explore benefit finding in response to the pandemic in a sample of yawMS. As part of a larger project, data were collected using a cross-sectional, web-based survey. Benefit finding was analysed using a qualitative thematic approach; descriptive and inferential statistics were performed to describe the sample and compare sub-groups. Out of 247 respondents with mostly relapsing-remitting MS, 199 (31.9 ± 6.97 years) reported at least one benefit. Qualitative analysis showed that during the pandemic yawMS found benefits related to three themes: personal growth, relational growth, and existential growth. No differences in benefit finding were found between age sub-groups (18-30 vs. 31-45). Participants reported a wide range of benefits, some of which seem to be specific to MS or the pandemic. Results have been transformed into tips to be introduced in clinical practice to promote resilience in yawMS through meaning making.

Objective: (1) To determine the prevalence and type of depressive symptoms at day-hospital clinical evaluation, before undergoing major surgery in patients diagnosed with pancreatic neoplasm. (2) To analyze the association between depression and sociodemographic, clinical, and psychosocial variables. (3) To understand how coping strategies, perceived social support, and self-efficacy might affect depressive symptoms in this cohort of patients., Methods: Secondary data analysis collected during the baseline phase of a randomized controlled trial performed at the Pancreas Institute of the University Hospital of Verona, Italy, between June 2017 and June 2018., Results: 18.5% of pancreatic patients had a PHQ-9 score ≥10 (cut-off). Depressed patients were basically more often female (p = 0.07), younger (p = 0.06), and married/with a partner (p = 0.02). Depression was associated to high trait anxiety (p < 0.01), the use of anxiolytics (p < 0.01), sleep-inducing drugs (p < 0.01), and painkillers (p < 0.01). Among psychosocial variables, depressed patients showed lower perceived self-efficacy (p < 0.01) and family and friends' social support (p < 0.01) and used significantly more often dysfunctional coping strategies (p < 0.01), compared to nondepressed. A logistic multivariate model using psychosocial variables as explanatory and depression as dependent was calculated and post hoc analyses were conducted to describe the contribution of each psychosocial variable on depression., Conclusions: Our study advocates the need for screening for distress and depression in cancer surgery units and recommends to strengthen patients' adaptive coping, social support, and sense of effectiveness in facing the challenges related to the medical condition and treatment process., (© 2020 John Wiley & Sons Ltd.)

Background: Multiple sclerosis (MS), the most common neurological disease that causes disability in youth, does not only affect physical functions but is also associated with cognitive impairment, fatigue, depression, and anxiety and can significantly impact health-related quality of life (HRQoL). Since MS is generally diagnosed at a young age-a period of great significance for personal, relational, and professional development-adaptation can become highly challenging. Therefore, enhancing the competence of young people to adaptively cope with these potential challenges is of utmost importance in order to promote their potentialities and talents. It has been shown that psychological interventions targeting MS patients can enhance resilience and HRQoL and that regular physical activity (PA) and social engagement can improve psychological well-being. However, literature on the development of global interventions based on the bio-psycho-social model of the disease is missing. Even less attention has been paid to interventions dedicated to young adults with MS (YawMS) and to the involvement of patients in the development of such programs., Aims: In collaboration with MS patients, this study aims to develop a bio-psycho-social intervention (ESPRIMO) for YawMS, aiming to improve their HRQoL and to explore its feasibility, acceptability, and effects., Methods: To tailor the intervention to the specific needs of YawMS, "patient engagement principles" will be adopted in the co-creation phase, performing a web survey and focus groups with patients and healthcare professionals. In the intervention phase, a pilot sample of 60 young adults with MS will be enrolled. The co-created intervention, composed of group sessions over a 12-week period, will cover psycho-social strategies and include physical activities. Adopting a longitudinal, pre-post evaluation design, self-report questionnaires measuring HRQoL and other bio-psycho-social features (e.g., resilience, well-being, mindfulness traits, self-efficacy, perceived social support, psychological symptoms, illness perception, committed action, fatigue, attitudes, subjective norms, perceived behavioral control, motivation, perception of autonomy support for PA, barriers and intentions to PA) will be administered, the quantity and quality of PA will be measured, and a questionnaire developed by the authors will be used to evaluate the feasibility and acceptability of the ESPRIMO intervention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Donisi, Gajofatto, Mazzi, Gobbin, Busch, Ghellere, Klonova, Rudi, Vitali, Schena, Del Piccolo and Rimondini.)

