Julia Menichetti

Giving patients a starring role in their own care: a bibliometric analysis of the on-going literature debate.

Patient‐centred care has been advocated as a key component of high‐quality patient care, yet its meanings and related actions have been difficult to ascertain.

Engaging older people in healthy and active lifestyles: a systematic review

ABSTRACT In 2002, the World Health Organization emphasised the concept of active ageing to manage and increase the last third of life. Although many efforts have been made to optimise treatment management, less attention has been paid to health promotion initiatives. To date, few shared guidelines exist that promote an active life in healthy older targets. To fill this gap, we conducted a systematic review to map health promotion interventions that targeted an active and healthy ageing among older citizens. Articles containing the key term active ageing and seven synonyms were searched for in the electronic databases. Because we were interested in actions aimed to promote healthier lifestyles, we connected the string with the term health. A total of 3,918 titles were retrieved and 20 articles were extracted. Twelve of the 20 studies used group interventions, five interventions targeted the individual level and three interventions targeted the community level. Interventions differed for the health focus of the programmes, which ranged from physical activity interventions to social participation or cognitive functioning. Most of the studies aimed to act on psychological components. The review suggests that different interventions promoted for active ageing are effective in improving specific healthy and active lifestyles; however, no studies were concerned directly with a holistic process of citizen health engagement to improve long-term outcomes.

Fertilizing a patient engagement ecosystem to innovate healthcare: Toward the first Italian Consensus conference on patient engagement

Currently we observe a gap between theory and practices of patient engagement. If both scholars and health practitioners do agree on the urgency to realize patient engagement, no shared guidelines exist so far to orient clinical practice. Despite a supportive policy context, progress to achieve greater patient engagement is patchy and slow and often concentrated at the level of policy regulation without dialoguing with practitioners from the clinical field as well as patients and families. Though individual clinicians, care teams and health organizations may be interested and deeply committed to engage patients and family members in the medical course, they may lack clarity about how to achieve this goal. This contributes to a wide “system” inertia—really difficult to be overcome—and put at risk any form of innovation in this filed. As a result, patient engagement risk today to be a buzz words, rather than a real guidance for practice. To make the field clearer, we promoted an Italian Consensus Conference on Patient Engagement (ICCPE) in order to set the ground for drafting recommendations for the provision of effective patient engagement interventions. The ICCPE will conclude in June 2017. This document reports on the preliminary phases of this process. In the paper, we advise the importance of “fertilizing a patient engagement ecosystem”: an oversimplifying approach to patient engagement promotion appears the result of a common illusion. Patient “disengagement” is a symptom that needs a more holistic and complex approach to solve its underlined causes. Preliminary principles to promote a patient engagement ecosystem are provided in the paper.

Lifestyle interventions to improve the quality of life of men with prostate cancer: A systematic review of randomized controlled trials

Improving quality of life is a key issue for patients with prostate cancer (PCa). Lifestyle interventions could positively impact the quality of life of patients. However, there is no clear-cut understanding of the role of diet, exercise and risky behaviour reduction in improving the quality of life of men with PCa. The aim of this review was to systematically summarize randomized controlled trials on lifestyle in PCa patients with quality of life as main outcome. 17 trials were included. Most of them referred to exercise interventions (71%) and involved men undergoing androgen deprivation therapy (47%). Exercise studies yielded the greater amount of positive results on quality of life outcomes (67%), followed by dietary interventions (50%) and combined lifestyle interventions (33%). In particular, supervised exercise programs with resistance training sessions were the ones producing greater convincing evidence for benefits on quality of life. Further studies with high methodological quality providing adequate information to develop evidence-based, personalized lifestyle interventions that can effectively ameliorate PCa-related quality of life are needed.

Eleven-year management of prostate cancer patients on active surveillance: what have we learned?

