Alberto Ghilardi

INvolvement of breast CAncer patients during oncological consultations: A multicentre randomised controlled trial-the INCA study protocol

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 patients perceived achievement of her information needs; the patients 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 patients 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

A follow-up study on students attending a university counselling service in Northern Italy

ABSTRACT The aims of this study were to evaluate the effectiveness of a university counselling service in Northern Italy, to assess the sociodemographic and clinical characteristics of students who used counselling service, and to assess the psychological conditions of the students who ended the counselling after a 4 month follow-up period. The study involved 100 students, who filled out the General Health Questionnaire (GHQ-12), the Brief COPE Inventory, and the Symptom Checklist-90-Revised (SCL-90-R). The results showed that who received counselling were positively affected by this experience. The areas of benefit were psychological well-being, coping behaviours, ability to positively reframe problems and less sense of guilt. Additional studies are needed to identify which factors influence the outcomes of university counselling services in Italy. These studies would be important to evaluate the services rendered, upgrade the skills of counsellors and visualise priority areas of need.

Salute mentale materna e attaccamento madre-bambino nella gravidanza a rischio: una revisione sistematica

La comparsa di sintomi psicopatologici e/o di complicanze gestazionali nel periodo perinatale puo influenzare il processo d’adattamento alla gravidanza e lo sviluppo dell’attaccamento madre-bambino. Obiettivo dello studio era analizzare la prevalenza di disturbi mentali e i pattern di attaccamento in campioni di donne con gravidanza a rischio. E stata condotta una revisione sistematica in Medline, Psychinfo, Embase. In totale sono stati inclusi 59 studi condotti con campioni di donne con gravidanza a rischio. I risultati indicano che la proporzione di donne con sintomi psicopatologici e superiore rispetto a quella riscontrata in gruppi di donne senza complicazioni, in particolare in caso di bassa scolarita, pregressi disturbi mentali, pregresse complicanze gestazionali e strategie disfunzionali di coping. Gli studi svolti nel periodo post-natale mostrano una stretta associazione tra sintomi ansiosi-depressivi materni e qualita dell’interazione madre-neonato. Gli studi svolti nel periodo antenatale sono invece scarsi e hanno prodotto risultati discordanti circa l’esistenza o meno di pattern specifici di attaccamento prenatale. In conclusione, si puo affermare che le complicazioni gestazionali costituiscono un fattore di rischio per la comparsa di sintomi psicopatologici, e dunque con possibili ripercussioni sulla qualita dell’interazione madre-bambino. Nel manoscritto vengono argomentati i meccanismi bio-psico-sociali che possono spiegare i risultati emersi dagli studi esaminati. Vengono altresi descritte le principali implicazioni cliniche che possono essere utili in ambito ostetrico, ma anche piu in generale, nell’intervento in casi di disturbo dell’organizzazione dell’attaccamento.

Beliefs and Prejudices Versus Knowledge and Awareness: How to Cope Stigma Against Mental Illness. A College Staff E-survey

The aims of this study were to collect information about attitudes toward mental illness from the staff of Brescia University, and to detect predictors of issues regarding mental disorders and evaluate their relationship with public stigma. The study involved 1079 people and each participant received a letter explaining the purpose of the e-research. Four hundred and eighty-six people completed the questionnaires. The results showed that those who had a higher level of education, a personal life experience with mental disorders and a higher professional role were more likely to develop behaviours of acceptance toward the mentally ill. Factor analysis of the CAMI showed three main factors: Social distance and isolation, Social integration, Social responsibility and tolerance. Through the structural equation model it was found that the latent construct stigma was mainly defined by the first factor. From this study it emerged that education and personal contact were protective factors against public stigma.

Detecting and Managing Mental Health Issues within Young Adults. A Systematic Review on College Counselling in Italy

Background: College counselling can be considered as a front-line service in detecting and managing mental health issues within young adults. In this sense, it is important to investigate the effectiveness of counselling interventions. Objective: To provide a systematic review about college counselling in Italy; to assess which psychological interventions really meet student needs, and their effectiveness; to focus on the level of cohesion between Italian counselling services and the international guidelines about college counselling. Method: A systematic review about college counselling through PsycInfo and PubMed was carried out. Because of the scarceness of pertinent available articles, the survey was extended to Google Scholar and Riviste Web. Keywords: counselling, mental health, wellbeing, psychological support, university, students, Italy. Results: Out of thirty-four articles retrieved, 16 are relevant to academic counselling, the other 18 have been considered not pertinent to the aim of the present review. Data show a lack of homogeneity in methodology and organization between each University: different approaches towards students’ needs. Furthermore, no follow-up studies or measurement of effectiveness were found. Conclusion: This review is a contribution to disseminate the results of counselling experiences in Italy and represents an effort to encourage colleagues working in a web environment to share results and methods for a more organized protocol application.