Objective: Recent evidence has demonstrated that the COVID-19 pandemic is taking a toll on the mental health of the general population. The psychological consequences might be even more severe for patients with special healthcare needs and psychological vulnerabilities due to chronic diseases, such as multiple sclerosis (MS). Thus, we aimed to explore the psychological impact of this pandemic and of the subsequent healthcare service changes on young adults with MS living in Italy and to examine their coping strategies and preferences regarding psychological support in the aftermath of the pandemic. Methods: Data were collected using a cross-sectional, web-based survey advertised on social networks. We report both quantitative (descriptive statistics, t -tests, and one-way ANOVA) and qualitative data (inductive content analysis). Results: Two hundred and forty-seven respondents (mean age 32 ± 7 years), mainly with relapsing-remitting MS, from all Italian regions participated. Participants felt more worried, confused, sad, and vulnerable because of the disease "during" the pandemic in comparison to their self-evaluation of the period "before" the COVID-19 outbreak. Similarly, their perception of control over MS decreased "during" the pandemic in comparison to the retrospective evaluation of the period "before" the COVID-19 outbreak ( p < 0.01). Canceled/postponed visits/exams were listed as the most frequent MS management changes, with modified/postponed pharmacological treatment representing the most stressful change. Psychological support in dealing with pandemic-related fears and improving MS acceptance and well-being was considered extremely important by almost 40% of the respondents. Different coping strategies were mentioned in the qualitative section of the survey, with social support, hobbies, and keeping busy being the most frequent ones. Conclusions: Considering the enormous impact of the pandemic on young adults with MS, we urge MS clinical centers to implement psychological support programs that address the potentially long-lasting psychological negative impact, thus fostering the therapeutic alliance that is being threatened by the infection prevention measures imposed during the pandemic, and promoting psychological resources for adaptively managing future waves of COVID-19., Competing Interests: AGa reports personal fees and non-financial support from Biogen, Merck, grants from Cesare Serono Foundation, Eurimmun, and Cariverona Foundation, outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Donisi, Gajofatto, Mazzi, Gobbin, Busch, Ghellere and Rimondini.)

Objectives: This study is based on a multi-centered RCT conducted on breast cancer patients during their first consultation with an oncologist. The main aim was to evaluate whether the introduction of a communication tool (i.e., the Question Prompt Sheet or Question Listing), with or without a companion, impacted the number of questions asked by patients during the consultation, and subsequent psychological and relational outcomes., Methods: The sample consisted of 324 breast cancer patients who were randomly placed into one of the two intervention groups: Question Prompt Sheet or Question Listing. Before and after the consultation, patients completed a set of standardized instruments: Satisfaction with decisions made during the consultation (SWD), Shared Decision Making Questionnaire (SDMQ-9), Patient Enablement Instrument (PEI), Patient Health Questionnaire Depression scale (PHQ-9), General Health Questionnaire (GHQ-12)., Results: The results indicate that the number of questions asked during the consultation was higher when a Question Listing was provided and when the patient was unaccompanied. Unaccompanied patients asked more questions in both groups and had significantly lower scores than accompanied on the GHQ-12 and on the PHQ-9, indicating lower clinical symptomatology., Conclusions: Results are in contrast with previous literature, indicating that being unaccompanied help patients to interact more with the oncologist. Further studies are needed to evaluate how the presence or not of a companion really impacts breast cancer patients during their first consultation with an oncologist., Trial Registration: ClinicalTrials.gov NCT01510964.

Objectives: To investigate the early information needs of women with a recent diagnosis of breast cancer (BC) according to their employment status., Design: Cross-sectional., Setting: Secondary-care patients attending three outpatient oncology clinics in northern Italy., Participants: 377 women with a recent diagnosis of early-stage, non-metastatic BC aged 18-75 were recruited. Of them, 164 were employed, 103 non-employed and 110 retired., Outcome Measures: The first consultation visit with an oncologist was audio-recorded and analysed for the number and type of questions asked. Linear regression models considering consultations' and patients' characteristics as confounding variables were applied., Results: Employed patients asked significantly more questions than non-employed and retired patients (17 vs 13 and 14; F=6.04; p<0.01). When age and education were included in the statistical model, the significance of employment status was rearranged among all the variables and was no more significant (b=1.2, p=0.44). Employed women asked more questions concerning disease prognosis (0.7 vs 0.4 and 0.6; F=3.5; p=0.03), prevention (1.4 vs 0.6 and 0.7; F=10.7; p<0.01), illness management (7.2 vs 6 and 5.4; F=3.8; p=0.02) and social functioning (37% vs 18% and 20%; χ 2 =14.3; p<0.01) compared with the other two groups. Finally, they attended more frequently the consultation alone (37% vs 18% and 25%; χ 2 =10.90, p<0.01), were younger (50 vs 58 and 67 years; F=63.8; p<0.01) and with a higher level of education (77% vs 27% and 45%; χ 2 =68.2; p<0.01)., Conclusions: Employment status is related to the type of questions asked during the first consultation. Also, it interrelates with other patients' characteristics like age and education in determining the number of questions asked. Patients' characteristics including employment status could be considered in tailoring work and social-related information provided during the first oncological consultation. Future studies could explore potential differences in information needs according to the different kinds of work., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This explorative cross-sectional study aims at exploring emotional distress, psychological profiles, and the attitude towards receiving psychological support in eighty-seven patients with chronic migraine (CM) undergoing OnabotulinumtoxinA prophylactic treatment (OBT-A, n = 40) or withdrawal treatment (WT, n = 47). The outcomes were explored through a specific battery of questionnaires. 25% of patients undergoing OBT-A and almost half of the patients undergoing WT reported psychological distress of at least moderate-severe level, respectively. Coping strategies, self-efficacy, and perceived social support were similar in the two groups. Patients undergoing OBT-A presented lower psychological inflexibility than patients undergoing WT. Predictors of higher psychological distress were low perceived social support by friends, low self-efficacy, and higher avoidance strategies. In both groups, most of the patients evaluated receiving psychological support to be useful (79%). The potential beneficial effects of OBT-A on the severity of symptoms and psychological distress might further support its role in the multidisciplinary management of patients with CM. Identifying patients with psychological vulnerabilities who may benefit from psychological support is relevant in patients with CM.