Purpose To evaluate the outcomes of active surveillance (AS) on patients with low-risk prostate cancer (PCa) and to identify predictors of disease reclassification. Methods In 2005, we defined an institutional AS protocol (Sorveglianza Attiva Istituto Nazionale Tumori [SAINT]), and we joined the Prostate Cancer Research International: Active Surveillance (PRIAS) study in 2007. Eligibility criteria included clinical stage ≤T2a, initial prostate-specific antigen (PSA) <10 ng/mL, and Gleason Pattern Score (GPS) ≤3 + 3 (both protocols); ≤25% positive cores with a maximum core length containing cancer ≤50% (SAINT); and ≤2 positive cores and PSA density <0.2 ng/mL/cm3 (PRIAS). Switching to active treatment was advised for a worsening of GPS, increased positive cores, or PSA doubling time <3 years. Active treatment-free survival (ATFS) was assessed using the Kaplan-Meier method. Factors associated with ATFS were evaluated with a multivariate Cox proportional hazards model. Results A total of 818 patients were included: 200 in SAINT, 530 in PRIAS, and 88 in personalized AS monitoring. Active treatment-free survival was 50% after a median follow-up of 60 months. A total of 404/818 patients (49.4%) discontinued AS: 274 for biopsy-related reclassification, 121/404 (30%) for off-protocol reasons, 9/404 (2.2%) because of anxiety. Biopsy reclassification was associated with PSA density (hazard ratio [HR] 1.8), maximum percentage of core involvement (HR 1.5), positive cores at diagnostic biopsy (HR 1.6), older age (HR 1.5), and prostate volume (HR 0.6) (all p<0.01). Patients from SAINT were significantly more likely to discontinue AS than were the patients from PRIAS (HR 1.65, p<0.0001). Conclusions Five years after diagnosis, 50% of patients with early PCa were spared from active treatment. Wide inclusion criteria are associated with lower ATFS. However, at preliminary analysis, this does not seem to affect the probability of unfavorable pathology.

Quality of life in active surveillance and the associations with decision-making—a literature review

Several studies have been conducted on the quality of life (QoL) in men with low risk prostate cancer (PCa) who choose active surveillance (AS). While recent reviews have shown a lack of consistency among the available QoL-studies, a few key points have been identified, including decision-making (DM)-related issues and their potential effect on QoL. The importance of this theme has also been recently highlighted by the international task force of the European School of Oncology. However, to our knowledge, there are no studies that have specifically marshalled scientific knowledge on the association between DM and QoL among men with low-risk PCa undergoing AS. We performed a literature review to fill this gap, taking a systematic approach to retrieving and selecting articles that included both DM and QoL measures. Among the 272 articles retrieved, we selected nine observational, quantitative articles with both DM and QoL measures. The most considered DM aspects within these studies were decisional conflict and preference for the patient’s role in the DM process, as well as health-related QoL aspects. The studies included 42 assessments of the relationship between an empirical measure of DM and an empirical measure of QoL. Among these assessments, 23 (55%) were both positive and significant. They mostly concerned the relationship between patient-related (decisional self-efficacy, decisional control and knowledge) and external (presence of social support, collaborative role within the DM process, and influence of different physicians) DM aspects, as well as the QoL after choice. The findings of these studies revealed key challenges to research and clinical practice related to DM and QoL in AS. These include adopting a person-centred perspective where clinicians, caregivers and their interactions are also included in evaluations and where the psychosocial existential experience of individuals within the DM and AS journey is considered. Much more attention needs to be paid to the DM process after diagnosis, as well as to all the other moments where patients may have to or want to review their decision. Healthcare professionals play a key role in enabling men to make informed decisions and to take care of their health and well-being during AS. There is still work that needs to be done in training healthcare professionals from different disciplines to work together in a model of shared DM and AS tailored to the needs of low-risk PCa patients and their family members.

