Chiara Mastroianni

Pressure ulcers in cancer palliative care patients

Terminally ill cancer patients are considered at high risk for pressure ulcers because of their clinical condition. However, in Italy, data about pressure ulcers and their prevalence are insufficient. This paper reports a study on pressure ulcers incidence and prevalence in a population of oncology patients cared for in an Italian palliative care service. A retrospective analysis of 414 clinical records of patients admitted over 6 months showed a prevalence of pressure ulcers of 22.9% and an incidence of 6.7%. Karnofsky Performance Scale Index scores, age and length of the stay were significantly related to the pressure sore development. These results support the need to focus attention on pressure ulcers prevention and treatment in terminally ill cancer patients, and to further define specific guidelines aimed at warranting patients’ comfort and quality of life.

Complementary therapy and support services for formal and informal caregivers in Italian palliative care hospices: an exploratory and descriptive study

PurposeThe present study is aimed to assess the availability and use of complementary medicine (CM) therapies in Italian palliative care hospices, and the support services available to caregivers and hospice staff.MethodsA national sample of 30 hospices meeting study criteria provided data by means of telephone interviews.ResultsAll hospices offered spiritual assistance and at least one other form of CM, with the most common being massage therapy (n = 24) and relaxation therapy (n = 10). When offered complementary therapies, 65% or more of the patients accepted them. Twenty-nine hospices provided spiritual and psychological support to caregivers during patient stays, but only 12 offered support at home. All hospices offered support services to their staff, both in individual and group formats.ConclusionsDespite limited empirical support, CM has become an important part of palliative care for end-of-life patients in Italy, as in many other countries.

Palliative care quality indicators in Italy. What do we evaluate

PurposeIn recent years, the number of palliative service providers has increased significantly. This expansion necessitates an evaluation in order to provide the basis for quality improvement of the care. Policymakers, managers of palliative care programs, and others committed to the improvement of end-of-life care need methods and criteria to measure and evaluate the care delivered. As quality measurement is expensive and difficult to undertake, it is fundamental that quality measures evaluate the right things. Quality evaluation in Italy is supported by health authorities who have developed some indicators of palliative care. The aims of this study were to give an overview of these indicators.MethodsWe analyzed all palliative care indicators developed by Italian national authorities from 2000 to the present. These indicators have been divided into three different levels of analysis (structure, process, and outcome). Subsequently, two reviewers have independently compared their degree of concordance with domains, and guidelines developed by the NCP for palliative care and after careful discussion an expert panel has elaborated a final consensus document.ResultsMost of the quality indicators analyzed deal with the structure and process of palliative care, however they miss outcomes and do not cover domains mainly concerned with spiritual, ethical, cultural, or existential aspects of care.ConclusionsMore attention should be paid to the development of outcome indicators of palliative care. The attempt to identify a group of indicators which cover every domain of palliative care represents a challenge for the future in terms of finding new cognitive models more oriented toward subjectivity.

Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: A retrospective chart review:

Background: Terminally ill patients are at high risk of pressure ulcers, which have a negative impact on quality of life. Data about pressure ulcers’ prevalence, incidence and associated factors are largely insufficient. Aim: To document the point prevalence at admission and the cumulative incidence of pressure ulcers in terminally ill patients admitted to an Italian home palliative care unit, and to analyse the patients’ and caregivers’ characteristics associated with their occurrence. Design: Retrospective chart review. Setting/participants: Patients (n = 574) with a life expectancy ⩽6 months admitted to a palliative home care service were included in this study. Results: The prevalence and incidence rates were 13.1% and 13.0%, respectively. The logistic regression models showed body mass index (p < 0.001), Braden score at risk (p < 0.001), Karnofsky Performance Scale index <30 (p < 0.001), patients’ female gender, patients’ age >70 and >1 caregiver at home as the dichotomous variables predictors of presenting with a pressure ulcer at time of admission and during home palliative care. Conclusion: The notable pressure ulcers’ incidence and prevalence rates suggest the need to include this issue among the main outcomes to pursue during home palliative care. The accuracy of body mass index, Braden Scale and Karnofsky Performance Scale in predicting the pressure ulcers risk is confirmed. Therefore, they appear as essential tools, in combination with nurses’ clinical judgment, for a structured approach to pressure ulcers prevention. Further research is needed to explore the home caregivers’ characteristics and attitudes associated with the occurrence of pressure ulcers and the relations between their strategies for pressure ulcer prevention and gender-related patient’s needs.