This study assessed the effect of a question prompt sheet (QPS) on the oncologist-patient relationship as compared with a question listing (QL). In particular, the differences in difficulties perceived by the oncologist during the consultation and in the patient's experience of the therapeutic aspects of the relationship were assessed. A total of 324 patients with a recent diagnosis of early stage breast cancer were involved in the study. The results showed that 15.7% of patients were perceived as 'difficult' by the oncologists. The proportion of 'difficult' patients varied in the two groups: 20.6% in the QPS group versus 11.8% in the QL group. The results also showed that the higher the difficulty perceived by oncologists, the lower the satisfaction of patients for their relationship with the oncologists during the consultation (r = - .135, p = .033). It is likely that the higher level of difficulty perceived by the oncologist in the QPS group may be connected with the pre-prepared list of evidence-based questions. Further research is needed to understand which components of the interventions, relating to the patient, the oncologist or their interaction, really promote patient participation in cancer setting. Trial registration: ClinicalTrials.gov NCT01510964. https://clinicaltrials.gov/ct2/show/NCT01510964.

Objective: Literature shows that emotional status can influence participation in screening/surveillance programs, and that screening/surveillance programs may alter the psychological well-being of subjects examined. This study aims to assess if participating in a surveillance program for pancreatic cancer early detection is associated with abnormal levels of psychological distress in high-risk individuals (HRIs), compared to the general population., Methods: Fifty-four HRIs participating in a magnetic resonance cholangiopancreatography (MRCP)-based surveillance program completed several psychological assessment questionnaires, investigating global functioning, self-efficacy, perceived stress, coping abilities, and social support. The questionnaires were administered by a clinical psychologist after the MRCP but before the subjects were informed about the results of the scans. The HRIs were subjects with strong familiarity of pancreatic cancer and/or carriers of known genetic mutations related to cancer susceptibility. The psychological assessment was made at the time of the first examination., Results: The population was characterized by an overall good psychological status. Scoring of our sample was comparable to the general population norms. The HRIs showed decent global functioning, high self-efficacy levels, low perceived stress in the last month prior to examination, efficient emotion-focused coping strategies, and an adequate social support system. The younger subjects' subpopulation only revealed higher levels of stress., Conclusions: From a psychological point of view, an MRCP-based pancreatic cancer annual surveillance seemed not to influence the HRIs' psychological well-being, unless in young people. Further studies are needed to better establish if there are any changes in distress levels over time and how emotional status influences participation in surveillance programs., (© 2020 John Wiley & Sons, Ltd.)

Introduction: The aim of the present paper is to establish feasibility and required power of a one-session psychological intervention devoted to increasing patient's self-efficacy and awareness in dealing with anxiety symptoms before major pancreatic cancer surgery., Methods: Parallel assignment RCT. All consenting patients listed for pancreatic major surgery during day-hospital visits (T0) between June 2017-June 2018 were assigned randomly in blocks of ten to a psychological intervention vs usual care group to be held the day before surgery (T1). The psychological intervention provided the patient the opportunity to increase self-efficacy in dealing with anxiety by talking with a psychologist about personal concerns and learning mindfulness based techniques to cope with anxiety., Results: 400 patients were randomized into the experimental vs. usual care group. 49 and 65, respectively, completed baseline and post-intervention measures. The dropout rate between day-hospital (T0) and pre-surgery intervention (T1) was high (74.5%) due to several management and organization pitfalls. The main outcome, perceived self-efficacy in managing anxiety, showed a significant increase in the intervention group compared to the control group ( p < 0.001), and was related to a reduction in state anxiety ( p < 0.001). The intervention group perceived also lower emotional pain ( p = 0.03). A power analysis was performed to define the appropriate sample size in a definitive RCT., Conclusion: Beneath the complexity in retaining patients along their trajectory in pancreatic surgery department, when they had the opportunity to follow a brief psychological intervention, most of them adhered, showing a significant reduction in preoperative emotional distress and less emotional pain perception after surgery. Even if results need caution because of the high attrition rate, we can infer that our psychological intervention has the potential to be proposed in surgical setting, being short, easy to learn and applicable to a wide range of patients., Clinical Trial Registration: The trial was registered on ClinicalTrials.gov (identifier: NCT03408002). The full protocol is available from the last author., (Copyright © 2020 Marinelli, Danzi, Mazzi, Secchettin, Tuveri, Bonamini, Rimondini, Salvia, Bassi and Del Piccolo.)