The involvement of early stage breast cancer patients during oncology consultations in Italy: a multi-centred, randomized controlled trial of a question prompt sheet versus question listing

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

La valutazione dell’attrazione sessuale, tipologie di attrazione e variabilità inter-individuale

L’attrazione sessuale, da sempre considerata sinonimo dell’orientamento sessuale, raramente e stata trattata come un fenomeno che meritasse di essere studiato in modo indipendente. Questo studio parte dalla considerazione che attrazione sessuale e orientamento sessuale sono costrutti autonomi e che, di conseguenza, la valutazione separata dell’attrazione sessuale potrebbe avere importanti ricadute sia in ambito clinico che di ricerca. Per indagare l’attrazione sessuale e stato utilizzato un questionario multidimensionale - il Questionario sull’Attrazione Sessuale - di cui si propone l’adattamento italiano su una popolazione adulta. I risultati di questo studio mostrano che il questionario gode di buone qualita psicometriche e che risulta essere un utile strumento in grado di promuovere una maggiore comprensione scientifica e una piu profonda valutazione clinica dei processi individuali coinvolti nell’attrazione sessuale.

Le abilità comunicativo-relazionali in medicina: Un percorso formativo in ambito ospedaliero

The present paper is aimed to describe methods and results of an educational intervention on doctor-patient communication. The intervention was addressed to 26 hospital physicians and lasted 20 hours, and it was formulated according to patient-centred model. At the end of the intervention, participants referred satisfaction for the course, and the proportion of doctors with patient-centred style was higher compared to the one of the initial assessment (Z Wilcoxon=2,236; p=.02). No associations were found between communicative-relational style and sociodemographic variables. For hospital physicians, three main topics seems require future interventions: the communication of bad news, the management of own emotions, the influence of contexts factors on doctor-patient relationship.The present paper is aimed to describe methods and results of an educational intervention on doctor-patient communication. The intervention was addressed to 26 hospital physicians and lasted 20 hours, and it was formulated according to patient-centred model. At the end of the intervention, participants referred satisfaction for the course, and the proportion of doctors with patient-centred style was higher compared to the one of the initial assessment (Z Wilcoxon=2,236; p=.02). No associations were found between communicative-relational style and sociodemographic variables. For hospital physicians, three main topics seems require future interventions: the communication of bad news, the management of own emotions, the influence of contexts factors on doctor-patient relationship.

Mental Disorders and Work Integration: A Retrospective Study in a Northern Italian Town

Objectives: The present study was conducted in a vocational integration service of a northern Italian town with two major aims: to assess vocational integration programs undertaken from 1st January 2004 to 1st January 2007; and to identify job tenure-associated predictors. Methods: This is a retrospective study; we collected data such as gender, age, duration, type and outcome of the vocational integration program, and number of interventions performed by the vocational integration service. Self-report questionnaires were also used to assess the satisfaction of users, caregivers, practitioners, and of the company contacts involved in the study. Results: The service has enrolled 84 users during the observation period. Out of these users, 64.3% of them still had their jobs after three years. Users, caregivers and company contacts expressed high levels of satisfaction for the support received by the vocational integration service. The company expressed less satisfaction for the collaboration received by the Departments of Mental Health (DMHs) that coached the users. The only variable associated to the outcome was the number of interventions that the users received before their placement on the job. Conclusions: Despite all the limits of this study, its results show that the chance of taking advantage of a supported job placement service has likely proven itself effective in helping people with mental disorders to obtain and maintain a competitive employment. Our results, however, also point to the necessity of implementing newer strategies meant to develop a greater integration among all services dealing with mentally ill people.

Comprendere i bisogni e creare contesti di cura

E forse il tempo che avvenga per la psicologia clinica qualcosa di analogo a quanto e avvenuto per la nascita della psicologia come scienza (Agazzi E., 1976), ovvero l’avvio di una riflessione epistemologica sullo stato attuale della propria identita, riflessione che includa anche la delineazione di una prospettiva di sviluppo professionale diretta alle nuove conoscenze e competenze di ruolo da utilizzare per le diverse funzioni professionali, richieste dai nuovi scenari che si presenteranno di fronte al lavoro clinico. Scenari non piu legati, ad esempio, solo al “classico” lavoro individuale, ma anche ad interventi gruppali ed istituzionali, rispondendo, con modalita adeguate, ad esigenze di strati sempre piu vasti di utenti, siano essi pazienti, gruppi o organizzazioni.