Breakthrough cancer pain tailored treatment: which factors influence the medication choice? An observational, prospective and cross-sectional study in patients with terminal cancer

Background Various options for the pharmacological treatment of breakthrough cancer pain (BTcP) are available. International guidelines on BTcP treatment are not univocal. A tailored treatment should be based on the assessment of different variables such as BTcP characteristics, oral mucositis, chronic rhinitis and a patient’s ability to take medication. Objective The goal of this study is to assess the relationship between these variables and the medication treatment for BTcP in a sample of patients with terminal cancer. Methods A prospective, cross-sectional study was carried out among 1180 patients who were receiving palliative care programmes. Patients were recruited if they had a diagnosis of BTcP and had been prescribed rescue opioids. Variables that might influence the BTcP treatment were assessed. Results One hundred and forty-nine eligible patients were enrolled; 59.1% of patients received short-acting oral morphine (OM), 27.5% transmucosal immediate-release fentanyl (TIRF) and 13.4% parenteral morphine for BTcP treatment. Short-acting OM prescription was related to background pain treatment with OM <60  mg daily (p<0.0001) and to home-care setting of assistance (p=0.004). Continuous intravenous morphine infusion and the presence of a vascular access were the main factors related to intravenous morphine prescription for BTcP. TIRF use was mainly related to background opioid dosage and the patient’s self-sufficiency in taking medication. Conclusion In clinical practice, the factors that most influenced the pharmacological treatment for BTcP were baseline opioid dosage, setting of assistance and self-ability to take medication. Further research is needed to improve the knowledge on tailored BTcP treatment.

Translation and Testing of the Italian Version of FAMCARE-2: Measuring Family Caregivers’ Satisfaction With Palliative Care

Family satisfaction is an important outcome of palliative care and is a critical measure for health care professionals to address when assessing quality of care. The FAMCARE-2 is a widely used measure of family satisfaction with the health care received by both patient and family in palliative care. In this study, a team of Italian researchers culturally adapted the FAMCARE-2 to the Italian language and psychometrically tested the instrument by measuring satisfaction of 185 family caregivers of patients admitted into two palliative care services. FAMCARE-2 showed excellent levels of internal consistency (Cronbach’s α coefficient = .96) and test–retest reliability (r = .98, p < .01). The confirmatory factor analysis showed a single-factor structure with good fit. Satisfaction levels were significantly correlated with family caregivers being females with less education, patient length of care, and place of assistance and death. This scale can help health care professionals identify which aspects of care need improvement and enable family caregivers to manage their challenging role.

Features and organization of Pain Centers in the Lazio Region, Italy, in 2011

BACKGROUND Evidence on pain management highlights the importance of a multidisciplinary approach in order to achieve optimal therapeutic results. Such programs can be guaranteed by the Centers for Pain Management (CPMs), in which multidisciplinary teams are able to provide advanced and specialized activities for the assessment, diagnosis and treatment of chronic benign pain. To date, information related to healthcare supply and the organizational structure of these centers in Italy is incomplete. The aim of this paper was to provide an overview of the healthcare network of the CPMs in the Lazio region. METHODS A descriptive survey was conducted in all the 37 CPMs existing in the Lazio region in 2011 of which 28 participated. RESULTS CPMs were located either in Universities or in public or private hospital facilities. They included a clinic, a Day Hospital service, Day surgery and day-beds. CPMs were managed by anaesthesiologists who, in most instances, did not work in a multidisciplinary team. The number of other health professionals available, such as nurses, psychologists and physiotherapists, was limited. CPMs mainly provided drug therapy, Complementary Alternative Medicine (CAM) and complex interventional treatments. The median waiting time was 30 days. The clinics were not homogeneously distributed in the region with a higher concentration in Rome (56%), followed by other provinces of the Lazio region (26%) and the province of Rome (18%). Clearly, Rome was the city which offered the greatest range of healthcare services and the highest number of consultations with patients, which significantly differed from those of the other areas (χ²=19.6 p<0.01). CONCLUSIONS In 2011, the availability of CPMs was not equally distributed throughout the territory, and there was an over-utilization of the facilities in Rome and an under-utilization in the provincial areas. Moreover, this study showed a lack of a multi-professional approach to chronic pain management.