Patients' first impressions obtained during early contacts with doctors represent the basis for relationship building processes. Aim of this study was to verify how patients' first impression of doctors' communication approach influences patients' global assessment of doctors' performance. This cross-sectional study was part of a larger, multicenter observational study aiming to assess lay-people's preferences regarding patient-doctor communication. All participants ( N  = 136) were equally distributed over two selected Italian and Dutch recruitment centers as well as for gender and age. In each center, panels of 6-9 persons each watched the same set of eight videotaped Objective Structured Clinical Examination consultations. Participants performed different tasks as to pick up salient communication elements while watching the videos and to rate doctors' global communicative performances on a 10-point Likert scale. We performed a mediation analysis to assess direct and indirect effects of participants' first impression on participants' global assessment. Among the 439 collected first impressions, 284(65%) were positive. When the first impression was positive, the mean value of the global assessment of doctors' performance was significantly higher ( M  = 7.4, SD  = 1.5) than when the first impression was negative ( M  = 6.0, SD  = 1.6); t (437) = 9.0 p  < .001. According to the mediation analysis, this difference was due to a direct ( c'  = 0.53) and an indirect effect ( ab =  0.86) deriving from the total effect of first impressions on the global assessment of doctors' performances ( c  = 1.39). In conclusion, the first impression has a strong impact on positive and negative judgments on doctors' communication approach and may facilitate or inhibit all further interactions.

Objective: (1) To report the number and type of emotional expressions (cues/concerns) raised by breast cancer patients; (2) to identify the influence of setting, patient characteristics, and doctor-patient interaction on emotional expression., Methods: 308 Italian-speaking female patients were recruited at their first breast cancer consultation. The visits were audio-recorded and analysed for number and type of emotional expressions (VR-CoDES). Oncologists' interaction skills were rated by the VR-COPE. Socio-demographic, clinical and personality variables were gathered before the consultation. Clinical variables and oncologists' evaluations of the patient were collected after., Results: Breast cancer patients raised emotional issues mainly as cues. The setting (centre where the consultations took place), the oncologist's attribution of anxiety, regardless of anxiety test screening (STAI-X1) score before the consultation, and the oncologist's ability to pick up on patient's worries, handle emotional needs or understand psychosocial condition were all positively related with the number of emotional expressions. More tightly structured consultations had fewer emotional expressions., Conclusion: Both contextual and interactional aspects have an impact on patient emotional expressions., Practice Implications: Oncologists need to be trained to manage both the content and the process of medical consultation. Work organization of the consultation setting needs to be taken into account., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Multiple sclerosis (MS), the most common neurological disease causing disability in young adults, is widely recognised as a major stress factor. Studies have shown that the first years after the diagnosis are distressing in terms of adjustment to the disease and that MS negatively affects patients' psychological well-being, quality of life (QoL) and social functioning. However, the links between disease-specific variables at diagnosis, resilience and psychological adjustment of patients with MS remain largely unexplored, especially in adolescents and young adults. This observational study aims to fill the gap of knowledge on b io p sycho s ocial characteristics and r esilience of young a dults with MS to evaluate the relationship among these variables and to develop a biopsychosocial model of resilience., Methods and Analysis: Biological and clinical characteristics of young adults newly diagnosed with MS will be investigated by collecting clinical information, performing neurological examinations, MRI and analysing cerebrospinal fluid and blood biomarkers (eg, measures of inflammation), body composition, gut microbiota and movement/perceptual markers. Psychosocial characteristics (eg, psychological distress, coping strategies), QoL, psychological well-being and resilience will be assessed by self-report questionnaires. Comparative statistics (ie, analysis of variance or unpaired samples t-test, correlation and regression analyses) will be applied to evaluate the relationship among biological, psychological and social factors. The results are expected to allow a comprehensive understanding of the determinants of resilience in young patients with MS and to inform resilience interventions, tailored to young patients' specific needs, aiming to reduce the risk of maladaptive reactions to the disease and to improve psychological well-being and QoL., Ethics and Dissemination: The study has been approved by the Verona University Hospital Ethics Committee (approval number: 2029CESC). The findings will be disseminated through scientific publications in peer-reviewed journals, conference presentations, social media and specific websites., Trial Registration Number: ClinicalTrials.gov (NCT03825055)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In the last years, patients' empowerment has been increasingly recognized as a crucial dimension of patient-centered healthcare and patient safety. Nevertheless, little work has been done so far in the field of patient safety to investigate strategies for empowering psychiatric patients. Therefore, the aim of this study was to identify, by using focus groups, whether and how psychiatric patients' empowerment can improve risk management according to the perspective of healthcare providers (HPs)., Methods: A mixed-method approach composed of a qualitative data collection method (i.e., focus groups) and a quantitative analysis technique (i.e., inductive content analysis) was applied. HPs working in mental health settings shared their perspectives on psychiatric patients' empowerment in risk management. After the transcription of the audio-taped discussions and the subsequent development of a hierarchical four-level coding system (strategy versus critical issue, thematic area, category, subcategory), two independent raters codified the transcripts and synthesized the content. Absolute frequencies are reported for quantitative data., Results: Twelve focus groups consisting of six to ten participants, each with an overall sample size of 95 participants (65 women; average age ± SD 47 ± 9 yrs), were enrolled. A total of 1252 participants' verbal contributions (i.e., units of analysis) were assessed. Strategies and critical issues (Level 1) were mentioned almost equally (52 and 48%, respectively) by the HPs. Most of the contributions at Level 2 referred to the thematic areas Treatment and Cure (69%) and Emergency Management (21%). In the area Treatment and Cure, the category Therapeutic Compliance (Level 3) was discussed in one third of all contributions., Conclusions: Our results suggest that HPs consider patients as crucial partners in risk management and expect them to play a key role in actively enhancing safety. Policy makers should be aware that risk management in mental health settings particularly relies on the therapeutic relationship between HPs and patients. Therefore, allocating sufficient human and financial resources to mental health care aiming to further support the relationship between patients and HPs is of utmost importance.