Self-managing type 2 diabetes is a unique challenge for older patients. A systematic review and thematic synthesis of barriers and facilitators

Obiettivo del presente contributo e sistematizzare le evidenze scientifiche inerenti le pratiche di gestione autonoma del diabete di tipo 2 in pazienti anziani, con una particolare at-tenzione ai fattori che possono ostacolare e facilitare un simile processo. A tal fine, e stata condotta un’analisi sistematica della letteratura su articoli estratti dai principali database scientifici, senza limiti di anno o di lingua di pubblicazione. Gli articoli estratti sono stata analizzati indipendentemente da due ricercatori seguendo una griglia costruita ad hoc e seguendo la SIGN checklist per la valutazione metodologica degli articoli. Le barriere e i facilitatori per la gestione autonoma della malattia sono stati sintetizzati tematicamente. 17 articoli sono stati inclusi nelle analisi. Cinque principali temi inerenti le barriere ed i facilitatori delle pratiche di gestione autonoma del diabete di tipo 2 nei pazienti anziani sono stati identificati: aspetti connessi alla malattia, aspetti socio-demografici, aspetti psicologici, aspetti legati alla relazione medico-paziente e aspetti legati al contesto sociale. In particolare, la sintomatologia, le comorbidita e la cronicita dei trattamenti appiano ostacolare principalmente le pratiche di gestione autonoma della malattia. Dall’altra parte, lavorare sulle risorse personali e coinvolgere la rete di pari e familiari rappresentano utili strategie per supportare le pratiche di gestione autonoma della malattia. Infine, la comunicazione con i professionisti sanitari risulta essere la principale fonte di informazione ed educazione per favorire comportamenti di self-care. Poiche coinvolgere i pazienti anziani affetti da diabete di tipo 2 nella gestione della loro malattia si configura come una sfida unica e multisfaccettata che coinvolge diversi livelli di azione potenzialmente modificabili (individuale, relazionale, sociale), si auspica l’individuazione di azioni capaci di considerare questi diversi livelli di azione. Inoltre, emerge il bisogno di un intervento specificamente dedicato ai pazienti anziani, che consideri sia le difficolta connesse all’invecchiamento sia quelle connesse al diabete di tipo 2.

Il coinvolgimento dei genitori nelle cure di fine vita: studio qualitativo in una Terapia Intensiva Pediatrica

Introduzione. Recentemente la letteratura ha iniziato ad occuparsi del tema del coinvolgimento dei pazienti nelle cure attraverso il concetto di patient engagement. Il costrutto di engagement e stato fin’ora studiato in relazione al paziente ma mancano contributi volti a studiare il processo di engagement dei caregivers. Il fine vita pediatrico e un ambito in cui il coinvolgimento dei genitori e stato invocato sotto diversi aspetti, eppure poco si sa dell’esperienza di engagement dei genitori nel processo di cura. All’interno di un piu ampio studio sulla qualita delle cure di fine vita in Terapia Intensiva Pediatrica (TIP), il presente lavoro ha avuto l’obiettivo di esplorare l’esperienza di engagement dei genitori. Metodi. Lo studio si e svolto presso la TIP dell’Ospedale Policlinico di Milano. Con i genitori dei bambini deceduti tra il 2007-2010 sono state effettuate delle interviste semi-strutturate riguardanti l’esperienza delle cure di fine vita. I passaggi delle interviste riguardanti l’esperienza di engagement sono state analizzate tramite analisi del contenuto. Risultati. Sono state condotte 8 interviste con 12 genitori. L’engagement dei genitori si articola su tre dimensioni: 1) informativa (sapere); 2) decisionale (decidere); 3) relazionale (esserci). Queste dimensioni possono variare come essere compresenti in gradazioni diverse durante il ricovero del figlio. Conclusioni. Dai risultati emerge un concetto multidimensionale di engagement. In questo ambito clinico sembra che l’engagement dei genitori nelle cure mediche si fondi sul ruolo genitoriale e ne costituisca una declinazione. L’engagement verso i clinici e la TIP sembra continuare anche dopo la morte del figlio durante il processo del lutto.