Complimentary and alternative medicine use in Italian palliative care hospices

Background: This study aims to examine the combined role of work and domestic burden on women’s and men’s perceived well-being. Methods: Observations result from two large Belgian cohorts [SOMSTRESS (1999-2002) and BELSTRESS III (2004-2008)] comprising 4810 workers in 9 firms, aged between 28 and 66. Three logistic regressions were performed using respectively (1) anxiety (SLC-90), (2) chronic fatigue (Vercoulen), and (3) subjective health evaluation as dependent variables. Sex, occupational stress (“iso-strain”, Karasek), and home-work interference (Kelloway) were entered as independent variables. Adjustments were made for age, education, occupation, social support outside work, child(ren) responsibilities, and marital status. Findings: High iso-strain, high home-work interference and their interaction are predictive of anxiety and chronic fatigue, especially in women. Bad health evaluation is linked to high iso-strain and high home-work interference but no sex effect was found. Discussion: findings will be discussed within the frame of the gender roles perspective.Background: The main objective of this study was to investigate if associations between psychosocial risks at work and absenteeism were consistent within our 4 Belgian databases. Methods: Belstress I, II, III and Somstress consisted globally of 36 enterprises and 28.198 workers. A cross-sectional survey with at least 1 year prospective follow-up to register objective absenteeism data was performed on men and women working in different sectors (public/private, profit/non-profit). Analyses were conducted by using « review manager » software resulting in Odds Ratios with global effect and a heterogeneity test. Socio-demographic variables, psychosocial risks (JDC-S and ERI model) as well as bullying were considered. Findings: Low job control and low social support at work showed, particularly in the private sector, a significant global and a non-significant heterogeneity effect in relation to high sick leave. Discussion: Findings will be discussed at the light of possible worksite wellbeing interventions.Poster and oral presentations (In alphabetical order by first author) Are worksite interventions effective in increasing physical activity? A meta-analytic review Abraham C.,* & Graham-Rowe E.; *University of Sussex, UK Worksite interventions (WI) have the potential to reach a broad and captive audience but there is debate about their effectiveness. A systematic review and hypotheses-driven, randomeffects, meta analysis assessed the effectiveness of (WI) to enhance physical activity (PA) over a ten year period. From 4,390 hits, 55 interventions could be included. WIs have small, positive effects on PA and this effect is smaller when fitness, as opposed to self-report, outcomes measures are reported (ds1⁄4 .15 versus .21). WIs targeting PA specifically as opposed to general lifestyle change were more effective whether evaluated in terms of increased fitness (.29 vs. .08) or increased self-reported PA (.25 vs. .14). Those promoting walking as opposed to other forms of PA were also more effective (.54 vs. .14). Given the potential public health economic benefits, walking or step counting WIs should be supported. Integrating social structure and social cognition measures in explaining adolescent condom use Abraham C.,* Sheeran P., & Henderson M.; *University of Sussex, UK This study assessed relationships between indices of social structure, including family socioeconomic status (SES), social deprivation, gender, and educational and lifestyle aspirations, behaviour-specific cognitions and adolescent condom use. Analyses of cross sectional survey data provided by 824 sexually active sixteen year olds (505 women and 319 men) reveled that (1) social structure measures correlated with behaviour-specific cognitions found to predict condom use (2) cognition measures did not fully mediate the association of social structure indices with condom use and (3) the association of cognitions with condom use was moderated by social structure measures and aspirations. Overall, including significant moderation effects, social structure measures increased the variance explained in condom use from 20.5% (for cognition measures alone) to 31%. Thus macro-level variables such as SES and gender, should to be considered in addition to cognitions when modelling antecedents of health behaviours such as condom use. Health-related quality of life in stroke patients one year later Accorsi A.,* Biagetti L., Procaccianti G., Magni E., Alberici S., & Nicoli M.A.; *Local Health Authority of Bologna, Italy ISSN 0887–0446 print/ISSN 1476–8321 online 2009 Taylor & Francis DOI: 10.1080/08870440903126421 http://www.informaworld.com In chronic disease area, the traditional outcome measures themselves are not sufficient to evaluate the quality of health interventions. The aim of this study is to measure quality of life (QoL) as perceived by patients one year after discharge from