Unhealthy lifestyles contribute, with other risk factors, to the high prevalence of mortality and physical comorbidity among mental patients compared to the general population. We collected data on the lifestyles of 193 subjects with psychosis in contact with a Community Mental Health Service in north-eastern Italy and compared them with a representative sample (total: 3219 subjects) of the general population of the same region. Diet, exercise, smoking and alcohol consumption were worse in mental patients. A higher percentage of patients was overweight or obese. The associations between socio-demographic and lifestyles variables showed that older patients exercise less, female patients tend to smoke and use alcohol less, while more educated patients tend to have higher alcohol consumption levels. Mental patients have unhealthier lifestyles and they appear to be more refractory to recommendations than the general population, indicating the necessity of specific health promotion programmes in this population.

Objective: To assess European patients' preferences regarding seven aspects of doctor-patient communication., Methods: 6049 patients from 31 European countries evaluated 21 doctor and 12 patient behaviours, through a patient-generated questionnaire (PCVq). Multilevel models explored the effects of patient characteristics, contextual and cultural dimensions on preferences., Results: Patients attributed more responsibility to doctors, by giving greater importance to doctor than to patient factors, in particular to Treating the patient as a partner and as a person and Continuity of care. Gender, age, education, the presence of chronic illness and two of Hofstede's cultural dimensions, Individualism and Indulgence, showed differential evaluations among patients. Women gave greater importance to all seven communication aspects, older patients to being prepared for the consultation, lower educated patients to Treating patient as a person and Thoughtful planning. Patients from countries with an indulgent background rated all seven communication aspects of greater importance. A more individualistic orientation was related to lower importance regarding the four doctor's factors and the patient factor Open and Honest., Conclusions: Treating the patient as a person and providing continuity of care emerged as universal values., Practice Implications: The findings should represent a landmark for the adaptation of patient-generated communication guidelines and programs in Europe., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: For many years, long-acting intramuscular (LAI) antipsychotics have been prescribed predominantly to chronic and severe patients, as a last resort when other treatments failed. Recently, a broader and earlier use of LAIs, particularly second-generation LAIs, has been emphasized. To date, few studies attempted to frame how this change in prescribing took place in real-world practice. Therefore, this study aimed to describe the clinical features of patients prescribed with LAIs, and to explore possible prescribing differences between first- and second-generations LAIs under ordinary clinical practice in Italy., Methods: The STAR Network "Depot" Study is an observational, longitudinal, multicenter study involving 35 centers in Italy. In the cross-sectional phase, patients prescribed with LAIs were consecutively recruited and assessed over a period of 12 months. Descriptive statistics and multivariable logistic regression analyses were employed., Results: Of the 451 recruited patients, 61% were males. The level of social and working functioning was heterogeneous, as was the severity of disease. Seventy-two per cent of the patients had a diagnosis of the schizophrenia spectrum. Seventy per cent were prescribed with second-generation antipsychotic (SGA) LAIs (mostly paliperidone, aripiprazole and risperidone). Compared to first-generation antipsychotic (FGA) LAIs, patients prescribed with SGA LAIs were more often younger; employed; with a diagnosis of the schizophrenia spectrum or bipolar disorder; with higher levels of affective symptoms; with fewer LAI prescriptions in the past., Discussion: LAIs' prescribing practices appear to be more flexible as compared to the past, although this change is mostly restricted to SGA LAIs., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Psychotic patients have poorer health behaviours, including poor diets and sedentary lifestyles increasing their risk for obesity, diabetes, hypertension, and dyslipidaemia, and tend to have a shorter life expectancy as compared to nonpsychiatric populations. Lifestyle intervention programmes that target modifiable risk factors in such patients have produced uneven results. The objective was to evaluate the efficacy of a package of health promotion strategies to improve diet and physical exercise in psychotic patients. Our hypothesis was that a pre- to post-treatment improvement in physical activity and dietary habits would occur in the group receiving intervention., Method: This randomised controlled trial was carried out in four psychiatric services. The intervention included psychoeducation sessions on diet and physical activity and regular participation in walking groups (experimental group). The control group received routine treatment. The primary outcome was an improvement of at least one World Health Organization recommendation on diet and exercise., Results: Of a total of 326 subjects recruited, 169 were randomly assigned to the experimental group and 157 to the control group. An improvement in one or more World Health Organization criteria over baseline was observed in 25.4% of experimental group subjects and in 12.2% of control group subjects (odds ratio 2.46, 95% confidence interval 1.22-4.97; p=0.01)., Conclusions: A statistically significant proportion of the sample achieved post-treatment improvement in lifestyle habits, especially as regarded increased physical activity. A post-intervention reduction in lifestyle variability was also noted. Interventions directly addressing dietary habits may be desirable in psychotic patients., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objectives: To investigate, prior to an oncology consultation, the use of a pre-prepared list of evidence based questions, Question Prompt Sheet (QPS), compared with a Question List (QL), a patient self-generated list of questions., Design: Multi-centred, randomised controlled trial., Setting: Secondary-care patients attending three outpatient oncology clinics in Northern Italy., Participants: 308 women completed the study. Inclusion criteria were an age between 18 and 75 years, a recent diagnosis of early stage, non-metastatic breast cancer, adequate Italian language skills, no previous oncology visits and no evidence of cognitive impairment., Intervention: Patients received the QPS or the QL prior to the consultation, completed it without suggestion or coaching session and delivered back before the visit.The consultations were audio-recorded and analysed for the number and content of questions. Multilevel linear models were used to compare the two groups., Outcome Measures: The primary outcome was the comparison of questions asked between QPS and QL group. Secondary outcomes included satisfaction about questions asked, satisfaction with decision, and level of anxiety., Results: Patients in the QPS and QL group asked 13 and 16 questions respectively. The difference was not significant (b=1.7, CI -0.3 to 3.6, p=0.10). A mean of 22 questions was selected in the QPS, while a mean of 2 questions was written in the QL. Patients in the QPS group were significantly less satisfied (t=3.60, p<0.01) with questions asked but wanted less additional information (t=2.20, p<0.05). Levels of patient decisional satisfaction were equivalent between groups. Similarly, anxiety levels were equal between groups prior to the consultation and decreased in similar way after the consultation., Conclusions: Both interventions have similar impact on patients' participation in terms of question asking during the consultation. Future research is needed in order to explore which components of the interventions are really useful and efficacious., Trial Registration: ClinicalTrials.gov NCT01510964., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: In a previous qualitative study (GULiVer-I), a series of lay-people derived recommendations ('tips') was listed for doctor and patient on 'How to make medical consultation more effective from the patient's perspective'. This work (GULiVer-II) aims to find evidence whether these tips can be generally applied, by using a quantitative approach, which is grounded in the previous qualitative study., Methods: The study design is based on a sequential mixed method approach. 798 patients, representing United Kingdom, Italy, Belgium and the Netherlands, were invited to assess on four point Likert scales the importance of the GULiVer-I tips listed in the 'Patient Consultation Values questionnaire'., Results: All tips for the doctor and the patient were considered as (very) important by the majority of the participants. Doctors' and patients' contributions to communicate honestly, treatment and time management were considered as equally important (65, 71 and 58% respectively); whereas the contribution of doctors to the course and content of the consultation was seen as more important than that of patients., Conclusions: The relevance of GULiVer-I tips is confirmed, but tips for doctors were assessed as more important than those for patients., Practice Implications: Doctors and patients should pay attention to these "tips" in order to have an effective medical consultation., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: The evidence that inspires and fosters communication skills, teaching programmes and clinical recommendations are often based on national studies which assume, implicitly, that patients' preferences towards doctors' communication style are not significantly affected by their cultural background. The cross-cultural validity of national results has been recognized as a potential limitation on how generally applicable they are in a wider context. Using 35 country-specific focus group discussions from four European countries, the aim of the present study is to test whether or not national cultures influence lay people's preferences towards doctors' style of communication., Methods: Lay people preferences on doctor's communication style have been collected in Belgium, the Netherlands, the United Kingdom and Italy. Each centre organized between eight and nine focus groups, where participants (n = 259) were asked to comment on a video of a simulated medical interview. The discussions were audiotaped, transcribed and coded using a common framework (Guliver Coding System) that allowed for the identification of different themes., Results: The frequency distribution of the topics discussed highlights lay people's generally positive views towards most part of doctors interventions. The regression model applied to the Guliver categories highlighted slight national differences and the existence of a cross-cultural appreciation, in particular, of five types of intervention: Doctors attitudes (both Task-Oriented and Affective/Emotional), Summarizing, Structuring and Providing solution., Conclusion: Lay panels valued doctors' communication style in a similar manner in the countries selected. This highlights the existence of a common background, which in the process of internationalization of heath care, might foster the implementation of cross-national teaching programmes and clinical guidelines.