stroke unit. Patients (n1⁄4 81) were interviewed by telephone and assessed for disability (modified Barthel index), QoL (EQ-5D), perceived social support, coping skills. In order to detect which investigated variables influence QoL, descriptive and inferential analysis were performed. Coping skills variables were summarized by Factorial Analysis in two factors: (1) concerning attitude; (2) optimistic attitude. Problems were mostly recorded in mobility and in the usual activities dimension. People who need help and suffer from pain/ discomfort and anxiety/depression are more likely to be worried. An optimistic feeling depends on the usual activities and the anxiety/depression state. Coping skills variables helped to deepen further what was obtained with EQ-5D instrument. A combined behavioral-pharmacotherapy treatment program for nicotine addiction within Department of Veteran’s Affairs-Atlanta Ackerman M.,* Drexler K., & Wright M.; *Department of Veteran’s Affairs Atlanta Medical Center, USA Tobacco use is the most preventable behavioral cause of chronic disease and morbidity worldwide. Although U.S. smoking prevalence has declined to 22.1% the percentage of veterans who smoke is significantly higher, making smoking cessation treatment a priority within VA. This has led to our integrated approach combining cutting edge behavioral modalities with the most recent pharmacotherapies, including the newest, Chantix (Varenicline). Our study evaluates treatment efficacy. Participants (n1⁄4 432) were veterans treated over 36 months. Final sample of 128 (96% male, M1⁄4 53 years) reported their smoking status in response to a set of standardized questions during follow-up telephone interviews. Correlation coefficients and analysis of variance were used for statistical analysis. Results showed abstinence of 69.5% reflecting either quit (28.9%) or smoking less (40.6%) rates and an additional finding that more frequent group therapy attendance significantly correlated (p1⁄4 .02) with higher cessation rates. Key health psychology treatment modalities including cognitive change, target dates, trigger awareness, and relapse prevention are highlighted. Online erotic chatting with potential sex partners: Does virtual fantasizing promote real-life risk? Adam P.,* & de Wit J.; *University of New South Wales, Australia To explain continuing sexual risk-taking in gay men we addressed the impact of online erotic chatting on real-life sexual behaviours. An online survey among 2,572 gay men in France assessed intention to use condoms; responsiveness to chat partners’ fantasizing about unprotected sex; and actual sexual risk behaviours. While intention to use condoms was high (M1⁄4 4.60), acceptance of fantasizing about unprotected sex was also evident (M1⁄4 2.54). 32.1% of respondents reported engaging in unprotected sex and this was negatively associated with intention to use condoms. Accepting online fantasizing about unprotected sex contributed to risk-taking over and above intention (ORa1⁄4 1.45, p5 .000). Most gay men do not intentionally go online to find a partner for unprotected sex. However, risk-taking is prevalent and promoted by accepting to engage in online fantasizing about unprotected sex. Innovative interventions are needed to support the self-regulation of online chatting to prevent risk in real life. 72 AbstractsBackground. Falls in older people decrease quality of life and increase mortality. There is littleresearch on perceptions of the cause of a fall and their influence on health outcomes. Method.A sur ...The purpose of this study was to examine what resource and coping variables that could predict emotional well being during the acute phase of spinal cord injury rehabilitation. All newly acquired i ...Other psychological/behavioral factors in addition to fear and traditional measures of psychopathology should possibly be considered in the assessment and treatment of dental fear. The present stud ...Hazardous alcohol use in adolescents has become a common problem. This study focuses on private peer group drinking settings as a contextual determinant of adolescent binge-drinking. In a cross-sectional survey a representative sample of 1516 15-year old students of all secondary schools in a semi-rural region in the Netherlands (Twente) participated. Adolescents visiting a private peer group setting have, compared to non-visitors, considerably higher average weekly alcohol consumption (15.2 vs. 7.4 glasses; p5.001), more frequent heavy drinking (p5.001) and drunkenness (p5.05). Differences remain highly significant after controlling for age and education level. Additional multivariate analyses reveal that the setting remains an independent predictor next to proximal determinants like attitude, social norms, and self-efficacy. Adolescents visiting private settings to meet friends and drink alcohol are at increased risk of hazardous alcohol consumption. Apparently, these non-licensed drinking locations increase accessibility and availability of alcohol for under-aged adolescents.