Purpose: Questions asked by patients during consultations reflect their most immediate information needs. The aim of this study is to observe the frequency and type of questions asked by Italian breast cancer patients and to explore associated factors., Methods: Breast cancer patients at their first meeting with the oncologist were asked to complete five questionnaires (STAI-X1, PHQ-9, GHQ-12, CPS and DSES) before the consultation and three other questionnaires (PEI, SDM-Q, SWD) after. Consultations were audio taped and subsequently analyzed for the content and number of questions to identify patients' information requests., Results: Patients asked an average of 18 questions, mainly about illness management: patients who were prescribed chemo-therapy asked more questions (t = -3.17, dof = 23.45, p < 0.01). Other factors related to a greater number of questions were younger age (r = -0.24, p = 0.05), being employed (t-test = 0.32; p = 0.04), and longer consultation length (r = 0.47, p < 0.01)., Conclusion: Italian breast cancer patients asked on average more questions than in other countries. Knowledge of the factors associated with information needs can contribute to achieve a major involvement and consequently a better quality of patient-centered care., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: The literature shows that the quality of communication is usually determined from a professional perspective. Patients or lay people are seldom involved in the development of quality indicators or communication., Objective: To give voice to the lay people perspective on what constitutes 'good communication' by evoking their reactions to variations in physician communication., Design: Lay people from four different countries watched the same videotaped standardized medical encounters and discussed their preferences in gender-specific focus groups who were balanced in age groups., Setting and Participants: Two hundred and fifty-nine lay people (64 NL, 72 IT, 75 UK and 48 BE) distributed over 35 focus groups of 6-8 persons each., Main Variables Studied: Comments on doctors' behaviours were classified by the GULiVer framework in terms of contents and preferences., Results: Participants prevalently discussed 'task-oriented expressions' (39%: competency, self-confident, providing solutions), 'affective oriented/emotional expressions' (25%: empathy, listening, reassuring) and 'process-oriented expressions' (23%: flexibility, summarizing, verifying). 'Showing an affective attitude' was most appreciated (positive percentage within category: 93%, particularly facilitations and inviting attitude), followed by 'providing solution' (85%). Among disfavoured behaviour, repetitions (88%), 'writing and reading' (54%) and asking permission (42%) were found., Conclusions: Although an affective attitude is appreciated by nearly everybody, people may vary widely in their communication needs and preferences: what is 'good communication' for one person may be disliked or even a source of irritation for another. A physician should be flexible and capable of adapting the consultation to the different needs of different patients. This challenges the idea of general communication guidelines., (© 2013 John Wiley & Sons Ltd.)

Objective: To describe how emotions are disclosed during psychiatric diagnostic consultations and the contribution of the psychiatrists in facilitating their expression., Methods: Descriptive naturalistic study. Sixteen psychiatrists recorded their first consultations with 104 patients. Emotions and the immediate response given by the psychiatrist were coded with the Verona Coding Definitions of Emotional Sequences. For each disclosed emotion, the potential link to preceding expressions with affective content (cue or concern) was checked and the immediate response given by the psychiatrist was coded., Results: Most emotions were expressions of anxiety in terms of psycho-physiological or cognitive correlates. Concerns were present in 94% of the consultations, 47.6% were not linked to previous cues/concerns. Cues which became concerns and concerns which were further elaborated by the patient were those that had been acknowledged and handled by the psychiatrist by actively providing space to their expression. Compared to all other diagnostic groups, patients with mood disorders talked more explicitly and more often about their feelings., Conclusion: The type and frequency of expressed emotions varies with patient diagnosis, suggesting different cognitive processes underlining psychopathology., Practice Implications: Psychiatrist's competence in providing space by using active listening skills is essential to uncover patients emotions., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Purpose: Companions often accompany patients to cancer consultations. The number of questions asked by patients and companions is an indicator of their active participation. The present study aims to provide first descriptive evidence on the characteristics of unaccompanied and accompanied Italian breast cancer patients that attend the first consultation after surgery and to analyse companions contribution to the type and quantity of questions asked during the consultation., Method: Seventy consultations of female patients with breast cancer were audio taped. Questions were transcribed and coded by content. Companion's questions were also classified in terms of function. Socio-demographic and clinical data, patients' role preference and confidence in decision making measures were gathered for each patient. Post consultation satisfaction with decision and the perceived level of shared decision making were collected either for the patient and the companion., Results: 69% of patients were accompanied, usually by one close family member, either husband or adult child. Non employed or retired patients and those with a preference for passive role in decision making were more likely to be accompanied. Unaccompanied patients and accompanied patients had comparable levels of anxiety, emotional distress and depression and were equally active in asking questions. These levels were far greater than those reported for other cancer patients in the literature. Companions did not increase significantly the number of questions per consultation., Conclusion: Accompanied and non accompanied patients differed more in socio-demographic than clinical characteristics. Companions sustained the patient and shared information without reducing the level of patient involvement., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Introduction: Studies on patient involvement show that physicians make few attempts to involve their patients who ask few questions if not facilitated. On the other hand, the patients who participate in the decision-making process show greater treatment adherence and have better health outcomes. Different methods to encourage the active participation during oncological consultation have been described; however, similar studies in Italy are lacking. The aims of the present study are to (1) assess the effects of a preconsultation intervention to increase the involvement of breast cancer patients during the consultation, and (2) explore the role of the attending companions in the information exchange during consultation., Methods and Analysis: All female patients with breast cancer who attend the Oncology Out-patient Services for the first time will provide an informed consent to participate in the study. They are randomly assigned to the intervention or to the control group. The intervention consists of the presentation of a list of relevant illness-related questions, called a question prompt sheet. The primary outcome measure of the efficacy of the intervention is the number of questions asked by patients during the consultation. Secondary outcomes are the involvement of the patient by the oncologist; the patient's perceived achievement of her information needs; the patient's satisfaction and ability to cope; the quality of the doctor-patient relationship in terms of patient-centeredness; and the number of questions asked by the patient's companions and their involvement during the consultation. All outcome measures are supposed to significantly increase in the intervention group., Ethics and Dissemination: The study was approved by the local Ethics Committee of the Hospital Trust of Verona. Study findings will be disseminated through peer-reviewed publications and conference presentations., Trial Registration: ClinicalTrials.gov identifier: NCT01510964.

Background: The project GULiVer explores how lay people in Belgium (Gent), the Netherlands (Utrecht), the UK (Liverpool) and Italy (Verona) evaluate physicians' communicative skills. The aims are to present the study design and to assess the quality of collected data., Methods: In each centre one out of two sets of four videotaped consultations involving medical students with varying communication skills were shown to eight lay panels of six to nine participants each (n = 259). The selection of lay participants was stratified by gender and age in order to obtain a heterogeneous sample. Background characteristics included socio-demographics, participants' general physical (COOP-WONCA) and mental health (GHQ), communication preferences (QUOTE-com) and trust in doctors (TMP). Participants were asked to give quantitative and qualitative evaluations of the student doctors' performance in a mixed-methods design. Quality assessment of the collected data and protocol adherence of the four centres was carried out by Generalized Linear Model (GLM)., Results: The overall sample comprised 259 participants. Participants were equally distributed among the centres and balanced in terms of age, gender and OSCE scenario, confirming the quality of collected data., Conclusion: The study design and the applied procedures will ensure a great richness of data allowing a wider European perspective on lay persons' views, assessed both individually and through focus group discussion.

Aims: Almost no data are available on whether patients and doctors have similar or dissimilar opinions on the presence and level of distress due to antipsychotic adverse effects. The aim of this survey is to compare doctors' versus patients' perspective on the presence and level of distress due to antipsychotic adverse effects in a sample of patients under the care of the South-Verona mental health services., Methods: All patients exposed to antipsychotic drugs during a census period of 6 months were identified. For each included subject, socio-demographic, clinical and treatment data were extracted. Patients' perspective on antipsychotic adverse effects was measured by means of the Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS). The LUNSERS was similarly employed to measure doctors' perspective on antipsychotic adverse effects., Results: During the recruitment period, 243 patients taking antipsychotic drugs were enrolled. The correlation between the total LUNSERS score reported by patients and doctors was very low (correlation coefficient 0.22, 95% confidence interval 0.15-0.30). On average, patients perceived more adverse effects and with a significant higher distress than doctors. Multivariate analyses found no factors simultaneously associated with both patient and doctor ratings of adverse effects., Conclusion: Our study suggests that doctors, researchers and health care providers should increasingly consider patient and doctor perspectives as two complementary dimensions that may provide different insights in the evaluation of antipsychotic drugs. Integrating different points of view may represent a way to develop a better therapeutic alliance that might decrease the likelihood of nonadherence.

Background: Factors influencing patient and clinician perspectives in the assessment of medication adherence have never been compared., Method: This study used baseline and 12-month follow-up data from the QUATRO study, an international multicentre study. At baseline, information on patient sociodemographic characteristics, treatment factors, psychopathology, functioning and experience of antipsychotic side effects was gathered. After 12 months of follow-up, psychopathology, functioning and patient experience of antipsychotic side effects were measured once more, and a patient and clinician rating of adherence was obtained by means of the Medication Adherence Rating Scale (MARS) and the Compliance Rating Scale (CRS)., Results: During the recruitment period, 409 subjects with a diagnosis of schizophrenia were recruited. Patients were more often men and single. Mean age was 41.5 years. At the time of the assessment, more than 40% were unemployed and on average had been on antipsychotic treatment for more than 10 years. Nearly 70% were receiving second-generation antipsychotics, and 50% received adherence therapy during the 12 months after enrollment. The relationship between the MARS and the CRS scores showed only a small overlap (correlation coefficient = 0.26). In the multivariate model, the only factor significantly associated with both patient and clinician ratings of adherence was psychopathology. Unemployment and poor subjective tolerability of antipsychotics were significantly associated with low levels of patient ratings of adherence. Conversely, length of treatments and use of newer antipsychotics were significantly associated with better clinician ratings of adherence., Conclusion: Patient and clinician ratings of adherence do not measure the same dimension. Factors that may positively affect adherence in terms of compliance with prescribed medication regimens may not affect patients' views on adherence, and this should be taken into consideration when planning and negotiating treatment modalities with each individual patient suffering from schizophrenia.